Lumbar spinal stenosis, often affecting the elderly, can cause debilitating symptoms such as leg pain, claudication, and functional impairment. The surgical approaches for treating lumbar stenosis have evolved, with both traditional open laminectomy and minimally invasive techniques like Unilateral Laminectomy for Bilateral Decompression (ULBD) offering distinct benefits. While both approaches aim to decompress the nerve roots and improve patient mobility, minimally invasive options provide advantages in terms of reduced muscle disruption and faster recovery times.
How Common It Is and Who Gets It? (Epidemiology)
Spinal stenosis is a prevalent condition, particularly among older adults. It is often linked to age-related changes in the spine, such as disc degeneration and facet joint arthropathy. As the population ages, the incidence of lumbar spinal stenosis and related surgical interventions, such as laminectomy, is expected to increase.
Why It Happens – Causes (Etiology and Pathophysiology)
Lumbar spinal stenosis occurs when the spaces within the lumbar spine narrow, placing pressure on the spinal cord or nerve roots. This can result from degenerative changes, such as disc herniation, hypertrophy of the ligamentum flavum, or osteophyte formation. These changes lead to the compression of nerves, resulting in pain, numbness, and weakness in the lower extremities.
How the Body Part Normally Works? (Relevant Anatomy)
The lumbar spine consists of five vertebrae (L1-L5) and is responsible for bearing much of the body’s weight. The spinal canal, which houses the spinal cord and nerve roots, can become narrowed due to degenerative changes. This compression can lead to symptoms such as pain and neurological deficits. The facet joints, disc spaces, and ligamentous structures in the lumbar spine all play a role in maintaining spinal stability and mobility.
What You Might Feel – Symptoms (Clinical Presentation)
Patients with lumbar spinal stenosis may experience:
- Lower back pain, particularly with standing or walking.
- Leg pain, numbness, or weakness that improves with sitting or bending forward.
- Difficulty walking or maintaining balance.
- In severe cases, bladder or bowel dysfunction due to nerve compression.
How Doctors Find the Problem? (Diagnosis and Imaging)
Diagnosis is made based on a combination of clinical symptoms, physical examination, and imaging studies. MRI and CT scans are commonly used to evaluate the degree of stenosis, the presence of disc herniations, and any nerve compression. These imaging techniques help guide treatment decisions, whether surgical or conservative.
Classification
Spinal stenosis can be classified based on the location and severity of the compression:
- Central stenosis: Narrowing of the spinal canal, which can compress the spinal cord.
- Lateral recess stenosis: Compression of the nerve roots within the lateral recess of the spinal canal.
- Foraminal stenosis: Narrowing of the spaces through which the nerve roots exit the spinal column.
Other Problems That Can Feel Similar (Differential Diagnosis)
Other conditions that can mimic the symptoms of lumbar stenosis include:
- Degenerative disc disease.
- Sciatica due to herniated discs.
- Facet joint arthropathy.
- Vascular claudication (poor circulation in the legs).
Treatment Options
- Non-Surgical Care: Includes physical therapy, anti-inflammatory medications, and steroid injections to reduce pain and inflammation. Bracing may also be recommended to support the spine.
- Surgical Care: Decompression surgery, such as laminectomy or ULBD, is recommended when conservative treatments fail. Surgical options aim to relieve pressure on the nerve roots and improve function.
Indications for Open Laminectomy
Open laminectomy is typically indicated in cases where non-surgical treatments have failed to alleviate symptoms, and imaging studies reveal significant spinal stenosis that is causing nerve compression. Specific indications include:
Severe Neurogenic Claudication:
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- Patients experiencing severe pain, numbness, or weakness in the legs that worsens with walking and improves with rest may benefit from open laminectomy.
Progressive Neurological Deficits:
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- Progressive loss of motor function, muscle strength, or sensation that does not respond to conservative treatments may necessitate open laminectomy.
Intractable Pain:
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- Persistent and severe pain that significantly impacts daily activities and quality of life, despite medications, physical therapy, and other non-invasive treatments, can be an indication for surgery.
