Laminectomy in Iran: All you need to know

Laminectomy, also known as decompression surgery, is an orthopedic surgical procedure designed to rid the patient from the back or neck pain that interferes with normal daily activities. During Laminectomy, the surgeon removes part or all of the vertebral bone (lamina), which helps ease pressure on the spinal cord or the nerve roots that may be caused by injury, herniated disk, narrowing of the canal (spinal stenosis), or tumors.

When is Laminectomy needed?

In general, laminectomy is needed when bony overgrowths within the spinal canal start narrowing the space available for your spinal cord and nerves, which causes pain, weakness or numbness that can affect your arms or legs.

However, doctors may recommend laminectomy for many other conditions. For example, laminectomy can be the best available treatment if:

• Medication or physical therapy fails to improve your symptoms.
• You have muscle weakness or numbness that makes standing or walking difficult.
• You experience loss of bowel or bladder control.
• You are showing signs of spinal stenosis or possible symptoms of a herniated disk.
• You are suffering from pressure on the spinal cord or nerve roots caused by spinal stenosis.
• If you are experiencing symptoms such as pain in the neck or lower back numbness, aching, or tingling that radiates from the arms into the hands, numbness or aching that runs down the buttocks and into the legs, cramping or weakness in the hands, arms, legs, or feet.

How is laminectomy done and how does it differ from laminectomy with fusion?

First, before starting the surgical procedure, you will be asked to remove your clothes and will be given a gown to wear, and an IV (intravenous) line may be started in your arm or hand.

Once you are under anesthesia, a urinary drainage catheter may be inserted. Afterwards, you will be positioned either on your belly or on your side on the operating table.

At the beginning of the surgical procedure, the surgeon will make an incision over the selected vertebra and spreads the muscles apart then removes the bony arch of the posterior part of the vertebra (lamina) to ease the pressure on the nerves in the area. This procedure may involve removing bone spurs or growths, or removing all or part of a disk.

In some cases, an instability of the spine might be detected, which may require a posterior fusion of the spine. In the fusion procedure, a bone graft (from your pelvis or spine) is taken, or a synthetic bone graft can be used around the spine to create a solid bony fusion across the unstable segments. In most cases, titanium screws and rods are placed to increase the stability, and sometimes the lumbar disc is removed and replaced with a plastic cage filled with bone graft.

How many types of Laminectomy are there?

There are several types of laminectomy (decompression surgery):

• Laminectomy: This procedure involves removing the entire bony lamina, a portion of the enlarged facet joints, and the thickened ligaments overlying the spinal cord and nerves.
• Laminotomy: In this procedure, a small portion of the lamina and ligaments is removed, usually on one side. In this method, the surgeon leaves the natural support in its place, which decreases the chance of spinal instability. However, in some cases an endoscope may be used, allowing for a smaller and less invasive incision.
• Foraminotomy: In this procedure, the surgeon removes the bone around the neural foramen, where the nerve root exits the spine, in order to relieve the pressure caused by the degeneration of a disk that has caused the height of the foramen to collapse and pinch a nerve.
• Laminoplasty: In this procedure, the surgeon expands the spinal canal by cutting the laminae on one side and swinging them open like a door. However, this procedure is used only in the neck (cervical) area.
• Discectomy: This procedure is done to remove a portion of a bulging or degenerative disc in order to relieve pressure on the nerves.
• Facetectomy: A lumbar facetectomy is a surgical procedure to remove the pressure of the spinal nerve roots near the facet joint when conservative medical treatment fails to control pain and other symptoms of facet disease
• Corpectomy or Vertebrectomy: this surgical procedure involves removing all or part of the vertebral body as a way to decompress the spinal cord and nerves. In most cases, corpectomy is performed in association with some form of discectomy.

What is the difference between microdiscectomy and lumbar laminectomy?

Microdiscectomy and lumbar laminectomy are both procedures performed to help relieve pain, numbness and discomfort from pressure on nerves in the spine.

During the microdiscectomy procedure, the patient is placed facedown and a tiny incision is made over the location of the herniated disc. The orthopedic surgeon uses a retractor to remove parts of the lamina bone so that there is a clear view of the spinal nerve and disc. The damaged disc is removed and replaced with bone replacement material. However, in laminectomy, the surgeon makes several tiny incisions to access the region.

