In this guide, we’ll explore why buttock pain happens after laminectomy, how to tell if it’s a normal part of recovery (or a warning sign that merits a deeper look), and treatment options to consider. 

Buttock Pain After Laminectomy: At a Glance

• Causes: Post-laminectomy syndrome, piriformis syndrome, scar tissue formation, nerve compression, sacroiliac joint dysfunction, and glute muscle weakness
• Treatment: Physical therapy, medications, steroid injections, spinal cord stimulation, revision surgery

Is Buttock Pain Normal After Laminectomy?

Buttock pain is a fairly common symptom during the recovery period of laminectomy, especially if it occurs as a dull ache, soreness, or tightness. But if it becomes persistent or intense, it may point to a complication like post-laminectomy syndrome, also known as failed back surgery syndrome (FBSS). FBSS isn’t common, but affects between 10 and 40% of patients following back surgery, according to an American Journal of Lifestyle Medicine study.   

What Causes Buttock Pain After Laminectomy?

Possible causes of buttock pain after laminectomy include post-laminectomy syndrome, piriformis syndrome, scar tissue formation, nerve compression, sacroiliac joint dysfunction, and glute muscle weakness. 

Post-Laminectomy Syndrome (Failed Back Surgery Syndrome)

Post-laminectomy syndrome is the term used for chronic pain after a laminectomy. A laminectomy is a common procedure used to decompress impinged spinal nerves by removing some or all of the lamina. 

Although laminectomy is a popular, time-tested procedure for conditions like spinal stenosis and herniated disc, it causes post-laminectomy syndrome in some patients. Also known as failed back surgery syndrome, post-laminectomy syndrome can cause symptoms including:

• Back pain
• Leg pain
• Numbness, tingling, and weakness that radiate from the back to the lower extremities
• Back stiffness
• Reduced range of motion in the back and lower extremities
• Buttock pain

Post-laminectomy syndrome can cause buttock pain resulting from lumbar nerve impingement. Often, the patient experiences buttock pain from sciatic nerve impingement, or sciatica. The sciatic nerve begins in the lumbar spine and extends through the buttocks, then down the backs of the legs. 

Scar tissue, recurring spinal stenosis or herniated disc, insufficient nerve decompression, and inflammation can cause or contribute to pain from post-laminectomy syndrome. 

Piriformis Syndrome

Buttock pain after laminectomy can result from piriformis syndrome. Piriformis syndrome results from the piriformis muscle pressing on the sciatic nerve. The most common symptom of this condition is buttock pain that worsens after walking, running, or sitting for prolonged periods. 

Piriformis syndrome can also cause numbness, tingling, and weakness in the buttocks. These neurological symptoms may radiate down the backs of the legs and even to the feet. 

Possible causes of piriformis syndrome are inflammation in the piriformis or surrounding tissues, scarring in the piriformis muscle, and muscle spasms. It’s possible to develop these issues after laminectomy, especially if you sit for prolonged periods or develop tight muscles from inactivity. 

Scar Tissue and Epidural Fibrosis

Scar tissue is a normal effect of surgery; it’s your body’s natural response to tissue damage. It’s stiffer than normal tissue, so it may compress nearby nerves and trigger pain.

Epidural fibrosis is the term for excess scar tissue formation around a nerve root, and it most often results from spinal surgery. Up to 30% of patients develop symptomatic epidural fibrosis after lumbar laminectomy, according to a Spine Surgery and Related Research study. 

Symptoms of epidural fibrosis include:

• New or recurring back or leg pain
• Burning or shooting pain
• Numbness, tingling, or muscle weakness
• Stiffness

Recurrent or Residual Nerve Compression

Buttock pain after laminectomy can point to recurrent or residual nerve compression. 

• Recurrent nerve compression occurs when the procedure provides initial pain relief, but symptoms reappear. This may point to a new injury (like a newly herniated disc) or scar tissue formation. 
• Residual nerve compression may occur if the decompression procedure didn’t fully decompress the nerve, or if the pre-existing nerve damage hasn’t yet healed. In the latter case, the pain may improve as the irritated nerve heals. 

