A laminectomy is a surgical operation designed to relieve pressure on nerves in either the back or neck.
The operation is performed under general anaesthetic. If the operation is performed on the neck (a cervical laminectomy), it is usually performed through a vertical cut, three or four inches long, along the middle of the neck at the back. The surgeon exposes the bones of the neck beneath the skin and a small amount of bone is clipped away, which relieves the pressure on the nerves. The operation is often combined with a closely related operation called a 'foraminotomy'. During this operation, the bony canal through which the nerves pass as they leave the spinal cord is widened, which again relieves the pressure on the nerves. The skin is closed at the end of the operation, usually with metal clips but sometimes with stitches. An adhesive dressing is applied over the wound. Sometimes, a plastic drain is left in the wound for a few days after the operation to drain any blood that may have collected under the wound.
When the procedure is performed on the neck it is most often performed for a trapped nerve (as may happen for example, in arthritis of the neck). When it is performed on the lower back it is a lumbar laminectomy. This procedure is often performed for disk protrusions, which may occur after a major accident but also sometimes occur after a quite minor twisting injury of the lower back.
On arriving at the hospital, you are seen by a nurse and then by a doctor, who explains the procedure to you and obtains your written consent for the operation. It is usual that you also see the anaesthetist to ensure that you are medically fit for the operation. A number of tests are performed before the operation, which include blood tests, urine analysis and sometimes an electrical recording of the heart (electrocardiogram, ECG) and a chest X-ray.
A laminectomy removes the entire laminae. Removal of the lamina helps relieve the pressure when the disc bulges. It is also performed when the disc is extensively damaged and the surgeon needs greater access to perform a disectomy. If stenosis is present, the surgeon may enlarge the foramen (opening between the vertebrae) to make adequate space for the nerve to exit.
On recovering from the anaesthetic you will feel drowsy. The aching and stiffness of the neck or back you will feel for several days is controlled with pain killing injections at first and tablets later. Usually, after cervical laminectomy you are nursed up-right in bed for the first day and not allowed to lie flat to prevent excessive build-up of fluid under the wound. If a drain has been inserted into the wound, this is usually removed after two days. You may be allowed out of bed one or two days after a cervical laminectomy.
The period of bed rest may be a few days longer for a lumbar laminectomy.
The exact details of the operation and care after the operation often vary and you should ask your surgeon about these.
Some degree of neck or back pain is common after this operation, but relief can be achieved with pain-killing injections or tablets. Some oozing from the wound is also common, but is not usually serious and settles spontaneously after a few days.
Infection of the wound is very uncommon and can usually be treated with antibiotics. Some surgeons routinely give antibiotics before the operation to help prevent this complication from occurring.
The average length of stay in hospital is two to three days, but this can vary somewhat, according to whether your operation was on the neck or back and on the size and exact nature of the operation performed.
The surgical wound clips or stitches may be removed while in hospital just before going home, but on occasion they will be removed after discharge from hospital by a GP or a nurse.
Neck ache, pain and stiffness often persist for several weeks after the operation, but gradually improve with time. On leaving hospital, a person may be given a supply of pain-killing tablets to take. Most people need to be off work for between one and three weeks after leaving hospital, depending on the nature of their work. Work that is physically demanding or that involves lifting heavy objects may require a longer time off.