Lumbar Laminectomy


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Think of the spinal canal as a room. The floor is made out of the disc space, the walls are the facet joints, the ceiling is the yellow ligament, and the roof is the lamina bone. With age, our spinal canal naturally becomes smaller due to thickening of the yellow ligament, bulging discs, and enlargement of the facet joints. In other words, our spinal room gets smaller because the floor is coming up, and the ceiling lower. The best way to make the room bigger is to raise the roof, or remove the lamina bone. In medicine, removing something is called an –ectomy. So removal of the lamina bone is called laminectomy. If you live long enough, your spinal canal will become so narrow your nerve roots will be pinched. As a result, laminectomy is one of the most common operations in the United States. A surgeon will operate through a microscope down a tube. This technology enables a fast recovery, while preserving as much normal tissue as possible, leading to a spectacular long term result.

Laminectomy vs. Fusion

Q: “I have severe spinal stenosis at L4/5. I saw a spinal surgeon and he found point tenderness on my back on examination. He recommended laminectomy and fusion at L4/5. Should I have a fusion as my doctor recommends?”

A: No. Here is why.

It is best practice to undergo laminectomy for severe spinal stenosis. Back in the day surgeons recommended fusion along with laminectomy. That is no longer best practice. Today, there are 3 primary reasons that doctors, surgeons, professional guidelines, commercial insurance panels, and Medicare all recognize you may need a fusion: spondylolisthesis, scoliosis, or instability. Pain to palpation on your surgeon’s examination is not an indication for fusion. You do not have spondylolisthesis, scoliosis, or instability. Therefore, you do not need spinal fusion.

And that’s good news. Spinal fusion is a life saver if you need it. But there are some real downsides as well. Spinal fusion is more invasive than laminectomy. It involves hardware, so you have a foreign body in your body. And we know from history that 16% of people who have a spinal fusion need another one within five years. No thanks!

You do need a laminectomy. Severe spinal stenosis crushes your nerve roots and can lead to permanent bladder dysfunction, weakness, and numbness. In fact, a recent study showed a horrible increased in death within one year for those who declined laminectomy for severe spinal stenosis when offered by a spine surgeon.

On the bright side, minimally invasive laminectomy is a highly effective surgery to relieve the severe spinal stenosis shown on your MRI (Magnetic Resonance Imaging). You can expect an incision less than an inch, outpatient surgery, and to be mostly recovered after 1 week, walking a mile a day for exercise in 3.