Sacroiliac Joint Dysfunction

The sacroiliac (SI) joints connect the pelvis to the lumbar spine. Too much or too little movement in these joints can cause sacroiliac joint dysfunction, a condition involving:

• Pain around the buttocks, lower back, hip, and/or groin
• Pain, tingling, and numbness that radiate into the leg(s)
• Leg instability (feeling like your legs are buckling)
• Pain during long periods of sitting
• Pain transitioning from sitting to standing

According to a European Spine Journal study, SI joint pain has a prevalence of 16% to 43% among patients with persistent back pain after spinal fusion surgery. 

Gluteal Muscle Weakness and Inactivity

Rest is, of course, essential after a procedure like laminectomy. But excessive bed rest without periods of walking and PT exercises can weaken various muscle groups, including your glutes. Gluteal muscle weakness can throw off pelvic alignment and increase stress on nearby nerves, potentially leading to buttock pain. 

Red Flag Symptoms: When to Seek Immediate Care

If you experience the symptoms below after laminectomy, go to the nearest ER right away. These symptoms may indicate a severe neurological complication, cauda equina syndrome, or other serious postoperative complications. 

• Saddle anesthesia (numbness in the buttocks, inner thighs, groin, and perineum)
• Bladder or bowel dysfunction
• Sudden or rapidly worsening leg weakness or numbness
• Fever
• Sudden confusion or disorientation
• Difficulty breathing or chest pain
• Persistent nausea and vomiting

How is Post-Laminectomy Buttock Pain Diagnosed?

Diagnosing post-laminectomy buttock pain starts with a physical exam and medical history. If the results indicate the need for further examination, your doctor will order imaging tests to view the inside of the body. They may also perform nerve conduction studies or electromyography (EMG) to evaluate nerve and muscle health. 

Physical Exam and Medical History

During your exam, your doctor will talk to you about your symptoms, including when they began, how often they occur, and how severe they are. They may also:

• Examine the incision area
• Check your reflexes, motor strength, and senses
• Evaluate your posture, gait, and mobility
• Perform the Straight Leg Test for nerve root irritation
  • During this diagnostic test, your doctor will lift your leg while you’re lying down to check for radiating pain and neurological symptoms. 

Imaging Tests: X-Ray, CT Scan, MRI

Depending on the results of your initial exam, your doctor may order imaging tests to determine or confirm a diagnosis. Options include:

• X-rays, which generate images of the inside of the body using electromagnetic radiation
  • Best for: Bone-related conditions, like bone spurs and fractures
• CT scans, which combine X-rays and computer technology to generate cross-sectional, 3D images
  • Best for: Emergencies (due to its speed)
• MRI (magnetic resonance imaging), which uses magnetic fields and radio waves to create detailed images of the inside of the body
  • Best for: Soft tissue conditions, including nerve impingement and herniated disc

Nerve Conduction Studies and EMG

Nerve conduction studies and EMG (electromyography) are used to check muscle and nerve function. Your provider might suggest them for post-laminectomy buttock pain to pinpoint where your symptoms are stemming from, confirm whether the pain is nerve- or muscle-related, and evaluate the extent of the nerve damage.  

• Nerve conduction studies use stimulating electrodes to send a nerve signal to your muscle; the provider then records how long it takes the muscle to respond to the nerve signal.
  • Used to: Diagnose nerve damage
• An EMG test uses a needle with an electrode to measure a muscle’s electrical activity when relaxed and in motion.
  • Used to: Evaluate if muscles are effectively responding to nerve signals

Treatment Options for Buttock Pain After Laminectomy

The most common treatment recommendations for post-laminectomy buttock pain include medications, PT, and steroid injections. More invasive options for more persistent cases include spinal cord stimulation and revision surgery. 

Medications: NSAIDs, Neuropathic Pain Meds, Muscle Relaxants 

Medications, like NSAIDs, muscle relaxants, and neuropathic medications, can help manage buttock pain and related symptoms after a laminectomy. 

• NSAIDs (non-steroidal anti-inflammatory drugs) reduce pain and inflammation by blocking the enzymes that produce prostaglandins, the hormone-like lipid compounds that cause inflammation.
  • Best for: Managing inflammation

• Neuropathic pain meds are drugs used to treat nerve pain, like anticonvulsants (gabapentinoids), certain antidepressants, and topical lidocaine. Unlike typical over-the-counter painkillers, these medications curb overactive nerve signals to reduce nerve pain.
  • Best for: Managing nerve pain
• Muscle relaxants may be prescribed to help manage muscle spasms and pain in the short term.
  • Best for: Managing muscle spasms

Physical Therapy and Rehabilitation

Physical therapy is typically implemented as the first line of defense for buttock pain after laminectomy. It doesn’t present the risk of side effects from medications, as it supports healing using targeted exercises and complementary therapies.

