Laminectomy and Spinal Stenosis: Risks and Complications

A lumbar laminectomy is able to alleviate spinal stenosis pain by removing painful pressure on the nerve root and/or disc space. However, the procedure is not foolproof. Complications from this surgery for lumbar stenosis can result from a variety of factors.

Lumbar Laminectomy Risks and Considerations

The potential risks and complications with a lumbar laminectomy include:

• Nerve root damage (1 in 1,000) or bowel/bladder incontinence (1 in 10,000). Paralysis would be extremely unusual since the spinal cord stops at about the T12 or L1 level, and surgery is usually done well below this level.
• Cerebrospinal fluid leak (1% to 3% of the time). If the dural sac is breached, a cerebrospinal fluid link may be encountered but does not change the outcome of the surgery. Generally a patient just needs to lie down for about 24 hours to allow the leak to seal.
• Infections (about 1% of any elective cases). Although an infection is a major nuisance and often requires further surgery to clean it up along with IV antibiotics, it generally can be managed and cured effectively.
• Bleeding. While possible, this complication is uncommon as there are no major blood vessels in the area.
• Postoperative instability of the operated level (5 to 10% of cases). This complication can be minimized by avoiding the pars interarticularis during surgery, as this is an important structure for stability at a level. Weakening or cutting this bony structure can lead to an isthmic spondylolisthesis after surgery. Also, the natural history of a degenerative facet joint may lead it to continue to degenerate on its own and result in a degenerative spondylolisthesis. Either of these conditions can be treated by a spinal fusion surgery for the affected joint at a later date.

General anesthetic complications such as myocardial infarction (heart attack), blood clots, stroke, pneumonia or pulmonary embolism can happen with a lumbar laminectomy as with any surgery.

Although in the general population these complications are rare, laminectomy surgery for spinal stenosis is generally done for elderly patients and therefore the risk of general anesthetic complications is somewhat higher.

• Article written By:
• Peter F. Ullrich, Jr., MD

October 21, 2009

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