Surgery for spinal stenosis - lumbar laminectomy


dr. David Oni here I'm a neurosurgeon

and spine surgeon based in Melbourne

Australia and today I'm gonna be talking

about a laminectomy to treat spinal

stenosis the lemon ectomy is a really

common operation that spinal surgeons do

it forms the beginning of most spinal

operations in order to best understand

what a laminectomy is it's important to

understand what the lemon are if we look

at this model of the spine we can think

of the spine really consisting of three

parts we've got the front of the spine

consisting of the vertebral bodies and

discs we've got the middle part which

consists of the nerves all running

through the spine on their way to the

legs or the arms and then we've got the

roof of the spine now it's the roof of

the spine which we call the lamina it's

made up of bone and also some ligament


now when the spinal canal all the space

where the nerves are is narrowed we turn

this spinal stenosis in order to treat

this wedi roof the spinal canal or

remove the lamina from the back we can

see here the various lamina stacked up

on top of each other here a laminating

laminectomy involves removing all of

these bones to create more room for the


the laminectomy is typically performed

under general anesthesia patients have

no awareness of what is going on you

have a small incision in the midline of

your back and we carefully dissect the

muscles off the bony parts of the spine

once we have the bony part of the spine

expose using drills and fine instruments

we carefully remove the bony lamina and

also the thickened ligament off the

nerves to decompress the spinal canal

once the pressure is off the nerves

patients typically get good relief of

symptoms laminectomy is a common and

safe operation having said that there

are some risks that need to be factored

into the surgery infection is 1%

infection it can occur with most spinal

operations and is 1% or less in most

surgeons hands bleeding can also occur

with the laminectomy and whether or not

you're likely to need a blood

transfusion really depends on how many

that was retreated with most one and two

level lemon economies the requirement

for a blood transfusion is very low one

of the biggest concerns a lot of

patients have is damage to the nerves

fortunately this is a very rare

complication of spinal surgery the

chance of having nerve damage is well

less than one in a thousand in fact it's

a very rare complication it's very rare

for patients to have permanent nerve

injury following spinal surgery another

complication that it can occur during

laminectomy is CSF leak all of the

nerves float in a sac of fluid this sac

can be very stuck to the lamina or the

ligament around the nerves when we're

removing this ligament sometimes it can

tear a small hole in that sac and spinal

fluid can leak out now we prepare it at

the time of the surgery however it does

typically take keep patients in hospital

for a few extra days as we monitor the

healing of the wound

once the laminectomy is complete we

stitch the muscle back together and the

skin back together and this affords

enough protection to the underlining

spinal elements laminectomy is a safe

and effective treatment for spinal canal

stenosis for more information check out

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