Surgical Procedure for Lumbar Laminectomy (Open Decompression) in Spinal Stenosis

Open lumbar laminectomy surgery is an inpatient procedure. Depending on the extensiveness of the procedure, age of the patient, and other accompanying health conditions, 1 to 4 days of postsurgical hospital stay may be required. ¹ National Health Services. Recovery (2018). [online] Available at: https://www.nhs.uk/conditions/lumbar-decompression-surgery/recovery/. [Accessed 15 May 2019].

Preparing for Lumbar Laminectomy Surgery

A week or two ahead of the surgery, certain precautions and preparations may be necessary to get the patient ready and to avoid future complications. A few examples include:

• Quitting smoking and/or other tobacco products
• Getting complete physical and medical tests done including medical imaging and blood tests
• Getting evaluated and cleared by the doctor for heart conditions and/or diabetes, if present
• Reviewing current prescription and over-the-counter (OTC) medications including nonsteroidal anti-inflammatory drugs (NSAIDs), anticoagulants, herbal supplements, vitamins, and anti-hypertensive/anti-diabetic medications, if any with the doctor.

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• Engaging in a short course of supervised physical therapy to improve the physical conditioning and activity level, which may help with recovery after surgery. ¹ National Health Services. Recovery (2018). [online] Available at: https://www.nhs.uk/conditions/lumbar-decompression-surgery/recovery/. [Accessed 15 May 2019].

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In general, open surgeries are scheduled in the morning with an overnight fast. No food or drink is typically allowed 8 hours prior to the surgery, except for small amounts of water (which may be given up to 2 hours before the surgery).

Step-by-Step Process for Lumbar Laminectomy (Open Decompression) for Spinal Stenosis

The laminectomy surgery is approached from the back. During the entire process, the patient lies face down, typically on a Jackson table. A Jackson table enables the abdomen to be free and the hip to be slightly elevated to recreate a standing posture. Keeping the abdomen free during the process prevents compression of blood vessels as well as epidural bleeding during the surgery. Bending the hip helps provide a better assessment of the degree of neural compression from spinal stenosis.

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Commonly, the following steps are involved:

• The patient is positioned face down, general anesthesia is administered, and the surgical site is cleaned.
• A 2 inch to 5-inch-long incision (can be longer depending on the number of levels treated) is made in the midline of the back.
• The left and right back muscles (erector spinae) are gently pulled back to gain access to the laminae.
• Once the muscles are pinned to the side, intraoperative radiographs are used to identify the correct vertebral level.
• After the superficial ligaments are moved aside, the laminae are cut and removed (laminotomy/laminectomy). Sometimes, the laminae may be cut but not removed (laminoplasty). Both these processes increase the space within the spinal canal for the neural elements.
• The next upper level follows the same procedure, if necessary.
• Once central stenosis is treated, facetectomy and/or foraminotomy (trimming of facets and/or intervertebral foramen) may be performed if lateral recess stenosis and foraminal stenosis are also present.

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• If indicated, fusion of the treated vertebrae is done.
• After all steps have been completed, the ligaments, muscles, and skin are sutured back in position.

Typically, laminectomies of the upper lumbar vertebrae (L1-L2) require more removal of the facets compared to the lower levels (L4-L5) and may require fusion.

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Some surgeons may perform spinal cord monitoring or intraoperative neurophysiological monitoring during the surgery. In this monitoring process, spinal cord and nerve tissue changes are detected through electrodes with wires that are placed on the patient’s skin. The nerve tissue responses are viewed on a computer and alerts the surgeon if a problem related to the spinal cord arises.

Once the surgery is completed, the patient is transferred to an observation room for a few hours where the vitals are continuously monitored until the anesthesia wears off. Surgeries with larger incisions may require the insertion of a surgical drain at the treated site to drain out any collected blood in the epidural space.