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Lumbar Laminectomy in New Jersey

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he spine has five levels – the cervical, thoracic, lumbar, sacral, and coccyx spine. A spine decompression surgery removes pressure off either the spinal cord or a spinal nerve root at one or more of these levels. When indicated, this spine surgery provides significant pain relief and a return to normal daily living activities. Examples of surgeries that provide a decompression are a laminectomy, discectomy, or foraminotomy. These types of spine surgeries remove bone or a spine tumor that compresses any spine nerves at one or more levels of the spine.

The spine care team at Centers for Neurosurgery, Spine & Orthopedics (CNSO), serving patients throughout northern New Jersey, is experienced in all types of spine surgery, including spinal decompression, at every level of the spine, including a lumbar laminectomy. Learn more about this procedure, what to expect, and the conditions it can treat.

What Is a Lumbar Laminectomy?

Each of the 33 vertebral bones of the spine have a distinct design and further specified anatomical structures. In the posterior region of each vertebral bone, is the anatomical structure called the lamina, which covers and protects the spinal cord and branching nerve roots. Due to natural aging, scoliosis, spinal pathology, spinal deformity, or a high-impact injury such as a car accident, any part of the vertebral bones that comprise the spinal column can become misaligned, resulting in compression on the surrounding nerve structures.

The compression of any neuronal structure results in pain, paresthesia, weakness, or loss of function in the extremities. If the compression occurs in the lumbar region of the spine, a lumbar laminectomy is a surgical procedure designed to either remove pressure off the spinal cord or spinal nerve caused by the lamina itself. It can also provide access to the anatomical structure, such as a herniated disc or spinal cord tumor, that needs to be removed.

Understanding Causes and Symptoms of Spine or Nerve Compression

To understand the symptoms associated with spinal cord or nerve root compression, it is necessary to understand the anatomy. The head rests on the cervical spine, which is within the neck. Throughout the thoracic cage is the thoracic spine. The lower back is considered the lumbar spine portion of the spinal column. Below the lumbar spine, located within the pelvis, is the sacral spine, and below it is the coccygeal spine. The coccygeal spine is otherwise known as the tailbone.

Between each of the vertebral bones of the spine is a spinal disc that mainly consists of gelatinous material. These discs act as shock absorbers and allow movement of the spine. Over time, the discs gradually start to dry out and the flexibility of the spine becomes lessened. As the spinal discs age, they are more prone to tearing or herniating outside of the spinal column. These structural changes can lead to compression of the surrounding nerve roots. If the spinal discs become herniated or tear, they can compress the spinal cord.

Over time, osteoarthritis can occur at any level of the spine. Spinal cord or spinal column disease processes besides osteoarthritis can cause spinal cord compression, such as scoliosis, spinal tumors, trauma, or injury to the spine. Typical symptoms of spinal compression at any level of the spine can include:

  • Acute or chronic neck or back pain
  • Weakness in the arms or legs
  • Numbness or tingling sensations in the arms, legs, hands, or feet
  • Pain that increases when lying down
  • Loss of balance
  • Difficulty walking

Lumbar spinal cord compression causes myelopathy, and lumbar nerve root compression causes radiculopathy, which is pain in the lower back that radiates down one or both legs. Depending on the area of the nerves or spinal cord that is compressed, either can cause serious conditions such as loss of function of the legs and loss of bladder and bowel control. CNSO surgeons accurately diagnose and treat causes of spinal cord and spinal nerve root compression.

Diagnostic Procedures for Lumbar Spine Compression

The lumbar spine is comprised of five vertebral bones, each with a superior to inferior name distinction starting superiorly with L1 down to L5. The vertebral bones support the weight of the upper body.

To diagnose any level of spine disease, including lumbar spine compression, a spine doctor will review the patient’s medical history and symptoms and then conduct a physical examination. The neurosurgeon or orthopedic spine surgeon may test the patient’s reflexes, balance, sensations and symptoms in specific areas of the body, such as numbness, hypersensitivity, or muscle weakness.

