Most back pain is due to degenerative changes that occur in the intervertebral discs of the lumbar spine and the joints between each vertebra. In some cases degenerative changes in the lumbar spine can cause too much pressure on the nerves that travel through the spinal canal. When this condition occurs, the nerves in the spinal canal are in danger. One surgical option is to remove the pressure on the spinal nerves by opening the spinal canal from the back to make the spinal canal larger. This procedure is called a lumbar laminectomy.
In order to understand your symptoms and treatment options, it helps to begin with a basic
understanding of the general anatomy of the low back. This includes becoming familiar with the various parts that make up the lumbar spine and how these parts work together.
The spinal cord and spinal nerves are protected inside a bony tube within the spinal column. The pedicle and lamina bones form this tube. The pedicles connect to the vertebral body. The lamina bones attach to the pedicles. The lamina bones cover the back surface of the spinal canal, forming a protective roof over the spinal cord and spinal nerves.
If spinal stenosis is the main cause of your back pain, the spinal canal must be made larger. Any bone spurs pressing on the nerves must also be removed. One way that this is done is with a complete laminectomy. Laminectomy means "remove the lamina." Removing the lamina and any bone spurs gives more room for the nerves. A laminectomy reduces the pressure on the spinal nerves, thereby decreasing any irritation or inflammation.
To perform a lumbar spine laminectomy, an incision is made down the center of the lower back. The muscles are then moved to the side. Once the spine is reached from the back, each vertebra is identified. The surgeon will probably take an X-ray during surgery to ensure that the correct vertebrae and laminae are identified. Once this is determined, the lamina of the affected vertebra is removed. Any bone spurs that are found sticking off the back of the vertebrae are removed as well. Great care is taken to not damage the spinal nerve roots.
In the lumbar spine, removing the lamina completely may cause problems with the stability of the facet joints between each vertebra. If these joints are damaged during the laminectomy, the spine may begin to tilt forward causing problems later. Sometimes removal of part or all the facet joints is unavoidable.
The surgeon sometimes has to remove too much of the facet joints during a laminectomy. In this case, a fusion may also be required at the same time to make sure there are no problems later. The surgeon will probably discuss this possibility with you before surgery.
Like all surgical procedures, operations on the spine may have complications. Because the surgeon is operating around the spinal cord and nerves, back operations are always considered extremely delicate and potentially dangerous. You should take time to review the risks associated with spine surgery with your doctor. Make sure you are comfortable with both the risks and the benefits of the procedure planned for your treatment.
You'll be able to get up and begin moving a few hours after surgery. Limit your activities to avoid doing too much too soon. Most patients are able to return home when their medical condition is stabilized, usually within one to two days after surgery.
Your doctor may have you attend physical therapy beginning four to six weeks after surgery. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.
Therapy sessions may be scheduled two to three times each week for up to six weeks.
The goals of physical therapy are to help you
Manage your condition and control symptoms
Improve flexibility and core strength
Learn correct posture and body movements to reduce strain on your back