Key elements of PT for post-laminectomy buttock pain include:

• Core strengthening and stabilization to reduce impact on the spinal nerves
• Targeted stretching to improve mobility and release tension
• Personalized body mechanics strategies strategies 
• Complementary therapies for pain relief, such as acupuncture, dry needling, massage, etc.

Epidural Steroid Injections

Epidural steroid injections involve injecting corticosteroids into the epidural space (the space around the spinal nerves). The medication reduces inflammation and pain, albeit temporarily (between weeks and months). 

That said, research shows that epidural steroid injections may be less effective for pain after spinal surgery. According to a systematic review in StatPearls, evidence for efficacy was good for lumbar herniated disc, fair for spinal stenosis, and poor for failed back surgery syndrome. That said, your doctor can help determine the best course of treatment for your condition. 

Spinal Cord Stimulation

Spinal cord stimulation, also known as SCS, is a minimally invasive treatment option for persistent pain and neurological symptoms after spinal surgery. It involves implanting a spinal cord stimulator into the body, which emits an electrical current to the spinal cord to block other pain signals. 

Research into the effectiveness of SCS for recurring pain after back pain is promising. A Neuromodulation study found that 75% of patients who received permanent spinal cord stimulator implants reported at least 50% pain relief after 34 months. 

When Revision Surgery is Considered

Revision surgery might be recommended if conservative therapies fail to improve your symptoms after six to 12 months. It’s an individual decision with many factors to consider, including:

• Imaging results (if an imaging test shows new or recurring spinal degeneration, like a herniated disc, spinal stenosis, or nerve impingement)
• Progressive neurological symptoms, like numbness, tingling, and weakness
• Worsening symptoms that impact day-to-day function

Surgery may also be required in emergency situations, like cauda equina syndrome, to address symptoms like:

• Loss of bowel or bladder control
• Saddle anesthesia
• Rapidly progressing leg or foot weakness

Why Is Sitting Bad After Laminectomy?

Sitting is bad after laminectomy for prolonged periods because it puts added stress on the spine and reduces blood flow to the healing tissue. 

Additionally, when you sit for long periods, it becomes more difficult to maintain good posture. If you hunch over or slouch, it places even more stress on the spine. This can lead to inflammation and ultimately compromise your recovery process. 

While it’s important to rest and limit strenuous physical activity in the early stages of your laminectomy recovery, avoid prolonged sitting and bed rest. When you do sit down, follow these tips to reduce impact on the spine:

• Take a break from sitting every 30 to 45 minutes. Stand up, gently stretch, and, if possible, take a short stroll – even if it’s just around your office. 
• Invest in a rolling chair with robust lumbar spine support. A rolling chair keeps you from having to twist the spine 

How Long After Laminectomy Can I Bend?

You can bend approximately one to two months after laminectomy. Your surgeon will provide detailed instructions based on your condition, age, procedure, and medical history. 

Surgeons recommend avoiding bending, twisting, and stooping for at least a few weeks after laminectomy. This is because bending and extending the spine puts pressure on the surgical site. Excessive pressure on this area can increase inflammation, trigger tissue damage, and compromise the healing process, increasing the risk of post-laminectomy syndrome. 

Are There Permanent Restrictions After a Laminectomy?

Permanent restrictions after a laminectomy can vary from patient to patient. If you undergo laminectomy with fusion, your spinal mobility will be permanently restricted at the fused level. You may also have to avoid certain activities, like heavy weightlifting and gymnastics, that place extreme stress on the spine.

Best Exercises for Buttock Pain After Laminectomy

The best exercise after a laminectomy if you have buttock pain is a piriformis stretch, which stretches the buttocks and surrounding muscles. 