Imaging tests, such as an X-ray, MRI, or CT scan, typically are used to examine the vertebrae and soft tissues of the nervous or musculoskeletal system. A spine surgeon may refer the patient to a physiatrist for an electromyography (EMG) and nerve conduction studies to assess unique muscle and nerve function.

Preparing for Lumbar Laminectomy

After receiving a diagnosis of a pinched lumbar nerve root or lumbar spinal cord compression, most patients will experience pain relief through conservative care, such as physical therapy. If symptoms are severe or are not alleviated by physical therapy, a spine specialist or fellowship trained in pain management may recommend a localized steroid injection, such as an epidural, to alleviate the swelling of the nerve roots. This is done before considering a lumbar laminectomy or discectomy with the hopes that by resolving any swelling of the irritated neural structure attributed to the patient’s symptoms, the patient will not require surgery to alleviate their discomfort.

At CNSO, the medical staff takes a conservative approach to care, using less invasive treatment options to avoid surgical intervention, and following medical guidelines. The CNSO doctors educate their patients on the benefits and risks of all treatment options.

Conditions Treated With Lumbar Laminectomy

A lumbar laminectomy may be recommended when conservative treatments do not relieve pain, numbness, or other symptoms. Conditions that might be treated with a lumbar laminectomy include:

  • Lumbar spinal stenosis: This is a narrowing of the spinal canal in the lower back that can irritate the spinal cord or the nerves that branch out from it.
  • Spinal cord tumor: This tumor may be a benign tumor or a type of cancer.
  • Schwannoma: A benign type of growth on a spine nerve root.
  • Degenerative lumbar stenosis: This form of spinal stenosis develops gradually over time as a natural result of the aging process.
  • Herniated disc: A laminectomy may be required to gain access to a portion of the herniated disc so it can be removed.
  • Spondylolisthesis: Occurs when the vertebral bones are not in alignment with each other.

Non-Surgical Treatment Options

Lumbar nerve and spinal cord compression do not always require surgery. Often, patients can be treated with more conservative pain management techniques, such as:

Types of Lumbar Laminectomy

A lumbar laminectomy may be performed as a minimally invasive procedure or as open surgery. Traditional (open) back surgery requires a two-centimeter incision. If the procedure involves multiple levels of laminectomy and spine fusion, it may require a longer incision. A microscopic laminectomy, in contrast, is only a small 3 cm incision site, which allows for rapid recovery.

The Lumbar Laminectomy Procedure

A patient typically must avoid eating or drinking on the day of the surgery. Lumbar laminectomy is performed under general anesthesia, which allows the patient to sleep throughout the procedure.

To perform the laminectomy, a spine surgeon or neurosurgeon will make a small incision in the patient’s lower back, separate the muscle tissue to access the vertebrae, and then remove a portion of the lamina. A laminectomy usually takes about one hour, but a patient may be in surgery longer if the procedure is performed along with a discectomy or other type of spinal decompression surgery.

Complications and Risks

All surgeries carry some degree of risk, including excessive bleeding or infection at the incision site or adverse reaction to anesthesia. Most patients experience notable symptom relief immediately after surgery.

Post-Operative Care and Recovery

After a one-level lumbar laminectomy, most patients will go home the same day. They may need minimal medication to relieve any pain or discomfort at the surgical incision site.

Most patients can return to work within a week, depending on the nature of their jobs. The surgical team will offer guidance on activity and weight restrictions during recovery. For most patients, rehabilitation after spine surgery will include physical therapy to reduce swelling, improve flexibility, and strengthen the muscles and ligaments in the back.

Rehabilitation and Physical Therapy

A one-level (sometimes even two-level) laminectomy will have a mild recovery course. By following the neurosurgeon’s, orthopedic spine surgeon’s, physiatrist’s, and physical therapist’s post-surgical treatment plan, patients can resume their regular activities more quickly and with less pain. This allows them to achieve a full recovery.

