Faculty of Public Health.

Name: Mariam droubi.Instructor: Samaher Sarout.Subject: Laminectomy.Department: Physiotherapy.Year: 2012-2013.Index:page:I. What is laminectomy?3II. What will happened before procedure?4III. The caregiver must know about:IV. The procedure:6V. After the procedure:7VI. Risks and complications:7VII. Prognosis:8VIII. Structure of the spine.8IX. Causes of law back pain. X. Home care instructions:11XI. Seek medical care if:12XII. For spinal stenosis:12XIII. Lumbar laminectomy surgery.13

I. What is laminectomy?Laminectomy is an orthopedic spine operation to remove the portion of the vertebral bone called the lamina. Many variations of laminectomy exist. The most minimal form involves only small skin incisions. The back muscles are pushed aside rather than cut and the parts of the vertebra adjacent to the lamina are left intact. Recovery from the minimal procedure can occur within a few days.As pictured, the lamina is a posterior arch of the vertebral bone lying between the spinous process, which juts out in the midline and the more lateral pedicles as well as the transverse processes of each vertebra. The pair of laminae, along with the spinous process, make up the posterior wall of the bony spinal canal. Although the literal meaning of laminectomy is "excision of the lamina", conventional laminectomy, which is the standard spine procedure in neurosurgery and orthopedics, involves excision of the posterior spinal ligament and some or all of the spinous process. Removal of these structures in the open technique requires disconnecting the many muscles of the back attached to them. Laminectomy performed as a minimal spinal surgery procedure, however, is a tissue preserving surgery that leaves more of the muscle intact and spares the spinal process. Another procedure, called laminotomy, is the removal of a mid-portion of one lamina and may be done either with a conventional open technique or in a minimal fashion with the use of tubular retractors and endoscopes.A lamina is rarely, if ever, removed because it itself is diseased. Instead, removal is done to break the continuity of the rigid ring of the spinal canal to allow the soft tissues within the canal to either expand (decompression), to help change the contour of the vertebral column, or to permit access to deeper tissue inside the spinal canal. Laminectomy is also the name of a spinal operation that conventionally includes the removal of one or both lamina as well as other posterior supporting structures of the vertebral column, including ligaments and additional bone. The actual bone removal may be carried out with a variety of surgical tools, including drills, rongeurs and lasers.II. What will happened before procedure?A medical evaluation will be done. This may include: A physical examination. Blood tests. Electrocardiogram (heart rhythm test). Imaging tests. This may include: Chest X-ray. MRI (magnetic resonance imaging). It can help locate disc problems. CT scan (computed tomography). You will talk with an anesthesiologist. This is the person who will be in charge of the anesthesia during the operation. A laminectomy usually requires general anesthesia (you are asleep during the procedure). The person having the laminectomy needs to give informed consent. This requires signing a legal paper that gives permission for theSurgery. To give informed consent: You must understand how the procedure is done and why. You must be told all the risks and benefits of the procedure. You must sign the consent form. A legal guardian can also do this. Signing should be witnessed by a health care professional. You will need to stop taking certain medicines. Stop using aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief. This includes prescription drugs and over-the-counter drugs, such as ibuprofen and naproxen. If possible, do this 10-14 days before the procedure. Also, stop taking vitamin E. If you take blood thinners, ask your caregiver when you should stop taking them. If you smoke, stop at least 2 weeks before the procedure. Smoking can slow down the healing process and increase the risk of complications. The day before the procedure, eat only a light dinner. Then, do not eat or drink anything for at least 8 hours before the operation. Ask if it is OK to take any needed medicines with a sip of water. Arrive at least 1-2 hours before the procedure, or whenever yoursurgeonrecommends. This will give you time to check-in and fill out any needed paperwork.

III. The caregiver must know about:On the day of the procedure, your caregiver will need to know the last time you had anything to eat or drink. This includes water, gum, and candy. Make sure your caregiver also knows about: Any allergies. All medicines you are taking, including: Herbs, eye drops, over-the-counter medicines, and creams. Blood thinners (anticoagulants), aspirin, or other drugs that could affect blood clotting. Use of steroids (by mouth or as creams). Previous problems with anesthesia. Possibility of pregnancy, if this applies. Any history of blood clots. Any history of bleeding or other blood problems. PreviousSurgery. Smoking history. Family history of problems with anesthesia. Any recent symptoms of colds or infections. Other health problems.

