Laminectomy

Laminectomy is surgery to remove the lamina, two small bones that make up a vertebra, or bone spurs in your back. The procedure can take pressure off your spinal nerves or spinal column.

Description

Laminectomy opens up your spinal canal so your spinal nerves have more room. It is usually done along with a diskectomy, foraminotomy, and spinal fusion. You will be asleep and feel no pain (general anesthesia).

You will lie face down on the operating table. The surgeon will make an incision (cut) in the middle of your back or neck.
The skin, muscles, and ligaments are moved to the side. Your surgeon may use a surgical microscope to see inside your back.
Part or all of the lamina bones may be removed on both sides of your spine, along with the spinous process, the sharp part of your spine.
Your surgeon will remove any small disk fragments, bone spurs, or other soft tissue.
The surgeon may also do a foraminotomy (to widen the opening where nerve roots travel out of the spine) at this time.
Your surgeon may do a spinal fusion to make sure your spinal column is stable after surgery.
Surgery takes 1 to 3 hours.

Why the Procedure is Performed

Laminectomy is often done to treat spinal stenosis. The procedure removes bones and damaged disks, and makes more room for your spinal nerve and column.

Your symptoms may be:

Pain or numbness in one or both legs. You may feel weakness or heaviness in your buttocks or legs. You may have problems emptying or controlling your bladder and bowel.
You are more likely to have symptoms, or worse symptoms, when you are standing or walking.

You and your doctor can decide when you need to have surgery for these symptoms.

Decompressive laminectomy is also used to treat other medical ailments including injury to the spinal cord tumors as well as herniated discs. After decompressive laminectomy recovery, the patient is usually able to resume all daily activities without any sensation of pain or discomfort. When the same procedure is

performed on the neck or cervical area, it is known as cervical decompressive laminectomy

You will have an MRI before surgery that shows you have

Risks for any surgery are:

Blood clots in the legs that may travel to the lungs
Breathing problems
Infection, including in the lungs (pneumonia), bladder, or kidney
Blood loss
Heart attack or stroke during surgery
Reactions to medications

Risks for spine surgery are:

Infection in wound or vertebral bones
Damage to a spinal nerve, causing weakness, pain, or loss of feeling
Partial or no relief of pain after surgery
A return of back pain in the future

If you have spinal fusion, your spinal column above and below the fusion is more likely to give you problems in the future.

Soon after your surgery, the physiotherapist will see you in your room.
Exercises are started to improve your body circulation, circulation of operated part.
This helps to reduce post-operative swelling, lung complications and prepares you to start your movements and early ambulation.

Day 0

A) Physiotherapist will guide you to perform simple lower limb exercises in bed.

Calf pump exercises – moving your ankle and toes.
Straight leg raising.
Taking your leg sideways.
Bending your knees.
Back press exercises in bed.
Tummy tuck exercises in bed.

B) Nursing staff and / or the physiotherapist will help you to turn on either sides with pillows kept in between the legs. Avoid twisting movements at back Log Rolling Technique.

C) Deep Breathing exercises in Bed.

D) Application of Ice Packs / cryotherapy around the operated site is given to reduce your post-operative pain.

These exercises should be done in set of 5, twice a day along with application of ice packs twice- thrice / day.

Day 1

Same set of Bed exercise is continued.
Buttock lifting exercise is taught.
Turning to either sides with helps of pillows is reviewed and eased.
Prop-up upto 600 of the bed is permitted today during meal sessions for about 10 minutes each time.
Ice packs / cryotheraphy continued.

Day 2

Same set of Bed exercise is continued.
Turning to either sides is reviewed.
If your drain tubes are removed, you would be made to sit upright with helps of lumbar brace.
If there are no complications, you would be allowed sit upright with help of lumbar brace for two meal sessions for about 10 minutes each time.
Ice packs / cryotheraphy continued in accordance with pain.

Day 3

Same set of exercise is continued.
You would be made to walk today with minimal abistance with lumbar brace once or twice a day.
You would now be allowed to sit up right for all meal sessions for about 10-15 minutes with lumbar brace.
Ice packs / cryotheraphy continued.

Day 4/5

Same set of Bed exercise is continued.
Independent sitting for about 20 minutes advices.
Independent walking and increase in walking distance in encouraged. You may be advised to walk at least three-four times a day in hospital corridor (under supervision of hospital staff).
Toilet –Training on commode is given with lumbar brace.
Stair case climbing with lumbar brace is given.
Ice packs / cryotheraphy is in accordance with your pain.