Physical therapy will help restore balance, strength, and mobility. During appointments, physical therapists may massage or manipulate muscles into relaxation. They will also teach the patient exercises and stretches to continue doing at home. This helps to re-train muscles and gives patients the knowledge to forgo physical therapy appointments altogether.

Preventive Measures for a Strong and Healthy Spine

While it may not be possible to prevent pinched nerves, spinal cord impingement, or spinal cord compression, preventive measures can help decrease a patient’s risk. These include getting regular exercise and maintaining a healthy weight. Patients should also regularly practice proper ergonomic techniques to support good posture. In addition, they should consider changing their furniture at work and home to reduce problematic pressure points on the neck and lower back.

Success Rates and Patient Outcomes

Over 95% of patients at CNSO experience a long-term complete resolution of their symptoms after treatment. Each patient is unique, so a complete cure depends on several factors. These include the severity of their condition, the duration of time in pain before the operation, the patient’s overall health/lifestyle, and whether they smoke.

Comparison With Other Spinal Surgeries

Lumbar laminectomy is one of many types of spine surgeries that are considered a surgical decompressive treatment. Other types of spine surgery that may need to be performed either separately or at the same time as a spinal decompression include:

  • Discectomy: This is the surgical removal of a slipped or herniated intervertebral disc.
  • Spinal fusion: This surgery permanently joins two or more vertebrae.

A herniated intervertebral disc is often the main reason a spinal cord becomes compressed or a nerve is pinched. If not resolved with an epidural by a pain management doctor, the patient will require a discectomy. Fusion surgery is usually reserved for cases of spine instability, or when there is a need to restructure a segment of the spine.

Frequently Asked Questions About Lumbar Laminectomy

Some frequently asked questions about lumbar laminectomy are:

How long does it take to recover from a lumbar laminectomy surgery?

Recovery time will depend on several factors, including the patient’s overall health, their occupation, and the type of surgical procedure. Patients may be able to go home the same day as their procedure, or they may need to spend a night or two in the hospital. Some patients undergo a lumbar laminectomy in combination with fusion surgery, which requires a longer recovery period. Most patients can resume light activity without a fusion, and most patients can resume daily activities within a few days to a week but should check with their CNSO as to when they can begin lifting heavy objects.

Can spine or nerve compression return after a lumbar laminectomy?

There is a significant amount of long-term evidence that shows the benefits of a lumbar laminectomy is a long-term cure and that there most likely will not be a need for a repeat laminectomy at the same level of the spine. However, there is a risk of continued degeneration at spinal levels (vertebrae) above or below the area where surgery was performed. This can become stenotic later in life but at the time of the laminectomy did not necessitate surgical treatment.

What can I do to prepare for surgery and ensure a smooth recovery?

The surgical team will provide instructions on what to do before and after surgery. Because a laminectomy requires anesthesia, a patient will need someone to give them a ride home from the hospital. If necessary, some healthcare plans provide aid to patients in need of post-operative support.

Trust CNSO for Lumbar Laminectomy

If left untreated, lumbar spinal compression can lead to serious issues, such as paraplegia, leg weakness, and loss of use and function. Fortunately, surgical procedures like lumbar laminectomy can relieve pressure on the spinal nerves and decrease back pain and the risk of paralysis.

Serving patients at locations throughout northern New Jersey, CNSO’s comprehensive team of neurosurgeons, orthopedic spine surgeons, pain management physicians, rehabilitation specialists, and certified physical therapists work in coordination to deliver personalized care for each patient. For more information about lumbar laminectomy and other treatment options, contact CNSO today.

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In order to provide an accurate diagnosis with the most effective treatment option for “back problems” and brain tumors, CNSO is led by neurosurgeons and orthopedic spine surgeons. Under the care of our award-winning neurosurgeons and orthopedic spine surgeons, Northern NJ patients can have the confidence that their medical condition will be handled with consideration for their comfort and long-term well-being as well as technical excellence.

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