IV. The procedure:Preparation: Small monitors will be placed on your body. They are used to check your heart, blood pressure, and oxygen level. You will be given an intravenous line (IV). A needle will be inserted in your arm. It is hooked to a plastic tube. Medication will flow directly into your body through the IV. You might be given a sedative. This medication will help you relax. You will be given anesthesia. For general anesthesia, the anesthesiologist may hold a mask gently over your face. You will breathe in gases that will make you sleep. A tube also might be put in your throat. This would let you continue to get anesthesia during the procedure. Your back will be cleaned with a special solution, to kill germs on the skin. A catheter will be placed into your bladder, to collect urine during thesurgery.Procedure: Once you are asleep, thesurgeonwill make a 2 to 5-inch cut (incision) in your back. The length of the incision will depend on how many spinal bones (vertebrae) are being operated on. Muscles in the back are moved away from the vertebrae, and pulled to the side. Pieces of lamina are removed. This is the bony roof of the central canal. The ligament (tough tissue) that lies under the lamina and connects the vertebrae is removed. The remaining ligaments and thickened joints are also removed, though not completely. Just enough is removed to take pressure off the nerves. The nerves are identified, and their passage is tracked and assessed for excessive tightness. Once they are no longer under any pressure, enough ligaments and bone has been removed. The back muscles are moved back into their normal position. The area under the skin is closed with small, absorbable stitches. In time, these will go away on their own. The skin is closed with small stitches (also absorbable) or staples. A dressing is put over the incision. The procedure may take 1 to 3 hours.V. After the procedure: You will stay in a recovery area until the anesthesia has worn off. Your blood pressure and pulse will be checked every so often. Then you will be taken to a hospital room. You may continue to get fluids through the IV for awhile. Some pain is normal. You may be given pain medicine while still in the recovery area. If your pain gets worse, be sure to tell your caregiver. It is important to be up and moving as soon as possible after an operation. Physical therapists will help you start walking. To prevent blood clots in your legs: You may be given special stockings to wear. You may need to take medicine to prevent clots. You may be asked to do special breathing exercises. This is to prevent a lung infection.Most people stay in the hospital for 1 to 3 days after a laminectomy.

VI. Risks and complications:Problems after a laminectomy are rare. But they can occur. They may include: Bleeding. Pain. Infection near the incision. Nerve damage. Signs of this can be pain, weakness, or numbness. Leaking of spinal fluid. Blood clot in a leg. The clot can move to the lungs. This can be very serious. A weakspine Trouble controlling urination or bowel movements.

VII. Prognosis:Most people have less pain after a laminectomy. This is especially true for people who had pain in their leg. Having less pain makes it easier to go about daily activities. It may take several months for weakness and numbness to go away. Sometimes, people need another procedure after a few years.

VIII. Structure of the spine:In order to understand why removal of a piece of bone from the arch of a vertebra relieves pain, it is helpful to have a brief description of the structure of the spinal column and the vertebrae themselves. In humans, the spine comprises 33 vertebrae, some of which are fused together. There are seven vertebrae in the cervical (neck) part of the spine; 12 vertebrae in the thoracic (chest) region; five in the lumbar (lower back) region; five vertebrae that are fused to form the sacrum; and four vertebrae that are fused to form the coccyx, or tail-bone. It is the vertebrae in the lumbar portion of the spine that are most likely to be affected by the disorders that cause back pain. The 24 vertebrae that are not fused are stacked vertically in an S-shaped column that extends from the tail-bone below the waist up to the back of the head. This column is held in alignment by ligaments, cartilage, and muscles. About half the weight of a person's body is carried by the spinal column itself and the other half by the muscles and ligaments that hold the spine in alignment. The bony arches of the laminae on each vertebra form a canal that contains and protects the spinal cord. The spinal cord extends from the base of the brain to the upper part of the lumbar spine, where it ends in a collection of nerve fibers known as the cauda equina, which is a Latin phrase meaning "horse's tail." Other nerves branching out from the spinal cord pass through openings formed by adjoining vertebrae. These openings are known as foramina (singular, foramen). Between each vertebra is a disk that serves to cushion the vertebrae when a person bends, stretches, or twists the spinal column. The disks also keep the foramina between the vertebrae open so that the spinal nerves can pass through without being pinched or damaged. As people age, the intervertebral disks begin to lose moisture and break down, which reduces the size of the foramina between the vertebrae. In addition, bone spurs may form inside the vertebrae and cause the spinal canal itself to become narrower. Either of these processes can compress the spinal nerves, leading to pain, tingling sensations, or weakness in the lower back and legs. A lumbar laminectomy relieves pressure on the spinal nerves by removing the disk, piece of bone, tumor, or other structure that is causing the compression

