Lumbar laminectomy, or “lami” is a lumbar procedure where the lamina is removed. The term “ectomy” is a surgical term meaning “removal”, and the lamina is the back part of the spinal canal that frequently enlarges along with the facet joints with advancing age. Patients with lumbar stenosis are candidates for lumbar laminectomy. When only the right or left half of the spinal canal needs surgery, the surgery is called “hemilaminectomy (or hemilaminotomy)”. Usually both right and left sides are compressed and need surgery, hence the term laminectomy.
The surgery is designed to decompress a narrowed spinal canal, which is caused by thickening of the lamina and facet joints from bone spurs, and often disc bulging, all of which narrow the spinal canal. The spinal canal houses the sciatic and associated nerves. The roof is the lamina, and the disc is the floor. The side walls are the facet joints. As all enlarge from wear and tear, the canal is narrowed and the nerves constricted causing buttock and leg pain, numbness, and tingling.
This procedure is usually done as an inpatient setting, with a 1-2 night stay. Excellent relief is expected in 90 percent of patients. Sometimes, the spine is unstable, and in addition to the laminectomy, a fusion at the same level is required to address the instability. Adding a fusion usually requires a 2-3 night stay.
Case study:
A 63 year-old active male had pain in both legs with standing, walking, and lying in bed. He did not have back pain or any signs of instability on x-ray. MRI showed severe narrowing of the spinal canal (Figure 1) at two levels due to degeneration. He underwent
L3-4-5 laminectomy with complete resolution of his leg pain immediately after surgery. At 6 weeks his back discomfort was minimal, he had no leg symptoms, and gradually returned to normal activities.
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