To perform a piriformis stretch, complete these steps:

• Lie flat on your back with your knees bent. 
• Cross one leg over the other. 
• Place your hands behind the opposite knee, gently pulling it toward your chest until you feel a gentle stretch in your buttocks. 
• Hold this position for 20 to 30 seconds, then release and repeat with the opposite leg. 
• Note: To deepen the stretch, you can cross your leg over the other at the mid-calf or ankle, creating a “figure 4” position. 

Other exercises that can benefit your recovery process after a laminectomy if you have buttock pain include:

• Knee-to-chest stretch
  • Lie on your back with your legs extended. 
  • Use your abdominal muscles to lift one leg toward you, placing your hands behind the knee. 
  • On an exhale, gently pull the leg toward your chest until you feel a stretch in the back of the leg. 
• Bird dog stretch
  • Begin on all fours, with your hands and knees on the ground.
  • Lift your arm to shoulder height.
  • Engage your abdominal muscles, then lift the opposite leg behind you (keeping your arm lifted). Your arm and leg should be on the same plane as the rest of your body.
  • Hold this position for 15 to 20 seconds, then repeat on the other side. 
• Foot taps
  • Lie on your back with your knees bent. 
  • Engage your abdominal muscles to lift one foot off of the ground, with your leg bent at a right angle. 
  • Keeping your abdominals engaged, lift your other foot up to the same position. 
  • Lower one leg at a time back to the ground. 
  • Repeat this exercise for around 10 sets.

Talk to your surgeon or physical therapists before attempting these exercises after a laminectomy.

How Long Does Buttock Pain Last After Laminectomy?

Buttock pain after laminectomy typically resolves within six to eight weeks. The pain may worsen initially, but should gradually improve over time. 

The laminectomy surgery recovery process typically involves the following stages:

• One to three days: Hospital stay
• One to three weeks: Recovering at home, light walking, avoiding “BLT” (bending, lifting, twisting)
• Three to six weeks: Physical therapy, return to light housework and desk work
• Six to 12 weeks: Gradual return to normal activities, with restrictions on high-impact activities and “BLT”
• Six months and beyond: Complete recovery with maintenance exercises and healthy lifestyle habits

Fusion Alternatives to Mitigate Long-Term Risks

Motion-preserving fusion alternatives can help prevent the risks associated with spinal fusion, including adjacent segment degeneration and reduced mobility. One option is the TOPS System, a dynamic implant device that replaces the tissues removed during spinal decompression. It establishes a controlled range of spinal motion, allowing stable movement in all directions. 

The TOPS System has earned approval and a superior-to-fusion claim from the FDA, making it a compelling choice for patients seeking a modern approach to surgery for lumbar spinal stenosis and spondylolisthesis. 

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FAQs

Why does my hip hurt after L4-L5 laminectomy?

Hip pain after L4-L5 laminectomy may result from nerve root irritation caused by scar tissue and residual inflammation, or muscle strain from changes to your gait and posture. 

Can sciatica come back after a laminectomy?

Yes, sciatica can come back after a laminectomy due to scar tissue, recurring issues (like a herniated disc), spinal instability, or lingering inflammation. Further down the line, laminectomy with fusion can cause adjacent segment degeneration, which can contribute to sciatica symptoms. 

What are the permanent restrictions after laminectomy?

After laminectomy, you’ll need to avoid high-impact activities and deep or repetitive bending, lifting, and twisting. 

What helps with nerve pain in the legs after back surgery?

Physical therapy, medications, and healthy lifestyle adjustments (gentle movement, anti-inflammatory diet, limiting alcohol) can help with nerve pain after back surgery. 

Does buttock pain mean back surgery failed?

Not necessarily – buttock pain after back surgery can result from normal postoperative nerve irritation. But if it persists for several weeks and doesn’t improve as your body recovers, bring it up with your doctor. 

The post Buttock Pain After Laminectomy: Causes, Treatment, and Recovery appeared first on Premia Spine.

But, what exactly does laminectomy with fusion involve, and is it the right choice for you? Read on to learn more about this topic and how it may impact your spinal recovery. 

Table of Contents

• What is Laminectomy with Fusion?
• How Successful Is a Laminectomy With Fusion?
• Do You Need Fusion with Laminectomy?
• What Is the Recovery Time for a Lumbar Laminectomy With Fusion?
• Returning to Work After a Lumbar Laminectomy with Spinal Fusion
• What Are The Risks of Laminectomy With Fusion?
• Can You Walk Normally After Laminectomy With Fusion?
• Non-Fusion Implants For Laminectomy
• How Premia Spine TOPS System Cures Spondylolisthesis and Spinal Stenosis Without Fusion

What is Laminectomy with Fusion?