IX. Causes of law back pain:The disks and vertebrae in the lower back are particularly vulnerable to the effects of aging and daily wear and tear because they bear the full weight of the upper body, even when one is sitting quietly in a chair. When a person bends forward, 50% of the motion occurs at the hips, but the remaining 50% involves the lumbar spine. The force exerted in bending is not evenly divided among the five lumbar vertebrae; the segments between the third and fourth lumbar vertebrae (L3-L4) and the fourth and fifth (L4-L5) are most likely to break down over time. More than 95% of spinal disk operations are performed on the fourth and fifth lumbar vertebrae. Specific symptoms and disorders that affect the lower back include: Sciatica. Sciatica refers to sudden pain felt as radiating from the lower back through the buttocks and down the back of one leg. The pain, which may be experienced as weakness in the leg, a tingling feeling, or a "pins and needles" sensation, runs along the course of the sciatic nerve. Sciatica is a common symptom of a herniated disk. Spinal stenosis. Spinal stenosis is a disorder that results from the narrowing of the spinal canal surrounding the spinal cord and eventually compressing the cord. It may result from hereditary factors, from the effects of aging, or from changes in the pattern of blood flow to the lower back. Spinal stenosis is sometimes difficult to diagnose because its early symptoms can be caused by a number of other conditions and because the patient usually has no history of back problems or recent injuries. Imaging studies may be necessary for accurate diagnosis. Cauda equina syndrome (CES). Cauda equina syndrome is a rare disorder caused when a ruptured disk, bone fracture, or spinal stenosis put intense pressure on the cauda equina, the collection of spinal nerve roots at the lower end of the spinal cord. CES may be triggered by a fall, automobile accident, or penetrating gunshot injury. It is characterized by loss of sensation or altered sensation in the legs, buttocks, or feet; pain, numbness, or weakness in one or both legs; difficulty walking; or loss of control over bladder and bowel functions. Cauda equina syndrome is a medical emergency requiring immediate treatment . If the pressure on the nerves in the cauda equina is not relieved quickly, permanent paralysis and loss of bladder or bowel control may result. Herniated disk. The disks between the vertebrae in the spine consist of a fibrous outer part called the annulus and a softer inner nucleus. A disk is said to herniate when the nucleus ruptures and is forced through the outer annulus into the spaces between the vertebrae. The material that is forced out may put pressure on the nerve roots or compress the spinal cord itself. In other cases, the chemicals leaking from the ruptured nucleus may irritate or inflame the spinal nerves. More than 80% of herniated disks affect the spinal nerves associated with the L5 vertebra or the first sacral vertebra. Osteoarthritis (OA). OA is a disorder in which the cartilage in the hips, knees, and other joints gradually breaks down, allowing the surfaces of the bones to rub directly against each other. In the spine, OA may result in thickening of the ligaments surrounding the spinal column. As the ligaments increase in size, they may begin to compress the spinal cord.

XIV. Home care instructions: Medication: Take whatever pain medicine has been prescribed by thesurgeon. Follow the directions carefully. Do not take over-the-counter painkillers unless thesurgeon says it is OK. Do not drive if you are taking narcotic pain medications. You may need to take blood thinners for several weeks to 2 months. The goal is to prevent blood clots. You may need to take a stool softener, if you take narcotic pain medication. Also, eat foods high in fiber to prevent constipation (difficult bowel movements), such as fruits and vegetables. Wound care: Do not get the incision wet until thesurgeonsays it is OK. After a few days you may take quick showers, but keep the incision clean and dry. A few weeks aftersurgery, once the incision has healed and thesurgeonsays it is OK, you can take baths or go swimming. Check the area around the incision often. Look for redness and swelling. Also, look for anything leaking from the wound. Activity: Take it easy for a while. Pain may go away fast. But, full recovery can take weeks or months. Your overall health before the procedure will make a difference. So will your age. Walk as much as possible. Do not lift anything heavier than 10 pounds, until yoursurgeonsays it is safe. For a few weeks, do not twist or bend. Try not to pull on things. And avoid sitting for long periods of time. Ask your caregiver when you can resume other activities, such as work, driving, or sex. Exercise: Ask your caregiver to explain what you should and should not do. Also, ask if you need physical therapy. The right kind of exercise can make your back stronger. It can also speed up your recovery. Follow up care: Yoursurgeonmay need to take out stitches or staples. This is usually done about 2 weeks after the operation. Your surgeonmay take X-rays. They can show how yourspineis healing.X. Seek medical care if: You have any questions about medicines. Pain continues, even after taking pain medicine. You feel weak. You are too tired to walk every day. You become nauseous. You are constipated. You have an oral temperature above 102 F (38.9 C).

