Decompressive Laminectomy for Lumbar Spinal Stenosis
Decompressive laminectomy is the most common
type of surgery done to treat
lumbar (low back) spinal stenosis. This surgery is done to relieve
pressure on the
spinal nerve roots caused by age-related changes in the spine. It also is done to treat other conditions, such as injuries to the spine,
herniated discs, or tumors. In many cases, reducing
pressure on the
nerve roots can relieve pain and allow you to resume
normal daily activities.
Laminectomy removes bone (parts of the
vertebrae) and/or thickened tissue that is narrowing the spinal canal and
squeezing the spinal nerve roots. This procedure is done by surgically
cutting into the back.
When you've got back pain, one of the best questions you can ask is, "Why is it happening?" That can be the first step to helping the problem.
Common causes for back pain include:
Muscle and ligament injuries. These are the most common causes of back pain. Shoveling snow or helping a friend move her couch can sometimes overstretch the muscles or ligaments. You can wind up with strains or sprains. Most of these injuries heal in a few days to weeks.
In some cases, spinal fusion (arthrodesis) may be done at the same time to help
stabilize sections of the
spine treated with decompressive laminectomy. Spinal
fusion is major surgery, usually lasting several hours. There are different
methods of spinal fusion:
In the most common method, bone is taken from
elsewhere in your body or obtained from a bone bank. This bone is used to make
a "bridge" between adjacent spinal bones (vertebrae). This "living" bone graft
stimulates the growth of new bone.
In some cases an additional
fusion method (called instrumented fusion) is done in which metal
implants (such as rods, hooks, wires, plates, or screws) are secured to the
vertebrae to hold them together until new bone grows between them.
There are a variety of specialized techniques that can be
used in spinal fusion, although the basic procedure is the same. Techniques
vary from what type of bone or metal implants are used to whether the surgery
is done from the front (anterior) or back (posterior) of the body. The method
chosen depends on a number of things, including your age and health
condition, how many vertebrae are involved, the severity of nerve root pressure and associated symptoms, and the
surgeon's experience. Spinal fusion increases the possibility of complications
and the recovery time after surgery.
What To Expect After Surgery
Depending on your health and the
extent of the surgery, it may take several months or more before you are able
to return to your normal daily activities.
Why It Is Done
Surgery for spinal stenosis is
Severe symptoms restrict normal daily
activities and become more severe than you can manage.
treatment does not relieve pain, and severe nerve compression symptoms of
spinal stenosis (such as numbness or weakness) are getting
You are less able to control your bladder or bowels than
You notice sudden changes in your ability to walk in a
steady way, or your movement becomes clumsy.
The decision to have surgery is
not based on imaging test results alone. Even if the results of imaging tests
show increased pressure on the spinal cord and spinal nerve roots, the decision
to have surgery also depends on the severity of symptoms and your ability to
do normal daily activities.
In some cases,
spinal fusion will be done at the same time to
stabilize the spine. Spinal fusion might make it easier for you to move around
(improve function) and relieve your pain. It can also help keep the bones from
moving into positions that squeeze the spinal canal and put pressure on the
spinal nerve roots.
How Well It Works
Surgery for spinal stenosis usually
is elective but may be recommended if symptoms cannot be relieved with
nonsurgical treatment. In general, experts feel that surgery has good results
and relieves pain in the lower extremities for people who have severe symptoms
of spinal stenosis and who have few other serious health problems.
Surgery may work better than nonsurgical treatments to relieve pain and help you move better. If nonsurgical treatments have not worked well enough, surgery might be able to help you.1
By 3 months, people who had surgery notice more improvement in their symptoms and can be more active than people who did not have surgery.1 This difference continues for at least 4 years after surgery.2
The benefits of surgery appear to last for many years. After 8 to 10
People treated with surgery were as
satisfied as those treated without surgery.
People who had surgery
were generally able to be more active and had less leg pain than those who had
Surgery appears to be more effective for leg pain than for back pain, but it may help both.4
symptoms may return after several years. A second surgery
may be needed if:
Spinal stenosis develops in another area of the
An earlier surgical procedure was not effective in
Instability develops, or fusion does not
Regrowth of tissue (lamina) presses on the spinal cord or
spinal nerve roots.
Spinal fusion may be done at the same time as decompressive
laminectomy. Spinal fusion may help to stabilize sections of the spine that
have been treated with decompressive laminectomy. In general, fusion is only
done if an area of the spine is unstable, which means the bones of the spine (vertebrae) move
too much or do not move in a normal way. This extra movement causes wear and tear on the nerves or other soft tissues, leading
to irritation and pain. The goal of fusion is to keep the damaged bones in the
spine from moving so that the soft tissues are protected.
Complications from spinal stenosis surgery may
result from the impact of other existing medical problems and the severity of
the spinal problem. Also, all surgery poses risks of complications.
These complications may be more serious in an older adult.
Nerve injury, including weakness, numbness, or
Tears in the fibrous tissue that covers the spinal cord
and the nerve near the spinal cord, sometimes requiring
a second surgery.
Trouble passing urine, or loss of bladder or bowel
Long-term (chronic) pain, which develops after surgery in
Death from problems caused by surgery, but this is rare.
If you have
diabetes or circulation problems or if you are a
smoker, you may be at greater risk for complications.
What To Think About
Most experts recommend that
people with spinal stenosis try nonsurgical treatments before choosing surgery.
Surgery for lumbar spinal stenosis is most
likely to relieve pain, numbness, and weakness that are mostly in your legs.
Surgery may not work as well for relieving pain that is mostly in your
Surgery is usually effective if
you have severe leg pain and numbness and you have not been able to move around
well for a long time. But in some cases, the symptoms return after surgery. It
is also possible that nerve symptoms, including numbness and clumsiness, may
not be relieved or may return.
laminectomy and fusion, spinal stenosis may develop directly above or below the
surgery site. Repeated surgeries for spinal stenosis increase your risk of
complications and instability in the spine.
Age should not be a factor in deciding whether to have decompressive
laminectomy. But if you have other medical conditions
that will make this procedure and follow-up rehabilitation less successful,
surgery may not be recommended.
Weinstein JN, et al. (2008). Surgical versus nonsurgical therapy for lumbar spinal stenosis. New England Journal of Medicine, 358(8): 794–810.
Weinstein JN, et al. (2010). Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine, 35(14): 1329–1338.
Atlas SJ, et al. (2005). Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8- to 10-year results from the Maine Lumbar Spine Study. Spine, 30(8): 936–943.
Pearson A, et al. (2011). Predominant leg pain is associated with better surgical outcomes in degenerative spondylolistheses and spinal stenosis: Results from the Spine Patient Outcomes Research Trial (SPORT). Spine, 36(3): 219–229.
Primary Medical Reviewer
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer
Robert B. Keller, MD - Orthopedics
February 13, 2012
WebMD Medical Reference from Healthwise
February 13, 2012
This information is not intended to replace the advice of a doctor.
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