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- This is a medical emergency characterized by severe compression of the nerve roots at the lower end of the spinal cord, leading to symptoms like bowel or bladder dysfunction, saddle anesthesia, and significant motor weakness. Immediate surgical decompression, often via open laminectomy, is required.
Spinal Instability:
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- Cases of lumbar spinal stenosis associated with instability, such as spondylolisthesis, may require open laminectomy with or without spinal fusion to stabilize the spine.
Microendoscopic Procedures: A Modern Approach
Microendoscopic procedures have become increasingly popular in recent years as they are designed to reduce invasiveness. Minimally invasive laminectomy involves smaller incisions in an attempt to decrease blood loss, pain, and hospital stay compared to the conventional open laminectomy method.
The primary microsurgical technique utilized has been the unilateral laminectomy for bilateral decompression (ULBD). Although minimally invasive techniques are being used more frequently, there is a scarcity of research that has directly compared their safety, effectiveness, and results with those of conventional laminectomy.
Advantages of Minimally Invasive Techniques
The utilization of minimally invasive laminectomy techniques, including ULBD, is on the rise. Compared to the open approach, ULBD is linked with a greater percentage of contented patients and lower Visual Analog Scale (VAS) scores. ULBD is a safe procedure that leads to lower blood loss and comparable rates of complications such as dural tears, wound infection, and cerebrospinal fluid (CSF) leakage. Randomized evidence suggests that reoperation rates are similar between minimally invasive and open procedures. Despite ULBD surgeries taking approximately 11 minutes longer than the open approach, this difference may not have clinical significance. ULBD also results in a considerably shorter hospitalization period.
Limitations and Complications of Open Laminectomy
While conventional laminectomy is generally viewed as a safe and effective treatment for lumbar spinal stenosis, its overall success rates may vary from 62% to 70%. Secondary spinal instability has been reported as a result of surgical failure. The invasive nature of the open procedure may be responsible for negative consequences such as spinal muscle atrophy, nerve damage, and disturbance of arteriolar blood supply. During the procedure, the multifidus muscles are retracted bilaterally for extended periods, which may result in muscle atrophy, as evidenced by CT and electromyography of endurance-tested muscles.
Addressing Issues with Open Laminectomy: The Microsurgical Approach
Muscle retraction during open laminectomy may cause denervation or tethering of the medial branch of the dorsal ramus, which innervates the multifidus. Moreover, the open laminectomy procedure entails the dissection of supraspinous and interspinous ligaments, which typically offer support and stability to the spine through their ligamentous functions. Flexion instability can be a potential complication as the procedure involves the removal of these ligaments.
To address some of the problems associated with open laminectomy, the literature has introduced microendoscopic laminectomy techniques through endoscopic discectomy. This approach employs a retraction system, tubular dilators, and an endoscope to provide visualization while minimizing damage to soft tissues and maximizing muscle preservation. Preserving the parasternal neck muscles during surgery may alleviate postoperative neck pain and dysfunction, especially for cervical spine pathologies. A mini-open incision has been utilized in different versions of this approach.
Technical Challenges of ULBD
The specialized operating microscope enables a clear view of important structures such as the spinal canal, nerve root interface, and ligamentum flavum during the procedure. A smaller incision and reduced patient trauma are characteristic of the minimally invasive ULBD procedure. Some patients who undergo conventional laminectomy may experience postoperative instability and kyphosis due to larger resections of the facet joint, which is not the case with smaller resections seen in minimally invasive ULBD.
However, ULBD for lumbar stenosis has been associated with several possible drawbacks. One of the concerns is related to limited visualization of crucial structures such as dura and nerve roots, which can lead to a higher likelihood of accidental durotomy. The incidence rates of complications such as wound infection are similar between ULBD and conventional laminectomy groups, consistent with general spinal surgery literature’s reported rates of 1.9%.
Additionally, ULBD is a technically challenging and complex procedure requiring significant experience to decompress neural structures adequately. The unilateral tubular technique used in ULBD provides a restricted visual field and limited physical space to maneuver surgical instruments. The restricted visual field during surgery may cause confusion and result in incomplete decompression. Furthermore, the ULBD technique may require a longer operation time compared to the conventional approach due to the learning curve associated with the procedure.
