The term Laminectomy is derived from lumber (lower spine), lamina (part of the spinal canal's bony structure) and -ectomy (removal). The operation is performed to relieve pressure on one or more spinal nerve roots. This pressure, often called nerve root compression or a "pinched nerve", is what often causes back and leg pain. Lumbar laminectomy surgery is performed with the patient lying on the abdomen or side after being put "to sleep" with general anesthesia. The surgeon reaches the lumbar spine through an incision in the lower back.
What is Laminectomy Surgery?
A Laminectomy Surgery is a surgical procedure to decrease pain for sufferers of lumbar spinal stenosis. Spinal stenosis is a complaint that generally afflicts older people. The pain is caused by degenerative changes that result in the facet joints becoming enlarged and placing pressure on nerves. The best way to treat this ailment is with a Laminectomy. Laminectomy surgery removes a small part of the bone, called the lamina, just over the nerve root. It can also remove disc material from underneath the nerve root in order to give the root a better healing environment or more space.
Why Laminectomy Surgery?
One of the most common reasons for Laminectomy Surgery is a prolapsed or herniated intervertebral disc. If the herniated disc is in the lumbar region, this can cause sharp and continuing back pain, a weakening of the muscles in the leg, and some loss of sensation in the leg and foot. It may also be difficult to raise the leg when it is held in a straight position. A herniated disc in the neck region can cause symptoms including pain, numbness and weakness in the arm. A herniated disc may be triggered by, for example, twisting the back while lifting something heavy. The surgeon will attempt to relieve the pressure on nerves and nerve roots by removing the pulpy material that is protruding from the disc.
What Medical Conditions does Laminectomy Surgery Treat?
Laminectomy Surgery is usually used to treat a condition called spinal stenosis. Spinal stenosis is a condition in which there is nerve impingement due to bone spurs, calcium deposits, or thickened ligaments. In the process of the laminectomy, these offending structures are removed, therefore "freeing up" the nerves. A laminectomy is also sometimes used to decompress the nerves when they are compressed by other conditions, such a tumor, large herniated disk, or bone fragments from fracture.
How is the Diagnosis for Laminectomy Surgery Performed?
The differential diagnosis of lower back pain is complicated by the number of possible causes and the patient's reaction to the discomfort. In many cases the patient's perception of back pain is influenced by poor-quality sleep or emotional issues related to occupation or family matters. A primary care doctor will begin by taking a careful medical and occupational history, asking about the onset of the pain as well as its location and other characteristics. Back pain associated with the lumbar spine very often affects the patient's ability to move, and the muscles overlying the affected vertebrae may feel sore or tight. Pain resulting from heavy lifting usually begins within 24 hours of the overexertion. Most patients who do not have a history of chronic pain in the lower back feel better after 48 hours of bed rest with pain medication and either a heating pad or ice pack to relax muscle spasms.
An orthopedic evaluation includes a physical examination, neurological workup, and imaging studies. In the physical examination, the doctor will ask the patient to sit, stand, or walk in order to see how these functions are affected by the pain. The patient may be asked to cough or to lie on a table and lift each leg in turn without bending the knee, as these maneuvers can help to diagnose nerve root disorders. The doctor will also palpate (feel) the patient's spinal column and the overlying muscles and ligaments to determine the external location of any tender spots, bruises, thickening of the ligaments, or other structural abnormalities. The neurological workup will focus on the patient's reflexes and the spinal nerves that affect the functioning of the legs. Imaging studies for lower back pain typically include an x ray study and CT scan of the lower spine, which will reveal bone deformities, narrowing of the intervertebral disks, and loss of cartilage. An MRI may be ordered if spinal stenosis is suspected. In some cases the doctor may order a myelogram, which is an x ray or CT scan of the lumbar spine performed after a special dye has been injected into the spinal fluid.
How to Prepare for Laminectomy Surgery?