Laminectomy is a form of spinal decompression that’s commonly done with fusion to stabilize the spine. During a laminectomy, the surgeon removes the smallest quantity of the lamina possible while effectively resolving the nerve compression. 

The lamina is a piece of bone that forms part of the vertebral arch. It acts like a roof over the posterior side of the spinal canal. 

Conventionally, spinal fusion is performed after a laminectomy (and most other forms of spinal decompression). During spinal fusion, the surgeon places an implant containing bone graft material between the vertebrae. Over time, this graft stimulates bone tissue fusion, creating a single vertebra. 

Fusion after laminectomy effectively lowers the risk of injuries due to spinal instability. However, it also eliminates all motion at the fused segment, which permanently removes motion at that level.  

How Successful Is a Laminectomy With Fusion?

Laminectomy with fusion is widely considered a successful procedure for disorders like spinal stenosis and spondylolisthesis. A study published in The New England Journal of Medicine concluded that lumbar laminectomy with spinal fusion provided a slightly greater improvement in overall physical health when compared to laminectomy alone. This study included 66 patients with degenerative grade 1 spondylolisthesis. 

However, laminectomy alone is considered safer than spinal fusion. According to Dr. Steven Atlas, an associate professor of medicine at Harvard Medical School, laminectomy provides 80% to 90% pain relief for spinal stenosis, without the risks associated with fusion.  

What Is the Success Rate of a Laminectomy and Fusion?

The success rate of a laminectomy and fusion is around 85% to 90% according to a study published in The New England Journal of Medicine. The remaining 10% to 15% of cases require reoperation. 

Success rates of this procedure indicate the percentage of cases that result in successful spinal decompression and bone fusion, without the need for reoperation. This differs from the patient satisfaction rate, which is based solely on how happy the patient is with the procedure’s results. Patient satisfaction rates range from 53% to 90%, according to a study published in The Spine Journal.   

What Affects The Success of Laminectomy with Fusion?

Many factors can impact the success rate of a laminectomy and fusion, including:

• The patient’s age: Older patients are at a higher risk of failed spinal surgery. With age, the body’s ability to regenerate cells and tissue declines, which can compromise the procedure’s results. 
• Underlying medical conditions: Certain underlying medication conditions can increase the risk of failed fusion and surgical complications, including hypertension, heart disease, and diabetes. 
• Smoking and alcohol consumption: Smoking before and after laminectomy with fusion can hinder the procedure’s success. Nicotine restricts blood flow – a crucial aspect of the body’s healing process. This can reduce the flow of healing nutrients and oxygen to the surgical site, potentially compromising tissue healing and bone fusion. 
• Being overweight or obese: Obesity increases the risk of blood clots, cardiovascular issues, and infection after any surgical procedure. It can also make it more difficult to get out of bed and walk around after surgery. Prolonged bed rest slows the recovery process for laminectomy with fusion. 
• Previous spinal surgeries: If you’ve previously undergone spinal surgery, you likely have scar tissue in the area, which can make future spinal procedures more complicated. Research shows that repeat lumbar procedures are linked to worsened clinical outcomes. 

Do You Need Fusion with Laminectomy?

You may need fusion with laminectomy if a part of the spine is unstable after laminectomy. Spinal instability creates the risk of further injury.

However, innovations in spinal medicine have produced alternatives to fusion for stability after decompressive laminectomy. We’ll discuss these innovations, including the TOPS System from Premia Spine, in a later section. 

What Is the Recovery Time for a Lumbar Laminectomy With Fusion?

The recovery time for a lumbar laminectomy with fusion can last between two months and a full year. Many factors can affect this recovery period, including the patient’s age and overall health, as well as the severity of the spinal condition. 

Spinal fusion extends the recovery period after a lumbar laminectomy. This is because spinal fusion involves bone tissue recovery, which is a lengthy process. 