Recovery and What to Expect After Treatment
- Non-Surgical Recovery: Most patients can manage pain with medications and therapy, gradually returning to daily activities. Recovery from non-surgical treatments can take a few weeks to months, depending on the severity of the stenosis.
- Surgical Recovery: Patients who undergo minimally invasive surgery often experience less postoperative pain, faster recovery, and shorter hospital stays. Recovery typically ranges from a few weeks for minimally invasive procedures to several months for traditional open surgeries.
Possible Risks or Side Effects (Complications)
Surgical risks include:
- Infection.
- Nerve damage.
- Dural tear leading to cerebrospinal fluid leakage.
- Blood loss and complications from anesthesia.
- Adjacent segment degeneration or reoperation for non-union.
Long-Term Outlook (Prognosis)
The prognosis after lumbar decompression surgery is generally favorable, with many patients experiencing significant pain relief and improved function. However, complications such as adjacent segment degeneration, non-union, or recurrent stenosis may occur over time.
Out-of-Pocket Cost
Medicare
CPT Code 63047 – Unilateral Laminectomy for Bilateral Decompression: $271.76
Under Medicare, 80% of the approved amount for this procedure is covered once your annual deductible has been met. The remaining 20% is typically the patient’s responsibility. Supplemental insurance plans—such as Medigap, AARP, or Blue Cross Blue Shield—generally cover this 20%, leaving most patients with little to no out-of-pocket expenses for Medicare-approved spine surgeries like laminectomy for bilateral decompression. These supplemental plans work directly with Medicare to provide full coverage for the procedure.
If you have secondary insurance—such as Employer-Based coverage, TRICARE, or Veterans Health Administration (VHA)—it functions as a secondary payer once Medicare processes the claim. After your deductible is satisfied, the secondary plan may cover any remaining balance, including coinsurance or small residual charges. Secondary plans typically have a modest deductible, ranging from $100 to $300, depending on your policy and network status.
Workers’ Compensation
If your lumbar spine condition requiring this procedure is work-related, Workers’ Compensation will fully cover all treatment-related costs, including surgery, hospitalization, and rehabilitation. You will have no out-of-pocket expenses under an accepted Workers’ Compensation claim.
No-Fault Insurance
If your lumbar spine injury resulting in bilateral decompression surgery is caused by a motor vehicle accident, No-Fault Insurance will cover the full cost of the surgery. The only potential out-of-pocket cost may be a small deductible depending on your individual policy terms.
Example
Sam, a 58-year-old patient with lumbar stenosis, underwent unilateral laminectomy for bilateral decompression (CPT 63047). His Medicare out-of-pocket cost was $271.76. Since Sam had supplemental insurance through Medigap, the 20% that Medicare did not cover was fully paid, leaving him with no out-of-pocket expenses for the surgery.
Frequently Asked Questions (FAQ)
Q. What is the best treatment for lumbar spinal stenosis?
A. Conservative treatments such as physical therapy and steroid injections are effective for many patients. Surgery is recommended for those with persistent symptoms or significant nerve compression that does not respond to non-surgical treatments.
Q. How long does it take to recover from lumbar spine surgery?
A. Recovery times vary depending on the surgery. Minimally invasive procedures typically offer quicker recovery times, with many patients returning to light activities within 2-4 weeks. More extensive surgeries may require 6-12 weeks of recovery.
Q. Are there any risks associated with lumbar spine surgery?
A. While lumbar spine surgery is generally safe, there are risks of infection, nerve damage, blood loss, and complications related to anesthesia. Careful surgical planning and postoperative care can minimize these risks.
Summary and Takeaway
Both open laminectomy and minimally invasive approaches like ULBD offer effective solutions for relieving the pain and disability caused by lumbar spinal stenosis. The choice of treatment depends on the severity of the condition, the patient’s overall health, and the surgeon’s expertise. Minimally invasive techniques offer the benefits of reduced recovery time, less postoperative pain, and fewer complications, making them a preferred option in many cases.
