Lumbar laminectomy Guide in Diagnosis and Treatment

Amidst the various sorts of back pains, lower back pain is the chief culprit in weighing down working adults. Figures show that 80% of the U.S. citizens have experienced some kind of this physical disorder during their lifetime. It is thought that about 14% of patients (400,000 US citizens) with low back pain have lumbar spinal stenosis.

What is lumbar spinal stenosis?
Most of the patients with lumbar spinal stenosis are over 50 years old. Through the aging process, some degenerative changes occur in the different structures of the spinal column including the discs, bones, muscles, and ligaments. These changes lead to the narrowing of the canal which cause spinal stenosis. In some cases, the spinal nerves in the lower back are impinged by the adjacent affected structures that contribute to lumbar spinal stenosis.

Symptoms of lumbar spinal stenosis
Typically, a disabling pain in the legs is the main symptom of this condition, which starts with physical activities such as walking and relieves immediately after rest. The symptoms are often variable, which ranges from severe symptoms to mild or no discomfort. The duration and seriousness of lumbar spinal stenosis differ in individuals. The patient may have sciatica. Claudication (Limping) while walking can be another feature of this condition. The patients may also feel numbness, loss of motor control, fatigue, and tingling that start from the lower back and radiate into the legs.

Causes of lumbar spinal stenosis
Lumbar spinal stenosis is typically connected to aging. The enlarged degenerated facet joints which are located around the backbones, exert pressure on the nerve roots in the lower back.Herniated discs,heredity, traumas, tumors, osteoarthritis, hypertrophy ofthe ligamentous structuresand spondylolisthesisare other factors. Young adults with a spinal canal curvature or injury may also develop this condition.
Standing upright diminishes the spaces of nerve roots and block the blood stream from around the nerve. Therefore, the congested blood begins to hurt the nerve resulting in pain.

Treatment of lumbar spinal stenosis
A lumbar laminectomy or as it is also called an open decompression is the treatment of choice in cases of lumbar spinal stenosis. In this surgical procedure, a small fragment of the backbone over the nerve root and/or the disc under it is removed to free the impinged structures and provide a better healing condition in the area.

Surgical procedure
In this surgical procedure, after a 5 to 13 cm incision in the back and dissection of the muscles, the lamina, and irritant facet joints parts are removed to provide more space for the nerve. The operation takes one to three hours. After the surgery, return to normal activity is largely dependent on the patient's condition. The patient is encouraged to walk but not bend, lift, or twist for 6 weeks. The patient needs to be in the hospital for two days. Usually, the success rate is satisfactory and nearly 75% of the patients with leg pain (sciatica) caused by spinal stenosis will have remarkable progress in their function and a reduction in pain and discomfort. However, the lower back pain caused by arthritic facet joints is not well treated by performing the surgery. In certain instances that stenosis is at one level from an unstable joint (degenerative spondylolisthesis), the success rate can be improved by also fusing a joint.

Risks and considerations of lumbar laminectomy
The possible risks and complications with open decompression procedure are as follows:

  • Bowel/bladder incontinence
  • Nerve root damage
  • Cerebrospinal fluid leak
  • Infections
  • Bleeding
  • Postoperative instability of the operated level
  • Common surgical complications

However, according to a World Health Organization census in 2001, “most patients who had undergone a lumbar laminectomy recovered normal function within one year of their operation.”

Prevention is the key of NOT getting back pain. Getting the exercises and eating healthy food.
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