Returning to Work After a Lumbar Laminectomy with Spinal Fusion

Generally, healthy patients with non-strenuous jobs can expect to return to work following a lumbar laminectomy with spinal fusion after four to six weeks of rest. Older patients or those with strenuous jobs may need four to six months of recovery time before returning to work. 

What Are The Risks of Laminectomy With Fusion?

The risks of laminectomy with fusion include those associated with all surgical procedures, including bleeding, infection, blood clots, and complications from anesthesia. Since this surgery involves the spine, it also presents a low risk of injury to the spinal cord or spinal nerve roots.

In permanently fusing two or more vertebrae of the spine, fusion creates the risk of a few other complications, including:

• Pain at the graft site

Some patients experience pain at the site of the bone graft. In 2.8% to 39% of patients, this pain has been reported to last for over three months. Graft site pain has been reported to last for up to two years in 15% to 39% of patients. 

• Pseudoarthrosis

Pseudoarthrosis refers to bone fusion failure. This complication is significantly higher in patients who smoke, as nicotine hinders the bone fusion process. Unfortunately, patients who experience pseudoarthrosis will likely require extra surgeries to reliably fuse the vertebrae. 

• Adjacent segment disease

Adjacent segment disease, or ASD, occurs when the spinal segments around the fused bone degenerate after fusion. The surrounding segments may undergo additional impact to compensate for the fused bone, leading to degeneration. Regrettably, ASD can lead to re-operation if it causes chronic back pain and neurological symptoms that don’t improve with non-invasive methods. 

Can You Walk Normally After Laminectomy With Fusion?

You can gradually walk normally after laminectomy with fusion, typically with the help of a physical therapist. Walking is actually highly beneficial after spinal surgery, as it’s a low-impact activity that promotes circulation and mobility.

Typically, surgeons recommend that patients stand up and gently walk (with assistance) the day after laminectomy with fusion to prevent muscle stiffness and atrophy. For the first six weeks or so after the procedure, walking may be the sole physical activity that you can safely complete. Many physicians recommend working up to two 30-minute walks per day in this early recovery stage. 

Non-Fusion Implants For Laminectomy

Non-fusion implants provide a solution for laminectomy without fusion. This allows patients to avoid the downsides of spinal fusion while achieving relief from chronic back pain and neurological symptoms. According to a research article published in BMC Musculoskeletal Disorders, walking time in the first week after lumbar spine surgery is one of the factors that predicts notable improvement at six months post-op. 

There are multiple non-fusion implants available to patients today, including artificial discs, expandable rods, and complete implant systems like the TOPS System. These devices (which are also referred to as motion preservation devices) generally fall under one of three categories: total disc replacement, posterior stabilization devices, and prosthetic nuclear implants. 

How Premia Spine TOPS System Cures Spondylolisthesis and Spinal Stenosis Without Fusion

The Premia Spine TOPS System cures spondylolisthesis and spinal stenosis without fusion by establishing a controlled range of motion in the spine. It’s a mechanical implant device designed to be implanted in the L2 to L5 segments of the spine with a posterior surgical approach. 

Regain your mobility with Premia Spine! Contact us now

The TOPS System facilitates motion in all directions, including axial rotation, lateral bending, extension, and flexion. Unlike fusion, it replaces the vertebral structures extracted in spinal decompression, such as the lamina removed during laminectomy. It also features a patented crossbar configuration, which imparts less stress on the screws than fusion implants. 

After nerve compression in spondylolisthesis and spinal stenosis patients is resolved during a laminectomy, the TOPS System can be placed to prevent instability. This technique effectively cures spondylolisthesis and spinal stenosis without fusion, with the TOPS system providing an average improvement of 81% in a clinical study published in the Operative Neurosurgery journal. 

Though the TOPS System has been used successfully for many years in Europe and other regions, it’s currently being tested in clinical trials across the United States. The device was awarded the FDA’s Breakthrough Device Designation in 2021, which will prioritize its process of obtaining FDA approval. 

If you’re interested in the TOPS System as an alternative to laminectomy with fusion, find a doctor in your area to learn more about this treatment option.  

The post Laminectomy with Fusion appeared first on Premia Spine.

But, what happens when a laminectomy goes wrong? Although laminectomy has a high success rate, it causes a condition known as post-laminectomy syndrome in some patients. 

Read on for a comprehensive overview of post-laminectomy syndrome, its symptoms, and whether or not it can be cured.

