Laminectomy or spinal cord release is a surgical procedure of the spine that involves the removal of a vertebral lamina. It can be offered as a second-line treatment to patients with lumbar spinal stenosis.

Laminectomy, also called spinal cord release, is a spinal surgery that removes a vertebral lamina (posterior part of the spine) in order to free the spinal canal.

As a reminder, the spine is made up of vertebrae in the middle of which is the spinal canal, which contains the spinal cord and nerves. In some people, due to natural wear and tear (osteoarthritis) or their constitution, there is a narrowing of the spinal canal. This is called “lumbar canal stenosis” or “narrow lumbar canal”. This stenosis causes compression of the nerves in the spinal canal, with the following consequences:

• difficulty walking, appearing after walking for a while, with feelings of weakness, numbness, tingling in the legs;
• sciatica occurring at rest or during exertion;
• very rarely, a more or less important paralysis of the lower limbs or sphincter functions.

The operation takes place under general anesthesia. It begins with a radiological assessment in order to visualize the compression zone, the number of stages to be released and the type of tissue to be removed.

An incision is made in the back, along the spine. The surgeon then separates the muscles of the back in order to have access to the channel, then he will remove part of the tissues obstructing the channel in order to free the nerve fibers from the compression. Depending on the area and extent of the stenosis, the technique and type of tissue will be different. These can be simple bone formations, joint surfaces, ligaments, or even part of the intervertebral discs if they form a herniation or if they are ossified.

Other procedures can be associated with laminectomy if necessary:

• a partial arthrectomy: part of the joint mass is removed;
• spinal arthrodesis: equipment (metal implants) and sometimes bone grafts are placed to unite and glue two vertebrae between them, if the spine is very deformed or mobile.

The muscle tissue is then closed, and a drain is put in place to suck up the bleeding and thus prevent the formation of a hematoma.

Laminectomy may be offered in cases of lumbar spinal stenosis, as a second intention only. The first-line treatment is conservative medical treatment: analgesics, anti-inflammatories, rehabilitation, or even corset or infiltration.

Surgical treatment is offered when the pain becomes too disabling on a daily basis, or when the stenosis of the lumbar canal leads, for example, to paralyzing sciatica, with paralysis of the foot or urinary disorders.

The days following the operation

Hospitalization lasts less than a week.

To relieve postoperative pain in the operated area, analgesic treatment is prescribed from the recovery room. It is generally a morphine derivative pump, or even morphine. The dressing is changed every 48 hours, and the drain removed after 2 to 4 days.

General anesthesia and / or morphine can cause slow transit, with constipation and abdominal bloating, and difficulty urinating. If necessary, a urinary catheter will be inserted.

The first lift usually takes place the day after the operation, assisted by a physiotherapist. The resumption of walking is gradual, under the supervision of the team of physiotherapists.

Back home, the only rehabilitation to be practiced is walking. After a post-operative check-up 3 weeks after the operation, more active rehabilitation is sometimes prescribed. It includes massages, stretching, muscle building.

The duration of the work stoppage varies from 6 weeks to 12 weeks depending on the action performed and the type of profession.

The risks of laminectomy

Like any surgical procedure, laminectomy involves risks. Apart from those inherent in general anesthesia, certain risks are specific to this surgery:

• sensitivity disorders in the lower limb, which usually go away gradually.
• a risk of partial or total paralysis of a muscle segment (most often in the foot), temporary or permanent.
• a risk of cerebrospinal fluid leakage, which requires the bed for 4 to 5 days
• a risk of infection of less than 1% (1). 

The results of laminectomy

Root pain associated with a trapped nerve usually decreases very satisfactorily after recovery from surgery. However, when a nerve has been stuck for too long, it is not possible to completely remove them, because the nerve root keeps the imprint of what compressed it. This phenomenon is called radiculopathy. Recent studies show, however, that laminectomy provides a good result in 80% of cases. The result is often less favorable for lower back pain for which total relief should not be hoped for (2). 

Also, laminectomy only treats the problem of the stuck nerve. If the intervertebral discs and muscles were painful before the operation, they will remain so after.

Finally, it should be noted that the lesions responsible for spinal stenosis being secondary to the aging of the spine, they are likely to reappear several years after the operation.