Introduction
A lumbar laminectomy involves the removal of the back portion of the lumbar vertebra. It is a similar procedure to a cervical laminectomy, and is performed to relieve pressure on the lumbar spinal nerves. When extended further up in the mid-back (thoracic spine), laminectomy can decompress the spinal cord.
A microdiscectomy is a minimally invasive ('keyhole') surgical technique to remove a section of the bone in one of the vertebra and remove disc material or shave the prolapsed fragment of disc that is pressing on a nerve.
Indications
These procedures are used to treat the following conditions…
Preoperative Instructions
Before all neurosurgical procedures, including the procedures for lumbar laminectomy and / or microdiscectomy, you should…
- Not eat or drink anything after midnight the night before the procedure. Medication can be taken with very small sips of water.
- Let our office know if you take blood thinners – you may need to stop taking these ahead of the procedure.
- As much as possible, avoid having dental treatment (within three weeks) or any other form of surgery (within three months) of the planned procedure.
- Notify our office as soon as you develop any symptoms of infection, e.g. a cold or flu, in the few days before surgery, because your surgery may need to be postponed.
Procedures
Lumbar laminectomy
A lumbar laminectomy is performed under general anaesthesia. The patient lies face down and a 5-12cm vertical incision is made to the midline of the lower back. The muscles of the back ('erector spinae') are moved away from the laminae sections of the relevant vertebrae. The laminae are then removed, and in some instances an extra section of bone (the 'facet joints') may need to be trimmed as well to decompress the relevant nerve/s.
Microdiscectomy
Again, the procedure is carried out under general anaesthesia. With a microdiscectomy, a 3-4cm incision is made to the midline of the lower back, over the affected vertebra. Through the incision, the spinal muscles are moved aside, and a small amount of lamina is drilled away to reveal the nerve root which is affected by compression. Any section of bone or disc material which is pressing on the nerve is removed using keyhole surgery techniques with an operating microscope. Once complete the incision is closed with absorbable sutures.
Postoperative Instructions
With a lumber laminectomy, patients are generally in hospital for 1-3 nights. After a microdiscectomy, patients are often able to return home on the next day after surgery.
After either a laminectomy or microdiscectomy procedure it is important to avoid bending, lifting or twisting for at least 6 weeks, however gentle exercise (eg walking) during this period is important to aid healing.
As a microdiscectomy is a minimally invasive procedure, recovery times are shorter. Most patients can return to normal gentle activities, including work, within 1 – 2 weeks. Avoiding lifting anything heavier than ~2kg for 2-4 weeks is advised. Full recovery is generally at the 6-week mark, with exercise/sport possible from around week 3.
Risks
Although complications are uncommon, the following may occur during these procedures...
General risks associated with all surgery and anaesthesia (although bleeding is less common as there are no major blood vessels in the surgical area)
- Nerve damage (0.1% of cases).
- Bowel/bladder incontinence (0.01% of cases).
- Instabililty (~7.5% of cases).
- Spinal fluid leak (1-2% of cases).
- Recurring disc prolapse (~5% of cases).