Decompressive Lumbar Laminectomy (DLL)

Most back pain sufferers are individuals who have experienced degenerative changes to the lumbar spine’s intervertebral discs as well as the joints that sit between each of the vertebra.

Patients who find themselves facing this circumstance may wish to consider undergoing decompressive lumbar laminectomy (DLL).

This minimally invasive procedure works to reduce this dangerous level of pressure on spinal nerves by enlarging the canal in which they sit and can provide much needed relief from the frequently debilitating symptoms of spinal stenosis.

Key Facts About Lumbar Laminectomy & Laminotomy

Thought to be the most commonly performed surgical procedure intended to address lumbar spinal stenosis, decompressive laminectomy helps alleviate pressure on nerve roots within the spinal canal. This pressure typically develops because of age-related degeneration, but can also be caused by spinal injury, tumors or herniated discs.

If a lumbar laminotomy is deemed an appropriate course of action, a surgeon generally will need to remove certain portions of the lamina to free up space in the spine for the nerves. Surgeons also may use this procedure to give them access to herniated discs in the spine that potentially may contribute to neck pain, back pain, or other symptoms.

Another type of decompressive lumbar surgery is laminotomy. A laminotomy partially removes the lamina, which is the bony, protective cover located at the back end of the spinal canal. Unlike a laminectomy—which completely removes the lamina—laminotomies typically remove just a portion.

When the nerves in the back become compressed, they can cause various painful and distressing symptoms. These surgical procedures can be used to create space for nerves to move freely and reduce such symptoms. Symptoms of a narrowed spinal canal may include:

• sharp pains or aches that radiate outward from the affected area

• muscle weakness

• tingling sensations

• electric shock-like sensations

Both the decompressive lumber laminectomy and laminotomy increase available space for the nerves to inhabit by full or partial removal of the lamina, which is the back portion of the vertebra covering the canal itself.

These procedures are generally offered when conventional, non-surgical treatments including physical therapy, drug treatments, and injections have not yielded the desired level of pain relief. They may also be used to help patients who are experiencing mobility loss, muscle weakness or reductions in bladder or bowel control due to nerve compression.

Minimally Invasive Lumbar Decompression Surgery

Traditional decompressive lumbar laminectomy begins with an incision made in the middle of the patient’s lower back area. The surgeon will then move the muscles over the side to provide access to the spine. Each of the patient’s vertebra will be specifically identified so that the surgeon can verify which portion of lamina needs to be removed. The laminectomy may then be commenced, and bone spurs which may also be present will be eliminated at the same time. Because such a delicate, functional area is involved, the surgeon will take all possible measures to preserve the integrity of the spinal nerves.

Many spinal surgeons have shifted in the direction of performing primarily minimally invasive laminectomies for treating lumbar stenosis, for a variety of reasons.

This type of procedure utilizes much smaller incisions than the conventional alternative, and employee camera-guided surgical tools to remove the lamina and perform any spinal fusion work deemed necessary. Important advantages of minimally invasive procedures such as this include shorter recovery times, less post-operative discomfort, lower blood loss and lower risk of spine destabilization.

Because patients with existing surgical scar tissue, those with spinal deformities or individuals afflicted with other health conditions may not be strong candidates for this type of procedure, it is important for each one to consult with an experienced surgeon to determine the most appropriate course of treatment.

Benefits of Decompressive Lumbar Laminectomy

Complications from DLL are quite rare, and most patients undergoing this type of procedure have reduced pain and symptoms for a significant period of time, with some achieving permanent results.

Though there is no cure for spinal stenosis, those affected by it need not quietly accept a life characterized by pain, weakness and reduced mobility.

Decompressive lumbar laminectomy (DLL) has given countless patients a new lease on the active lifestyle they have long enjoyed and is an option worthy of real consideration by anyone plagued by chronic discomfort.

Risks of A Decompressive Lumbar Laminectomy

Given that a laminectomy is a type of spinal surgery, it is a serious procedure. Following this procedure, an infection may develop at the site of the surgery or in the vertebrae. To reduce the chance of developing an infection, it is important the follow all instructions on cleaning the surgical site and changing the bandages covering the site once released from the hospital.