Clinical Insight & Recent Findings
A recent study compared the outcomes of biportal endoscopic unilateral laminectomy for bilateral decompression (BE-ULBD) and traditional unilateral laminectomy for bilateral decompression (ULBD) in elderly patients with multilevel lumbar spinal stenosis.
The study found that BE-ULBD resulted in significantly lower postoperative visual analog scale (VAS) scores for low back pain, improved Oswestry Disability Index (ODI) scores, and better preservation of the facet joints compared to the traditional method. Additionally, BE-ULBD showed better outcomes in terms of reduced fat infiltration of paraspinal muscles and fewer cases of postoperative spondylolisthesis, indicating superior spinal stability.
The study suggests that BE-ULBD offers advantages in clinical efficacy, radiological improvements, and long-term spinal stability without increasing complications, providing a promising alternative to conventional surgical techniques. (“Study on BE-ULBD for multilevel lumbar spinal stenosis – see PubMed.“)
Who Performs This Treatment? (Specialists and Team Involved)
Lumbar spine surgery is typically performed by orthopedic surgeons or neurosurgeons specializing in spinal conditions. The team may also include interventional radiologists and anesthesiologists, depending on the procedure.
When to See a Specialist?
If you experience persistent back pain, leg numbness or weakness, or difficulty walking, it is important to consult a spine specialist for evaluation and possible treatment.
When to Go to the Emergency Room?
Seek emergency care if you experience significant neurological deficits, such as loss of bladder or bowel control, sudden weakness or paralysis, or severe back pain following trauma.
What Recovery Really Looks Like?
Recovery varies depending on the procedure, but most patients undergoing minimally invasive surgery can expect a quick return to normal activities, while open surgery may require a longer recovery period.
What Happens If You Ignore It?
If left untreated, lumbar spinal stenosis can lead to worsening symptoms, including increased pain, loss of function, and permanent nerve damage.
How to Prevent It?
Maintaining a healthy weight, staying active, and practicing good posture can help prevent the development of lumbar spinal stenosis. Regular exercise, especially core strengthening exercises, is important for spinal health.
Nutrition and Bone or Joint Health
A diet rich in calcium and vitamin D supports bone health and helps reduce the risk of spinal conditions. Weight-bearing exercises like walking or strength training are also beneficial for maintaining strong bones.
Activity and Lifestyle Modifications
After recovery, maintaining spinal health involves avoiding heavy lifting, maintaining a healthy weight, and practicing regular stretching and strengthening exercises to support the spine.
Do you have more questions?
How can I prepare for lumbar spinal stenosis surgery?
Preparation includes stopping certain medications, quitting smoking, arranging for help during recovery, and following preoperative instructions provided by your surgeon, such as fasting before surgery.
What can I expect during the postoperative follow-up appointments?
Follow-up appointments are crucial for monitoring healing, assessing pain levels, ensuring there are no complications, and adjusting physical therapy or medications as needed. Your surgeon will evaluate your progress and make recommendations for further recovery steps.
What is laminectomy and what is the purpose?
Laminectomy involves removal of the back of the vertebrae so as to remove pressure from the spinal cord or the spinal nerves in the vertebral column. This can be performed in the neck, chest, or lower back area depending on the location of the compression over the neural elements.
Who does the laminectomy?
A laminectomy is performed by spine surgeons or surgeons who specialize in doing spine surgeries.
Will the laminectomy remove all my pain?
Laminectomy in the lower back is very helpful in patients who have radicular pain going down their legs. In most of the patients, the symptoms are well resolved, and these patients are able to get back to their normal life within six to ten weeks after the surgery.
What if, during my surgery, you encounter a different issue other than expected?
Usually, before the surgery, we discuss with the patient regarding all the possible spine issues that we may expect and how to manage them. If there is an unexpected issue, which has not been discussed earlier, we would go ahead and discuss it with the patient’s relative and treat it accordingly from there. If there is something which can wait, and is not detrimental to the patient, and relatives are not able to make decision on it, we may leave it for a later date to be discussed with the patient after the surgery.
How long is it possible to stay for back surgery?