During the procedure, the surgeon removes a small part of the bone, called the lamina, just over the nerve root, and can also remove or trim disc material underneath the nerve root to allow for more space.

What is spinal stenosis and can Laminectomy treat it?

Spinal stenosis is the narrowing of one or more bony openings in the vertebrae of the spine. When spinal stenosis occurs in the spinal canal, it is called central canal stenosis and it may cause compression of the spinal cord. When all other medical treatments fail, a decompressive laminectomy is the most common type of surgery done to treat lumbar (low back) spinal stenosis.

What causes spinal stenosis?

The causes of spinal stenosis include:

• Arthritis of the spine, including osteoarthritis and rheumatoid arthritis
• Spinal injuries from motor vehicle accidents or falls
• Herniated or slipped disks from aging or moving heavy objects
• Tumors that grow inside the spinal canal
• Bone spurs that grow into the spinal canal

What is a cervical laminectomy?

A cervical laminectomy is an operation done from the back of the neck to relieve pressure on the spinal cord and nerves. It involves carefully removing the bony roof (or laminae) of the spinal canal, as well as any soft tissue which may also be causing compression.

Why might I need a cervical laminectomy?

A cervical laminectomy is usually performed for one or more of the following reasons:

• To relieve pressure on multiple spinal nerves in the neck, which may be caused by cervical spondylosis, foraminal stenosis, or an intervertebral disc prolapse.
• To relieve pressure on the spinal cord, which may be caused by cervical canal stenosis/spondylosis or an intervertebral disc prolapse.
• Cervical laminectomy is recommended when all reasonable medical treatments, such as painkillers, nerve sheath injections, and physical therapies have failed.
• In cases of significant instability or neurological problems, surgery may be the most appropriate first treatment option.
• To treat cervical spine instability, which may be caused by degenerative changes, arthritis, or trauma.

What are the main laminectomy recovery stages?

In the first stage after the surgery, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room.

Laminectomy usually requires that you stay in the hospital for one or more days. You will most likely start getting out of bed and walking the evening of your surgery, as your pain will be controlled with medicines so that you can take part in the exercise plan given to you by your doctor.

In the second stage, once you are at home, it is important to keep the surgical incision area clean and dry. Moreover, your healthcare provider will give you specific bathing instructions. Finally, the surgical staples or stitches are to be removed during the next checkup.

How can I speed up the healing process?

• First, you must follow the doctor’s instructions when it comes to taking medicine, as certain types of medicine may increase the chance of bleeding. So, you must be sure to take only the prescribed medicines.
• notify your healthcare provider immediately about any of the following:
• Fever
• Redness, swelling, bleeding, or other drainage from the incision site
• Increased pain around the incision site
• Numbness in your legs, back, or buttocks
• Trouble urinating or loss of control of your bladder or bowel
• Limit your physical activities for a period of time, and don’t pick up heavy objects or drive till your healthcare provider tells you that it is OK to do so.

What are the most important discharge teachings for Laminectomy?

• Take your medicine as directed. It is also recommended to keep a list of the medicines, vitamins, and herbs you take in order to show it to the doctor during your checkup or in a case of emergency, such as an allergic reaction to any medicine.
• Take your prescribed pain medicine, which may be given to you, with the proper instruction on how to safely take them, as too much acetaminophen may cause liver damage and other unwanted side effects.
• Take all the rest you need. You may feel like resting more often after the surgery, which is totally normal, and it is advised to rest when you feel it is needed.
• Do not lift heavy objects for 14 days after surgery, and most importantly, do not lift anything over your head.
• Limit your physical movement, and avoid bending at the hips or twisting at the waist. Instead, bend your knees and keep your back straight when you pick something up off the floor.
• Change your sleeping habits. When you lie on your back, place 2 or 3 pillows under your knees and the lower part of your legs to raise them. When you lie on your side, bend your knees and use a small pillow under your head and neck, as these positions will decrease the strain on your shoulders, neck and arms. However, sleeping on your stomach is not recommended.
• Do not sit for longer than 15 to 20 minutes at a time. Keep your back straight by sitting on a firm chair, and keep your knees bent and slightly higher than your hips for the first 3 weeks after surgery.
• Apply warm compress on your surgery area. Warm compress is known for its ability to help decrease pain and muscle spasms.
• Carefully wash the wound with soap and water. Dry the area and put on new, clean bandages as directed. Make sure your bandages remain clean, and change them when they get wet or dirty.

