The lumbar region, or lower back, may be painful with radiating pain in the leg called sciatica or radiculopathy. The pain may be caused by nerve pinching and pressure that is the result of a lumbar herniated disc or a condition called lumbar spinal stenosis.
Laminectomy is a decompression surgery that creates space by removing the lamina—the back part of the vertebra that covers your spinal canal. This small portion portion of bone over the nerve root or the disc material under the nerve root may be removed to relieve the pinching of the nerve and make room for it to heal. This pressure is commonly caused by bony overgrowths within the spinal canal that can narrow the space available in your spinal cord, and pinch the nerves. This may happen with arthritis in the spine. Spinal stenosis, spinal tumors as well as synovial membrane cysts, and fractures with bone filling the spinal canal can be causes of the pinching of the nerve, and treated with this procedure.
Laminectomy is generally used only when more-conservative treatments—such as medication, physical therapy or injections—have failed to relieve symptoms. Laminectomy may also be recommended if symptoms are severe or worsening dramatically. Bony overgrowths within the spinal canal can narrow the space available in your spinal cord and nerves. This pressure can cause pain, weakness or numbness that can radiate down your arms or legs. Laminectomy is usually better at relieving these types of radiating symptoms than it is at relieving actual back pain.
In some cases, laminectomy may be necessary as part of surgery to treat a herniated spinal disc. Your surgeon may need to remove part of the lamina to gain access to the damaged disk.
Surgeons usually perform laminectomy using general anesthesia, so you're unconscious during the procedure. The procedure can either be minimally invasive with a smaller incision, a microlaminectomy, or it may involve a larger open incision and is considered open surgery. The surgeon makes an incision in your back over the affected vertebrae and moves the muscles away from your spine as needed. Small instruments are used to remove the appropriate lamina. If laminectomy is being performed as part of surgical treatment for a herniated disk, the surgeon also removes the herniated portion of the disk and any pieces that have broken loose—this is called discectomy.
Alternatives to laminectomy for the mid spine or thoracic region may include corpectomy, laminotomy or interspinous process spacer. Corpectomy involves removing part of a vertebra to relieve the pressure on the spinal cord or spinal nerves. Laminotomy is essentially the same as laminectomy except that a hole is made in the lamina as opposed to removing the entire lamina. Interspinous process spacer relieves the pressure associated with spinal stenosis by the use of devices that go within and between the spinous processes and the general category of this is called interspinous process spacers. By pressing open the spinous processes in the back of the spine, there is a more room for the nerves behind the spine running behind the vertebrae and without any direct surgery to the nerves. These are best used for patients with spinal stenosis who do have pain in an activity-related standing or walking position that’s relieved by bending forward or by sitting down.