Most of the patients with back surgery can be discharged within one to four days after the surgery depending on the type of surgery and the type of recovery that they have. Patients who undergo complex spine surgeries may need longer period of hospitalization and recovery.
Which pain medications will I be sent home with? What are the possible side-effects of these prescriptions?
Most of the patients with cervical spine surgery, will be sent with some narcotic pain medication to take care of their pain. These medications do have their multiple side-effects, which may be constipation, nausea, vomiting, impaired judgement, drowsiness, headache. Though patients who are treated with narcotic pain medication for acute pain, mostly do not lead to addiction, but these medications do have addiction potential.
Will you know before the surgery if I need a brace afterwards? If so, will I be fitted for one before the surgery?
Most of the patients with spine surgery do not need a brace. If we expect that the patient will need a brace, we will get the patient pre-fitted with a brace so that it is available immediately after the surgery. Occasionally the need for brace may be decided at the time of surgery. In such cases a brace is arranged in immediate post-operative period.
Will I need any other medical equipment like a walker when I go home? Should I get an adjusted bed or sleep downstairs?
Patient may need other medical equipment like walker or a stick. If that is required, patients are provided with such equipment in the hospital before their discharge and are trained how to use them by the physical therapist and occupational therapist. If the patient needs to use stairs, patients are trained by the physical therapist before they are let go home. If the patient needs an adjustable bed, they are informed about that. That can be done prior to the surgery. It is desirable for patients to stay downstairs for a few weeks if possible.
Who can I call if I have questions after the surgery?
In case patient has routine questions regarding after the surgery or regarding the surgery, they can call the physician’s office and talk to the nurse or secretary or the physician. If they’re not available on the phone, they can leave a voice mail and they will be answered later. In case the patient has a medical emergency, then they should not call the physician office but rather call 911 or get to the hospital ER as soon as possible.
How often will I see you after my surgery?
Patients are usually followed at two weeks, six weeks, three months, six months, and a year after surgery.
What symptoms would warrant a call to your office after the surgery?
If the patient develops problems like chest pain, breathing problems, sudden neurological deterioration, or any other emergency they should call 911, or go to the emergency room directly. Patients who develop worsening pain at the surgery site, discharge from the wound, fever; they should call in the office.
How long should I wait to bathe after the surgery?
Patients are usually asked to avoid bathing, until the incision heals, which may take two to three weeks. Patient can take shower after 72 hours of surgery with an impervious dressing in place. The dressing can be changes if the wound is visibly soaked. Patients are asked not to rub the area of surgery for about two to three weeks. They can gently dab it dry with a towel.
How long will I be out of work?
Patients with low demand work and desk job, can be back to work as soon as three to six weeks after the surgery depending on patient pain control as well as recovery. Patients who are in heavy lifting or control of heavy machinery or handyman job, may take three to four months, or even more to get back to work depending on their recovery from the surgery.
How soon after the surgery can I start physical therapy?
Patients after back surgery are usually started on physical therapy, if they need, depending on physician’s advice, at two to four weeks after the surgery. Many of the patients do not need physical therapy. A decision to go into physical therapy will depend on the surgery as well their recovery.
What if I get an infection?
If the patient has a superficial infection, few days of antibiotics will help heal these infections. Occasionally patient may develop deep infection. In these patients may need IV antibiotics for a longer period. If despite all efforts or in patients with rapid deterioration due to infection, surgery may be needed to help clean off the infection.
How common is surgery?
Most of the patients do not need surgery and can be treated with conservative means. When the patients do not respond to conservative measures, or if they have worsening neurological deficit, or worse pain, they may need surgery.
Will I have irreversible damage if I delay surgery?
Patients who develop neurological deficit in the form of weakness or involvement of bowel or bladder may have irreversible damage if the surgery is delayed enough.
When do I need fusion?
When patient has back pain or has a surgery in which enough bone is removed to destabilize the spine, in these cases patient may need a fusion surgery to stabilize the spine, as well as to alleviate the symptoms.
What are my risks of low back surgery?