What are the risks of having a Laminectomy?

As with any surgical procedure, common complications can be expected. Common complications after laminectomy may include:

• Bleeding
• Infection
• Blood clots in the legs or lungs
• Spinal cord or nerve root injury
• Nerve or blood vessels in the area of surgery may be injured, which in turn can cause weakness or numbness.
• Wound pain
• Muscle, ligament, or nerve damage
• A possible infection in the surgical site
• A blood clot in the legs
• Difficulty breathing as an allergic reaction to the anesthetic or medication

In addition to the common complications, there are severe life-threatening complications that may occur in rare cases, such as:

• Nerve roots injuries and dural tears can occur. However, these are more common among older adults.
• Cerebrospinal fluid (CSF) can leak out of tears in the dura mater, which is a serious issue that can lead to additional complications, including dizziness, headaches, and seizures.
• Unsuccessful treatment, which can lead to recurring symptoms
• An infection in the surgical site
• Damage to the nerves, muscles, or tendons that stabilize the spine

Can laminectomy treat osteophyte (bone spur)?

Osteophytes are bony lumps (bone spurs) that grow around the joints or on the bones of the spine. They often form next to joints affected by osteoarthritis, a condition that causes joints to become painful and stiff. Osteophytes can grow from any bone, but they are most likely to be found in the:

• neck
• shoulder
• knee
• lower back
• fingers or big toe
• foot or heel

During a laminectomy to treat osteophyte, the bone spur and other tissues pressing on the spinal nerve are removed to create more space for the spinal nerve.

Can laminectomy be done to remove a tumor?

A laminectomy is a surgery to remove the lamina (back part) of your vertebra and the tumor on your spinal cord. This will relieve any pressure that may be on your spinal cord. It may also help to relieve symptoms such as pain, numbness, tingling, or weakness caused by the tumor.

How is the tumor removed during your surgery?

During this procedure, the surgeon uses general anesthesia, meaning that you will be asleep during your laminectomy. But before that, you will be asked to lay on your belly on the operating table, so the surgeon can make an incision in your upper, middle or lower back. Then, the surgeon will spread your soft tissue and muscles apart to see your lamina. Finally, the surgeon will remove your lamina and other parts of the bone surrounding your spinal cord to reach the tumor that will be removed fully or partially before closing the incision.

What is post-laminectomy syndrome?

Post-laminectomy syndrome is a condition where the patient suffers from persistent pain in the back following surgery to the back. In rare cases, a number of patients suffered from back pain and sometimes leg pain following laminectomy. This persistent pain is called post laminectomy syndrome.

Can post laminectomy syndrome be cured?

Post-laminectomy syndrome can often be successfully treated with noninvasive methods such as nerve blocks, spinal cord stimulation, and facet joint injections.

Is it important to exercise after Laminectomy?

During the recovery process, doctors recommend regular exercise to restore the strength of your back and to help you return gradually to your everyday activities. In most cases, your orthopedic surgeon and physical therapist will make a specific exercising plan for you to follow. However, if this is not the case, there are common exercises that are recommended for most patients. These exercises include:

• Ankle pumps
• Heel slides
• Single knee to chest stretch
• Piriformis stretch
• Abdominal contraction
• Wall squats
• Heel raises
• Hip flexor stretch
• Straight leg raises
• Hamstring stretch
• Lumbar stabilization exercises with Swiss ball
• Lying on Swiss ball using different positions
• Aerobic exercises
• Stationary bike for 20 to 30 minutes.
• Treadmill for 20 to 30 minutes.

How can I arrange my medical trip to undergo laminectomy in Iran?

All you have to do is to surf AriaMedtour’s website and click ‘Free Consultation’ so you can fill a simple form, or you can simply contact AriaMedtour directly via WhatsApp using the number provided on the website. We will take care of every single detail of your journey to have laminectomy in Iran so that you only need to take care of yourself.