XI. For spinal stenosis:Most commonly, laminectomy is performed to treat spinal stenosis. Spinal stenosis is the single most common diagnosis leading to any type of spine surgery and laminectomy is a basic part of its surgical treatment. The lamina of the vertebra is removed or trimmed to widen the spinal canal and create more space for the spinal nerves and thecal sac. Surgical treatment that includes laminectomy is the most effective remedy for severe spinal stenosis; however, most cases of spinal stenosis are not severe enough to require surgery. When the disabling symptoms of spinal stenosis are primarily neurogenic claudication and the laminectomy is done without spinal fusion, there is generally a very rapid recovery with excellent long term relief. But if the spinal column is unstable and fusion is required, there is a recovery period of months to more than a year, and relief of symptoms is less likely.

XII. Lumbar laminectomy surgery.What is lumbar laminectomy surgery? This medical procedure may sound really complicated however performing this could also pose great benefits. From the laminectomy, this procedure means the removal of the lamina which is seen on the spinal column. This procedure is otherwise known as lumbar decompression. This surgery is usually recommended for people suffering from back problems like stenosis. This term is used to identify problems in the column which involves the narrowing of the spinal canal which could compress the nerves of the spine. If this condition is not treated immediately, this could cause bad effects and could sometimes lead to serious complications. Lumbar laminectomy surgery is done in order to relieve the pressure on the spinal cord. There are two ways wherein pressure is created on the spinal nerve. First, the spinal column is actually made up of 33 vertebral bones. Each bone is separated by a spinal disc which then serves as the cushion for each bone. However there are instances where in the disc is compressed by the bones causing hernia to happen. Once this takes place, the herniated portion of the disc could rupture and compress the spinal nerve. This then could cause mild to severe pain depending on the gravity of the situation. Another instance where in extreme pressure is placed on the spinal nerve is when the bones becomes overgrown which is commonly known as bone spurs. These bone spurs could likewise press a certain portion of the spinal nerve which could result to compression. Having these conditions could actually cause discomforts at the back which is why the lumbar laminectomy surgery is being performed. During the actual laminectomy procedure, a small incision at the back is made. It is ideal to have a small incision as much as possible in order to avoid greater risks and longer wound healing. Once the incision is made, the underlying muscles are then pushed aside in order to expose the affected area of the spinal column. As soon as the area is exposed, the bone spurs which is part of the lamina is then removed or detached from the column. This removes the pressure thus relieving pain. If there are also problems related to herniated discs, the exposed nerve is then carefully adjusted in order to have a clear view of the ruptured disc. This could then be easier for the surgeon to incise and removed the affected portion. The lumbar laminectomy is indeed a very therapeutic management in dealing with increased spinal pressure caused by either herniated discs or bone spurs. Nevertheless, this procedure also holds a lot of risks and could also cause complications post procedure. This is why proper, sufficient and correct health teaching is given prior, during and after the surgery in order to lessen unwanted or untoward reaction

References:American Psychiatric Association. "Somatoform Disorders." In Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Revised text. Washington, DC: American Psychiatric Association, 2000. "Low Back Pain." In The Merck Manual of Diagnosis and Therapy , edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999. "Nerve Root Disorders." In The Merck Manual of Diagnosis and Therapy , edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999. "Osteoarthritis." In The Merck Manual of Diagnosis and Therapy , edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999. Pelletier, Kenneth R., MD. "Acupuncture." In The Best Alternative Medicine . New York: Simon & Schuster, 2002. Pelletier, Kenneth R., MD. "Chiropractic." In The Best Alternative Medicine . New York: Simon & Schuster, 2002.

Read more: http://www.surgeryencyclopedia.com/Fi-La/Laminectomy.html#ixzz2FWztJ5rS2