Lumbar Laminectomy for Spinal Stenosis
Why am I in pain?
The most likely cause of your pain is compression of the spinal nerves by a combination of overgrown ligaments, prolapsed disc and overgrown bony spurs within the spinal canal, which together cause compression of the lumbar nerve roots. The spinal cord is not being pinched – it ends approximately 2 inches above where your problem lies.
You will drift off to sleep under general anaesthesia in a safe and controlled fashion by an anaesthetist. While you are under anaesthesia, you will not feel any pain, nor will you be aware of time passing. Having cleaned your lower back in a sterile fashion, an incision about 2 inches long in your lower back will allow us to push the muscles off of the bones surrounding the spinal nerve roots. The nerves will be exposed through the removal of portions of the 5 bones of your lower back. The ligaments causing the nerve compression and any bony spurs will also be removed. If a large disc is causing nerve root compression, it will also be removed. Once the nerves have been successfully decompressed, the wound will be stitched up, and the anaesthetist will allow you to wake up in a safe manner. The procedure itself will take approximately one and a half hours, but your stay in the operating room environs may be a little longer than this.
Everything you need to know
What are the potential benefits of this procedure?
The primary benefit of lumbar laminectomy is to provide a significantly more rapid relief of neurogenic claudication ("numb painful legs") pain, in patients who have failed more conservative treatment options.
What are the potential risks of this procedure?
The main risks particularly associated this procedure are spinal fluid leak, wound infection, failure of your symptoms to improve, worsening of your symptoms, a recurrence of your symptoms, damage to the spinal nerves with resultant weakness of your leg muscles, a progression of the weakness in your lower back joints, or damage to your bladder and bowel continence. A more extensive list of risks is detailed on the consent form.
Will my symptoms be reversed?
The great majority of patients with leg pain do experience significant pain relief. Patients with predominantly back pain do not experience such impressive results.
Are there alternatives to surgery?
Alternatives to lumbar laminectomy would include physiotherapy, nerve root injections, and epidural injections by a pain management specialist. These are successful in alleviating the pain temporarily in approximately 50% of cases. Whilst you can walk, perhaps, for 15 minutes now without stopping, next year you may find you can only walk for 10 minutes, and the year after that, 5 minutes. In other words, this condition is progressive in the vast majority of cases.
How long will my expected hospital stay be?
You will be admitted to the hospital on the morning of surgery, and will be discharged home within 2 days. You will need to get somebody to drive you home from the hospital on the day of discharge.
How long will my expected recovery take?
The stitches used to close the wound are dissolvable, but you will need to some superficial skin-clips removed by your GP/Practice nurse 12 days later. You will have a stiff sore back for the first 3 weeks after this procedure, but by the time you are reviewed in the clinic this should be significantly better. Typically an improvement in your leg or foot pain will be the first benefit you will notice after this procedure, next an improvement in any "pins-and-needles", and lastly an improvement in any numbness (this may take a number of months or may in fact persist permanently). The scar will fade to a dull white mark over the next 12 months.
How long before I return to work?
Desk-work people are advised to refrain from returning to full-employment for 6 weeks. Housewives (and house-husbands!) need a similar period of time to recover also. People with flexible work hours, and those that can complete their duties whilst standing upright may return to work after 3 weeks. People who return to work too early have been shown to experience a greater degree of long-term back pain.
How long before I return to sports?
Athletes can usually return to full training in approximately 10 weeks, though each case will need to be judged on it's individual merits, taking factors such as the athlete's age, particular athletic activity, and body habitus into account.
When will I need to be seen in the clinic again?
You will be reviewed in the clinic after 6 weeks. You will have been given a regime of low-back muscle exercises by the physiotherapy department - it is important that these exercises become as regular a part of your daily routine as brushing your teeth!
Tell me what worrying symptoms I need to look out for whilst I'm recovering.
Should you experience any unusual symptoms or signs either prior to your surgery or during your subsequent recovery period, you must contact our office line immediately. Should that not be possible, we would advise you to seek immediate medical advice from a registered medical practitioner. Urinary or faecal incontinence, urinary retention, constipation, difficulty breathing or completing sentences, new-onset numbness or leg weakness, a painful calf or thigh (especially if red or swollen) are all reasons to call us immediately, or to go to your local hospital emergency department.
Always tell your surgeon if you are taking Aspirin, Disprin, Plavix (Clopidrogel), Warfarin, Dipyridamole (Persantine), Asasantin, Aggrenox or if your medical condition has changed in any respect in the period of time prior to your procedure.