Weeks before your surgery is scheduled, both your doctor and your orthopedic surgeon will examine you to make sure you are healthy enough for the surgery. A few days before the surgery, you will meet with the anesthesiologist to discuss your options. Usually you will have either a general anesthesia or spinal anesthesia.
You should give the surgeon and anesthesiologist a list of all prescriptions and over-the-counter medications you are taking.
The doctor may instruct you to stop taking anti-inflammatory such as aspirin and ibuprofen (Advil, Motrin) before surgery.
If you smoke, you should stop or at least cut down before surgery.
On the day of surgery, take no food or drink by mouth after midnight. Most surgeons do allow you to brush your teeth and take medicine.
You should arrive at the hospital about 2 hours early to do paperwork, last-minute tests, and prepare for the surgery.
What is the Procedure of Laminectomy Surgery?
Patients are given a general anesthesia to put them to sleep during most spine surgeries. As you sleep, your breathing may be assisted with a ventilator. A ventilator is a device that controls and monitors the flow of air to the lungs. Some surgeons have begun using spinal anesthesia in place of general anesthesia. Spinal anesthesia is injected in the low back into the space around the spinal cord. This numbs the spine and lower limbs. Patients are also given medicine to keep them sedated during the procedure. This surgery is usually done with the patient kneeling face down in a special frame. The frame supports the patient so the abdomen is relaxed and free of pressure. This position lessens blood loss during surgery and gives the surgeon more room to work. The surgeon makes a short incision down the middle of the low back.
The skin and soft tissues are separated to expose the bones along the back of the spine. An X-ray of the low back ensures the surgeon works on the right vertebra. Some surgeons use a special surgical microscope during surgery to magnify the area they'll be working on. In a complete laminectomy, the spinous process (the bony projection off the back of the vertebra) and the lamina on each side are removed over the area where stenosis is occurring. To accomplish this, the surgeon cuts along the inside edge of the facet joint on each side and detach the lamina bone completely from the pedicle bones. This opens a section in the bony ring.
A small portion of the ligamentum flavum is removed. The ligamentum flavum runs all the way down the spinal canal between the lamina bones and the spinal cord. Removing a small section of this ligament exposes the nerves inside the spinal canal. The surgeon may use small cutting instruments to carefully remove soft tissues near the spinal nerves. Then the surgeon takes out any disc fragments and scrapes off nearby bone spurs. In this way, the nerves inside the spinal canal are relieved of additional tension and pressure. The surgeon also enlarges the neural foramina, if needed. The neural foramina are the small openings between the vertebrae where the nerves travel out of the spinal canal. The muscles and soft tissues are put back in place, and the skin is stitched together.
What is the Post-operative care following a Laminectomy Surgery?
Aftercare following a Laminectomy Surgery begins in the hospital. Most patients will remain in the hospital for one to three days after the procedure. During this period the patient will be given fluids and antibiotic medications intravenously to prevent infection. Medications for pain will be given every three to four hours, or through a device known as a PCA (patient-controlled anesthesia). The PCA is a small pump that delivers a dose of medication into the IV when the patient pushes a button. To get the lungs back to normal functioning, a respiratory therapist will ask the patient to do some simple breathing exercises and begin walking within several hours of surgery.
Aftercare during the hospital stay is also intended to lower the risk of a venous thromboembolism (VTE), or blood clot in the deep veins of the leg. Prevention of VTE involves medications to thin the blood and wearing compression stockings or boots.
Most surgeons prefer to see patients one week after surgery to remove stitches and check for any postoperative complications. Patients should not drive or return to work before their checkup. A second follow-up examination is usually done four to eight weeks after the laminectomy.
Patients can help speed their recovery by taking short walks on a daily basis; avoiding sitting or standing in the same position for long periods of time; taking brief naps during the day; and sleeping on the stomach or the side. They may take a daily bath or shower without needing to cover the incision. The incision should be carefully patted dry, however, rather than rubbed.
What is the Laminectomy Surgery Recovery?