General surgical risks of low back surgeries include bleeding, infection, persistence of pain, reversible/irreversible nerve damage leading to tingling, numbness, or weakness down the legs or involvement of bowel or bladder, failure of resolution of symptoms, failure of fusion, failure of implants. Most of the patients can undergo a safe surgery due to the development of vision magnification as well as refined surgical techniques. There are anesthesia risks also associated with this surgery.
When will I be back to my normal activities?
Though these things depend on the type of surgery patient has undergone, patient can usually be progressively back to their normal activities, starting from three to five days from surgery. Patients are encouraged to take care of their activities of daily living, as well as light household activities. Patients can get back to driving once they are free from pain medication and are able to sit for a duration of period for driving, which may take upto 2-3 weeks or more.
What type of surgery is recommended?
The type of surgery depends on the presenting complaint, examination findings, as well as imaging findings in the form of x-ray and MRI. Some patients may need to undergo just discectomy, or laminectomy, while others may need a fusion surgery on their back to relieve their symptoms. To know more about the type of surgery, the patient needs to discuss this with their spine surgeons.
How long will the surgery take?
Spine surgeries like discectomy and laminectomy usually last about one to one and a half hours. Spine fusion surgeries, may take longer periods, up to two and a half to four hours or more. It depends on type of surgery, and as well as the level of spine to be operated upon.
What is degenerative disc disease?
Degeneration means gradual damage of the tissue. Degenerative disc disease represents aging of the disc, either appropriate to the normal age of the patient, or maybe accelerated due to injury or chronic disease, or other factors like smoking, obesity.
What is Lumbar instability?
Lumbar instability means that the spine is not stable and there is excessive abnormal movement between two vertebrae. This is usually diagnosed by imaging in the form of X-rays, CT scan, or MRI of the patients. Instability may lead to compression of nerve roots causing radiculopathy with or without back pain.
What is Spinal Stenosis?
Spinal Stenosis means narrowing of the spinal canal. It is can be at the cervical or thoracic or lumbar level. Most common spinal stenosis is at lumbar level and it, when narrowed, can compress nerves, causing pain going down the legs, with or without tingling, numbness, weakness, or involvement of bowel or bladder.
What is sciatica?
Sciatica is another name for lumbar radiculopathy, in which patient has pain going down their legs. The pattern of pain depends on the nerve root involved, but the most common is pain going down the outer side of the thigh and leg into the foot.
What is lumbar disc disease? How is this problem diagnosed?
The diagnosis of Lumbar disc disease is made by history and examination of the patient. The confirmation of diagnosis is done by imaging in the form of X-rays and MRI. Occasionally the patient is having contraindication to MRI, patient may need to undergo a CT scan. When a CT scan is done, occasionally the patient may need to get injected with a dye before the CT scan and this is called CT myelography. Occasionally patient may need a CT scan along with MRI also.
When should I consider surgery for the back pain?
Most of the patients get treated with conservative means. In case the patient is not getting relief despite continuous conservative measures, or if there is worsening of pain associated with or without weakness or involvement of bowel or bladder, the patient may need surgical intervention in the form of surgery.
Am I a candidate for minimal-invasive spine surgery?
Some patients are good candidates for minimally-invasive spine surgery and they can get better with that. History, physical examination, as well as special investigations like X-ray and MRI, are needed in order to discuss regarding options of minimal invasive spine surgery. Some patients are not good candidates for minimal invasive spine surgery and doing such a surgery in such patients may lead to non-resolved solution of the symptoms or worsening.
Are there any warning symptoms?
Warning symptoms of lumbar disc disease include worsening pain, tingling and numbness, development of weakness, or worsening of weakness, involvement of bowel or bladder in the form of incontinence of urine or stools, presence of fever, unintentional weight loss. In such conditions patients should immediately seek medical attention.
Do you need any tests?
General blood workup is needed in most patients before the surgery. This will include blood counts as well as metabolic profile. Special tests may be needed in some patients if the physician has suspicion of some other disease. Most of the patients will have to undergo X-ray and MRI, or a CT scan before the surgery to confirm their diagnosis.
What are the possible surgical complications from a low back surgery?
