Laminectomy

Laminectomy or decompressive surgery is a surgical procedure in which the lamina is removed from the vertebral arch to increase the space within the spinal canal. This surgery aims to enlarge the vertebral canal and relieve pressure on the spinal cord by removing the laminae and the spinous processes within the affected region of the vertebral column. Laminectomy can be performed in the cervical, thoracic, lumbar, and sacral regions of the spine. It can be also performed with a spinal fusion, which permanently joins two or more vertebrae together.

 

Types of Laminectomies include:


Cervical Laminectomy:  This is a procedure performed on a cervical vertebra in the neck.

Lumbar Laminectomy:  This involves the vertebrae in the lower back. This procedure helps relieve pain in the lower back, buttocks, and legs.

Sacral Laminectomy:   In this procedure, the lamina on the fused sacral vertebrae is removed.

Laminectomy is done in case the conservative treatment fails to subside the symptoms and treat conditions like:

 
Pain in the neck or back.
Sharp shooting pain.
Limitation in mobility.
Cramps in the neck.
Weakness.
Numbness down the arms and legs.
Difficulty with balance.
Herniated disc.
Spinal stenosis.
Ankylosing spondylitis.
Overgrowths or bony spurs.
Tumors.
Infection.
Trauma.
 

Pathology

The word laminectomy means excision of the lamina. However, in most cases, it involves the excision of the supraspinous ligament and part or all of the spinous process. Lamina is rarely removed if required, it is done to break the continuity of the rigid ring of the spinal canal to allow the soft tissues within the canal to expand, change the contour of the vertebral column, and permit access to deeper tissue inside the spinal canal.

X-rays:

X-ray is a reliable diagnostic tool that helps to determine the extent to which the bone is damaged.

 
MRI:

MRI is another diagnostic tool used to determine disc, bone, muscular or ligamentous damage.

Medication: NSAID, muscle relaxant, acetaminophen, etc.



Note:  Medication should not be taken without a doctor's prescription.

Rest:

Excessive mobility and stress on the tissues should be avoided to enhance healing.

 
Cryotherapy:

Ice therapy or cryotherapy may be used to help decrease swelling and pain at the surgical site and should be applied for 20 minutes several times a day.

 
Thermotherapy:

Heat therapy or thermotherapy is used to help relax muscles and improve circulation around the back.

 
TENS:

Transcutaneous electrical stimulations may be used to help control pain.

 
Scar massage:

Scar massage relieves tightness around the surgical incision, and scar mobilization techniques are recommended.

 
Collar:

For the first 6 weeks, a multilevel fusion hard collar is recommended.

 
Breathing exercises:

Breathing exercises include diaphragmatic breathing, which involves lying straight on the back and with hands on the stomach practice diaphragmatic breathing. This breathing exercise involves breathing in from the nose and breathing out from the mouth.

 
Assistive devices:

Assistive devices help prevent falls, promote comfort, and avoid certain back movements. Examples are a shower stool and rails, a reacher/grabber an elevated toilet seat, slip-on shoes, etc. A cane or walker for a short time after surgery can be used for comfort and stability

 
Range of motion exercises:

Simple spinal exercises are done to maintain mobility and also reduce the risk of secondary complications such as blood clots, increased pain, and infection. Ankle pumps prevent the formation of clots, hence doing ankle pump exercises helps prevent clotting and regulate blood circulation in the legs. This further prevents muscle shortening and improves muscle flexibility. Bending and twisting, lifting, pushing, and pulling 5kgs or more for two weeks should be avoided. Other exercises like shoulder rolls, and shoulder shrugs. Scapular retraction and depression are also recommended.

 

Strengthening exercises:

Strengthening exercises involve isometric exercises for the upper extremity and lower extremity. Exercises with weight and resistance are done for strengthening, progressing to weight bearing, balance, Swiss Ball, Reformer, etc. Other examples are chest press, pull down, shoulder shrugs/rolls, seated rows, and incline push-ups. Exercises like glutes and quads exercises, enable the muscles to pick up accurate weight while physical movement so that there is the least stress on the back.

 
Stretching exercises:

Stretching exercises like quadriceps, hamstrings, calf, hip flexors, gluteal, multifidus, transverse abdominus, etc, without tilting the pelvis.

 
Posture and balance training:

The patient is given balance training and advised to emphasize correct posture by maintaining and doing exercises for the same. Advised to limit sitting, including in the car, to no more than 30 minutes at a time (standing/walk breaks).

 
Mobilization:

Soft tissue mobilization to decrease guarding and joint mobilization over restricted joints is done to increase the movement.

 
Cardiovascular exercises:

These exercises include cardiovascular training, running, stationary bike, and treadmill. etc.

The patient is advised to identify proper movements and postures and avoid strenuous activities. He/she should work together with the physiotherapist to properly progress all exercises to restore movement, safely return to daily activities of living and prevent future injury.