Laminectomy means removal of the lamina. This procedure is most commonly performed for patients who have debilitating leg and/or buttock pain from spinal stenosis or large disc herniation, and who have failed non-operative treatment. Laminectomy is performed with the patient lying face down. An incision is made in the back and the muscles are retracted.
The lamina is removed to free the nerve roots. Additionally, the facet joints are undercut to free the nerve throughout its course. The undercutting of the facet joints is called facetectomy, and the freeing of the nerve throughout its course is called a foraminotomy.
Usually freeing of the nerve can be performed without much removal of the facet joints. If excessive facet joint removal is needed, or if there is instability of the spine, sometimes a fusion is also necessary.
Risks and potential complications associated with a lumbar laminectomy include:
- Dural tear (cerebrospinal fluid leak)
- Nerve root damage
- Recurrent disc herniation
- Bowel/bladder incontinence
These complications are quite rare. A dural tear, which occurs in 1% to 2% of these surgeries, does not change the results of surgery, but post-operatively the patient may be asked to lay recumbent for one to two days to allow the leak to seal.
In addition, lumbar laminectomy carries a few added potential complications because it is a larger procedure, and greater proportions of elderly patients have this procedure. Post-operatively, there is also the added risk of a slipped vertebral body (postlaminectomy spondylolisthesis) if the remaining bones are not strong enough to support the spine.