Table of Contents

• Can a Laminectomy Go Wrong?
• Does Lamina Grow Back After Laminectomy?
• What Are the Long-Term Problems After a Laminectomy?
• Can Post-Laminectomy Syndrome Be Cured?

Can a Laminectomy Go Wrong?

A laminectomy can go wrong, although severe complications are rare. 

Ways in which a laminectomy can go wrong include:

Surgical Complications

Photo: https://www.pexels.com/photo/surgeon-working-in-hat-and-gloves-25205116/ 

Certain complications can occur with any surgical procedure, including bleeding, blood clots, infection, and reactions to anesthesia. These complications are relatively rare, but your risk may be elevated if you’re over age 65, have underlying medical conditions, smoke, or are obese. 

Your surgeon will evaluate your risk of developing these complications while determining whether laminectomy is right for you. Certain lifestyle choices, like quitting smoking, eating healthily, avoiding alcohol, and staying active can also reduce your risk of surgical complications. 

Nerve Damage

Laminectomy involves the spinal area, and the surgeon must work close to the spinal cord, adjacent nerves, and dura (the spinal cord’s protective covering). This creates the risk of nerve damage. However, nerve damage is a rare complication of laminectomy, affecting 0% to 2% of patients. 

Recurring Pain

Pain that returns after surgery is the most common way in which a laminectomy can go wrong. Also known as failed back surgery syndrome (FBSS) or post-laminectomy syndrome (PLS), recurring back pain after laminectomy may result from:

• Scar tissue formation
• Damage to surrounding muscle, ligament, or nerve tissue during the procedure
• Degeneration in the surrounding spinal segments
• Fusion failure, if laminectomy is performed with spinal fusion
• Hardware failure, with which the screws, rods, and plates used to stabilize the spine fail over time

Often, the exact cause of recurring pain after laminectomy is unknown. 

Does Lamina Grow Back After Laminectomy?

Photo: https://www.pexels.com/photo/high-angle-view-of-doctors-during-an-operation-24193884/ 

The lamina can partially grow back after laminectomy, but full regrowth doesn’t occur. 

Research published in 2019 shows that bone regrowth has been reported in up to 94% of people who underwent laminectomy or laminotomy. The highest rate of regrowth appears at the L3-L4 spinal level and in cases of laminectomy with spinal fusion.  

Bone regrowth after laminectomy doesn’t always cause problems or recurring pain. However, in some patients, the redeveloped bone causes the spinal stenosis and/or nerve impingement to return. 

What Are the Long-Term Problems After a Laminectomy?

Long-term problems after a laminectomy can include post-laminectomy syndrome, returning lumbar spinal stenosis, pain from scar tissue, and adjacent segment degeneration. 

What Exactly is Post-Laminectomy Syndrome?

Post-laminectomy syndrome is the term used to describe back and leg pain after laminectomy. Also known as failed back surgery syndrome, this condition causes recurring or even worsening pain after the procedure. 

An estimated 8% to 40% of adults who have lumbar spine surgery, including laminectomy, experience chronic or returning back and leg pain after the procedure. 

Returning Spinal Stenosis After Laminectomy

Spinal stenosis, which occurs when the spinal canal narrows and potentially impinges on nearby nerves, can return after laminectomy. This problem can arise if bone tissue regrows at the spinal level that was operated on. This tissue can take up space in the canal, causing symptoms of spinal stenosis like back pain, numbness, tingling, and weakness. 

Recurrent spinal stenosis can also result from ongoing spinal degeneration after the procedure. Degenerative spinal stenosis is often caused by herniated discs, bone spurs, and thickening spinal ligaments – all common age-related spinal changes. 

Scar Tissue From Laminectomy

Scar tissue is a type of fibrous tissue that forms as a response to tissue damage, including the incisions that occur in surgery. It’s a normal part of your body’s healing process and helps replace the damaged tissue. However, scar tissue can also cause pain after spinal surgery and is a prevalent cause of failed back surgery syndrome. 

In some cases, scar tissue forms around the spinal cord or nerves. This is known as epidural fibrosis. The scar tissue can press on the spinal nerves, leading to back pain and neurological symptoms. 