DISCHARGE : Usually after the post-operative Day-5

A) Discharge is planned when

You are able to get out of bed unaided.
You are able to walk to the toilet.
You are able to sit and get up comfortably on your own with lumbar brace.
You do not have any other complaints.

B) On discharge, you are allowed to ride in a regular car but make sure it is easy to get in and out of it. It goes without saying that you will not be allowed to drive your own vehicle home.

What are you expected to do after you go home ? upto 2 weeks post-surgery

A) Home modifications :-

Put things that you think you will need close to where you can get them without stressing your back i.e. without bending forwarded.

B) Activities :- You will be spending half of your twice resting in the bed and other half, up and around)

1. Exercises :-

Same set of exercises as told to you during your discharge should be continued in set of 10, twice-thrice / day till 2 weeks post-surgery.

2. Sitting

You are allowed to sit upright with lumbar brace for about 20-30 minutes according to your comfort level.
Change your position from sitting to walking after every 30 minutes.
Avoid forward bending in sitting for about 4-6 weeks.
Avoid crossed legged sitting for about 4-6 weeks.
Twisting movements at back to be avoided.

3. Standing and walking

You are allowed to stand for session about 30 minutes with lumbar brace.
Walking should be carried out 4-5/day.
Slowly increase the frequency and distance of walking.
Avoid forward bending for about 4-6 weeks.
Lifting of heavy weight is to be avoided
You are allowed to lift object leber than 10 pounds by bending your knees.
Twisting movements at back to be avoided.

4. Sleeping

· Sleep either on your back or side.

· Use pillows for support.

· Lying on your stomach is to be started after 2-3 weeks.

· Avoid twisting movements at back while getting in and out of the bed.

5. Bathing and toilet activities

· You are recommended to use shower while bathing.

· You can take off the brace when is shower. Remember to avoid any bending, twisting or lifting.

· Recommended to use a chair while showering.

· Use of commode is recommended for toilet activities.

· Complete No for Indian style toilets.

2 weeks – 4 weeks post surgery

I. Activities

As the week program, you can gradually increase your amount of activities but your restrictions do not change at this point.

II. Exercises :

Set of exercises at the point of discharge are now discontinued.

The physiotherapist tailors your exercise program to help you to resume all your normal daily activities.

a) Abdominal strengthening - upper

- lower

b) Knee to chest position exercises.

c) Stretching of tight strucheres and strengthening of back and lower limb muscles.

d) Dynamic back extension exercises in prone i.e. laying on stomach.

e) Cat-Camel exercises.

III. Return to your work

If you do a sedentary (mainly sitting down) job you may be back at your desk at about 4 weeks. Light work is permitted.

May be a good idea to consider returning on part-time hours after 2 weeks and then gradually to full time hours from 4th week.

Avoid sitting for too long at a stretch. Get up and walk around suggestive of you change position.

IV. Driving and traveling

You are now allowed to drive for shorter distances as you are confident chougle to operate a vehicle.

Short car ride with support in place and seatbelt fastensed

If you have to travel longer journey, it is advisable to travel with pillow and get out of your vehicle every hourly to shetel and walk around.

V. Sexual activities

You can resume your sexual activity by now, if comfortable.

VI. You can continue other activities like sitting, standing, walking as per your comfort level longer duration & frequency.

4-6 weeks post surgery

I. Activities

You will now begin to increase your level of activities.

But any event, any exercise motion of lumbar spine and pelvis is to be avoided.

Side bending activity at 4 weeks, rotations at 6 weeks.

Multi-directional activities as tolerated.

II. Exercises

Vigorous physical therapy exercises regimen will be initiated.

Core stabilization exercises.

More of dynamic exercises on ball are started.

Can start with gym if desired, lighter exercises regimen heavier exercises regimen.

III. Return to work :

If you have jobs that require prolonged sitting with minimal lifting, you can resume your work by 4-6 weeks.

IV. Sitting, standing, walking should definitely be increased in respect to strengthening of muscles. Treadmill, stationary bicycle can be used, swimming can be resumed.

6 weeks – 8 weeks - 12 weeks post operative

Activities
Full release of all activities may well provided at this time
Most of the reskichons will be lifted at this time.
Lifting, stooping can be gradually prolonged with proper biomechanious ergonomic.
Work
Heavily labourous work may be resumed with some modifications.
Sports
Sports can be started back by approximately 10m week.
Functional training exercises for sports should be preceding it.
Jogging can be taken up by 10m week.
Minimize the use of brace.
Can wear it only driving, traveling, longer distance.