Common complications of a low back spine surgery are bleeding, infection, leak of cerebral spinal fluid temporary or permanent neurological deficits, blindness, worsening of pain, failure of fusion, failure of implants. There may be risks due to the anesthesia also.
What is foraminotomies?
Foraminotomies is the surgery done from the back in the neck or the lower back area in which a small amount of bone is removed to increase the size of the foramen where the nerve roots pass to give more space to the nerve root and to relieve the symptoms. These surgeries do not involve removal of enough bones to require insertion of screws and rods to fuse the spine.
What are the risks of laminectomy?
Apart from the usual risks of having some back surgery, the risk of laminectomy includes injury to the nerve roots of the spinal cord, bleeding, injury to the sac, covering the spinal root or spinal cord leading to leakage of the fluid, persistence of pain or worsening, temporary or permanent worsening of symptoms. It may also lead to delayed restenosis as well as destabilization of the fragment leading to forward bending of the spinal column.
What is post laminectomy pain syndrome?
Post laminectomy pain syndrome usually involves the lower back and presents in patient who have undergone laminectomy for spinal stenosis. These patients, due to worsening of their degenerative condition or osteoarthritis of the back, start having pain involving the disc in their lower back. They may also develop flattening of the back due to weakness and muscle spasm.
Is laminectomy an outpatient surgery?
One or two level laminectomy of the lower back can be done through outpatient. Laminectomies more than two levels or laminectomies of the cervical spine or thoracic spine are usually performed in a hospital setting due to the complexity of the surgery.
What is the difference between a laminectomy and discectomy?
The disc is present in the front of the spinal cord or nerve roots and the lamina are present behind the spinal cord of the nerve roots. Discectomy involves surgery usually from the front, though it can also be performed from the back especially in the lower back and involves removal of the disc to remove the pressure from the front of the neural elements. Laminectomy on the other hand is performed from the back and involves removal of pressure from the neural elements from the back. Sometimes especially in the lower back area, both the surgeries can be combined and usually performed from the back.
What is laminectomy of the neck?
Laminectomy of the neck involves removing the lamina from the vertebrae or the bones of the neck. These laminae are present on the back of the neck and the surgery is done through the back of the neck. These patients also need to undergo fusion with screws and rods so as to prevent later complications of laminectomy. This is usually done for patients who have impingement of their nerves in the neck from the back side rather than the commoner form that is from the front.
What is thoracic laminectomy?
Thoracic laminectomy involves removal of the lamina from the back of the vertebrae or bones of the thoracic spine or the chest region. The surgery is done from the back and may or may not involve fixation with screws and rods. This surgery is usually performed for patients who have compression on their spinal cord in the thoracic spine.
What is cervical decompressive surgery?
Cervical decompressive surgery is removal of pressure that is on the spinal column or the spinal cord in the neck region. This can be performed from the front or from the back depending on the location of the compression on the spinal cord. This surgery may or may not be accompanied with fixation of the vertebrae using screws, rods or plates.
What is laminectomy and what is the purpose?
Laminectomy involves removal of the back of the vertebrae so as to remove pressure from the spinal cord or the spinal nerves in the vertebral column. This can be performed in the neck, chest, or lower back area depending on the location of the compression over the neural elements.
Who does the laminectomy?
A laminectomy is performed by spine surgeons or surgeons who specialize in doing spine surgeries.
What is laminoplasty of the neck?
The laminoplasty involves cutting of lamina on one side so as to open it up and fixing it in an open position with the use of mini plates so as to increase the size of the spinal canal and decrease the pressure on the spinal cord. This surgery is performed from the back of the neck and does not involve fusion of the neck thereby decreasing the restriction of movement of the neck as may be present after laminectomy and fusion surgery.
What is cervical spine foraminotomy?
Cervical spine foraminotomy is a minimal invasive surgery which is performed from the back of the neck for pinched nerve in the neck. These patient’s usually have radiating pain into the arm and the surgery helps in decreasing the pressure over the cervical spine nerve root to allow space for the nerve and eliminate the symptoms. This surgery if done in suitable candidate can avoid fusion surgery that is traditionally needed to decrease the pressure of the spinal roots.