The surgery could also fail to be successful or result in damage to the spinal nerve. Additionally, like any other surgical procedure, there is a risk blood loss, blood clots, negative reactions to medication, breathing difficulties, heart attack, or a stroke.

To decrease the chances of suffering any of the aforementioned conditions, it is important to be honest with your physician about your habits and lifestyle before surgery. Implement any recommended changes in your diet or routine as suggested by your doctor. This will improve the chances of a successful recovery or limit the chances of setbacks during surgery.

Post-Laminectomy Surgery

After a laminectomy, a patient’s mobility is typically impacted by their general condition prior to the surgery. This may be dictated by the patient’s age. Doctors may encourage patients to walk immediately after a laminectomy in some cases. However, it is commonly advised to avoid lifting, stooping, and/or twisting after a stenosis surgery to avoid accidently reopening the incision.

Patients are typically encouraged to begin a light exercise routine and physical therapy soon after laminectomies. Following the surgery, a patient should follow the advice of his or her surgeon. Medical advice is not based solely on common practices, but a patient’s specific needs, age, and condition.

Post-Laminectomy Syndrome

If you underwent back surgery and it did not work, you could be experiencing post laminectomy syndrome which is also known as failed back syndrome. Unfortunately, post-laminectomy syndrome may result in different symptoms, so a correct diagnosis is crucial.

What may appear as post-laminectomy syndrome following a surgery may actually result from a surgical complication or from a new back issue. Your doctor can determine the right diagnosis so that you receive the right treatment for your pain.

Why Post Laminectomy Syndrome Occurs

Laminectomies are generally performed to relieve pressure on the spinal cord resulting from a bulging, herniated disc. This relief is often obtained by removing part of the vertebrae protecting the spinal cord. Most patients recover well from this procedure, but for a small percentage, the pain persists after surgery, developing into post-laminectomy syndrome.

Post-laminectomy syndrome may develop for several reasons. Often, the spinal nerve root is decompressed by the operation and does not recover properly, causing chronic pain. Scar formation during healing, known as fibrosis, may involve the nerve roots, again leading to chronic pain. Any sort of nerve damage due to the surgery could potentially result in chronic pain.

Other causes of post-laminectomy syndrome may include continued disc herniation or pelvic ligament instability after the surgery. If the patient underwent a spinal fusion, the spine may undergo structural changes above or beneath the site. There is also the possibility that the surgery did not target the actual cause of the patient’s back pain.

Symptoms of this Condition

Patients with post-laminectomy syndrome may experience persistent back and leg pain following the surgery. Many patients may have problems sleeping due to the pain, and the pain could interfere with work and other daily life activities.

Pain often ranges from the dull and aching to the sharp, stabbing pain of sciatica. Depression and anxiety often accompany the pain of post-laminectomy syndrome. Weakness in the affected area is another common symptom. Patients who smoke are often more likely to develop post-laminectomy syndrome than non-smokers.

Treatment Options

Your doctor can perform a physical examination and may conduct thorough diagnostic testing to determine the actual cause of your pain. These tests, which may include X-rays, CT scans, MRIs, and electromyograms, should show whether there are any outstanding spinal issues causing the pain.

Treatment for post-laminectomy syndrome often includes physical therapy and non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief. Some patients may benefit from anti-depressants or anti-seizure medications, which may lessen nerve pain.

Epidural corticosteroid injections may relieve pain for weeks or months. If the patient does not find relief, a spinal cord stimulator could be another treatment option. This is a non-invasive procedure that may aid in pain relief, one common stimulator is a Transcutaneous Electrical Nerve Stimulation (TENS). With TENS, a low voltage electric current is used to help with pain relief. The device is generally not suitable for those with a pacemaker.

Once surgically implanted, the spinal cord stimulator could replace the pain signals coming from the nerves with a more tolerable buzzing feeling. The stimulator is first placed temporarily, but if the patient’s pain is relieved, it is possible to install the stimulator permanently.

If you are experiencing any problems after a decompressive lumbar surgery, call your Elite Spine & Orthopedics doctor at (727) 807-3114.