Successful recovery from lumbar laminectomy requires that you approach the operation and recovery period with confidence based on a thorough understanding of the process. Your surgeon has the training and expertise to correct physical defects by performing the operation; he and the rest of the health care team will support your recovery. Your body is able to heal the involved muscle, nerve, and bone tissues. Full recovery, however, will also depend on your having a strong, positive attitude, setting small goals for improvement, and working steadily to accomplish each goal. You can do several things to make your recovery at home easier.
Move groceries, toiletries, and other supplies to places between the level of your hip and shoulder where you can reach them without bending over.
Make sure someone can drive you around for 1-2 weeks after surgery and to help with chores and errands.
Buy a pair of slip-on shoes with closed backs to make dressing easier and to minimize bending over.
Short frequent walks each day may reduce your pain as well as speed your recovery.
Do not drive a car for 1-2 weeks, or as long as you are taking any medication that makes you drowsy.
What are the Benefits of Laminectomy Surgery?
The potential benefits of a lumbar laminectomy or discectomy include: Relief of pressure on a spinal nerve, decreased pain or numbness in the affected leg, increased strength in the affected leg. In a Laminectomy Surgery, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate treatment choice for you.
What are the Risks of Laminectomy Surgery?
The possible complications of Laminectomy Surgery include: infection, ongoing leg pain and numbness, poor wound healing, damage to the spinal cord and/or spinal nerves and adverse reaction to general anesthesia.
What is the Alternative to Laminectomy Surgery?
The most common surgical alternative to laminectomy is a minimally invasive laminotomy and/or Microdisectomy. In this procedure, which takes about an hour, the surgeon makes a 0.5-in (1.3-cm) incision in the lower back and uses a series of small dilators to separate the layers of muscle and fatty tissue over the spine rather than cutting through them with a scalpel. A tube-shaped retractor is inserted to expose the part of the lamina over the nerve root. The surgeon then uses a power drill to make a small hole in the lamina to expose the nerve itself. After the nerve has been moved aside with the retractor, a small grasping device is used to remove the herniated portion or fragments of the damaged spinal disk. The advantages of these minimally invasive procedures are fewer complications and a shortened recovery time for the patient. The average postoperative stay is three hours. In addition, 90% of patients are pleased with the results.
Why Laminectomy Surgery in India?
Of late, Laminectomy Surgery in India has emerged as the most preferred solution for global patients having back pains. The reason behind this is the presence of specialized orthopedic hospitals with state of art facilities. These are world class hospitals and specialized multi specialty health centers providing expertise of trained experts at an affordable price.
Laminectomy Surgery in India comes through one of the best qualified professionals in the medical field. Regarding Medical facilities, India has the most competent doctors and world class medical amenities with highly trained experts and skilled orthopedic surgeons who deal with patients with back problems. Thus we see a sea of international patients coming to India every year for surgeries and medical treatments and then enjoy their recuperative holidays.
The hospitals and clinics catering Laminectomy Surgery in India are spread all over the country with presence of more than five thousand healthcare professionals treating with the most advanced medical amenities in the world. These are available at hospitals in the following cities with latest amenities and state-of-art-facilities.
Mumbai
Hyderabad
Kerala
Delhi
Pune
Goa
Bangalore
Nagpur
Jaipur
Chennai
Gurgaon
Chandigarh
What is the Cost of Laminectomy Surgery in India?
Prices for Laminectomy in India are normally 75% below the cost for the same performed in the USA. While adding the fee for medical expenses of hospital stay, surgeon's fees, operation room fees, anesthesia, anesthesiologist's fees, medicine, nursing, semi-private room, meals, pre-op diagnosis, local phone etc, which still comes less to the cost incurred in US for the treatment. One can have a fair idea of having the low cost medical treatments done in India and US.
Medical Treatment
Procedure Cost (US$)
United States
India
Laminectomy Surgery
60,000
17,000
Spinal Fusion
77,000
15,000
Disc Replacement Surgery
55,000
11,000
Cervical Spine Surgery
58,000
10,000
Some of the common countries from which patients travel to India for surgery are:
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