Adjacent Segment Degeneration

Adjacent segment disease, or ASD, is a possible complication of laminectomy with spinal fusion. When two or more vertebrae are fused, it forces the adjacent segments to bear more impact throughout the day. This can cause the adjacent vertebrae and intervertebral discs to gradually break down, causing back pain and other symptoms. 

Some patients who develop adjacent segment disease require reoperation. However, it may be managed with conservative methods, like physical therapy and pain medications, in some cases.  

What Are the Symptoms of Post-Laminectomy Syndrome?

The symptoms of post-laminectomy syndrome are back pain, stiffness, numbness, weakness, and tingling. These symptoms may radiate from the back to the lower extremities. 

With post-laminectomy syndrome, your pain may feel similar or different from the pain you experienced before the laminectomy. It may feel like:

• A dull ache in the back, along the spine
• A sharp or stabbing pain in the back or legs
• A prickling or “pins and needles” sensation in the back or legs

What Causes Post-Laminectomy Syndrome?

As we mentioned in a previous section, the exact cause of post-laminectomy syndrome isn’t always clear. However, some common causes include scar tissue formation, returning spinal stenosis, herniated discs, surgical complications, and adjacent segment disease. 

Post-laminectomy syndrome can also develop if the true cause of your initial symptoms isn’t properly addressed in the procedure. For example, this condition can occur if the impinged nerve isn’t fully decompressed, or a pinched nerve in a neighboring segment isn’t treated.

Can Post-Laminectomy Syndrome Be Cured?

Post-laminectomy syndrome can be cured in many cases with conservative treatments, although corrective surgery is necessary in severe cases. 

Treatment options for post-laminectomy syndrome include:

Physical Therapy

Physical therapy for post-laminectomy syndrome generally includes targeted exercises to strengthen the core and abdominal muscles, along with stretches to reduce muscle tension. Your PT can also provide a personalized exercise plan and complementary therapies (like massage, acupuncture, and electrostimulation) to support your recovery. 

Medications

Medications, including NSAIDs and other types of painkillers, may help you manage the symptoms of post-laminectomy syndrome. Your doctor can provide individualized suggestions based on your symptoms, medical history, and risk of side effects. 

Epidural Steroid Injections and Nerve Blocks

Epidural steroid injections and nerve blocks involve administering steroid medication directly to the affected area of the spine. By dampening the immune response to the injury, these injections may offer temporary pain relief. 

Spinal Cord Stimulation

Spinal cord stimulators are specialized devices that are implanted into the body. It delivers low-level electrical pulses straight to the spinal cord, providing pain relief. This treatment is commonly implemented for cases of failed back surgery syndrome that don’t respond to physical therapy or medications. 

Radiofrequency Ablation

Radiofrequency ablation delivers radiofrequency waves to the affected area of the body. These waves heat the targeted nerve tissue, thus destroying the nerve and blocking its pain signals. As a minimally invasive procedure, this procedure is often considered before reoperation for post-laminectomy syndrome. 

Reoperation

Reoperation for post-laminectomy syndrome is only considered when all other treatments fail. Talk to your spine specialist to learn more about the treatment options available to you.

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The post Post-Laminectomy Syndrome appeared first on Premia Spine.

Keep reading for a complete overview of laminectomy recovery and how to support your body’s healing process.

Table of Contents

• How Bad Is Pain After a Lumbar Laminectomy?
• How Long Does It Take to Recover From Laminectomy Surgery?
• What Are the Do’s and Don’ts After Laminectomy?
• Can You Live a Normal Life After a Laminectomy?

How Bad Is Pain After a Lumbar Laminectomy?

Pain after a lumbar laminectomy is comparable to pain from other spinal procedures. While you can expect to experience back soreness and stiffness, your surgeon will likely prescribe pain medications to make it manageable for the first few weeks. 

If your surgeon doesn’t prescribe medications for pain management, you can ask whether over-the-counter painkillers are right for you. Follow your doctor’s instructions closely, and only take medications as advised. 

Managing Pain After a Lumbar Laminectomy

Aside from pain medications, you can implement various other remedies to manage discomfort after a laminectomy, including:

• Heating pads and warm water bottles

Heat relaxes stiff muscles and helps alleviate soreness after surgery. It also improves blood flow to the treatment area, which can help support recovery. In the first few weeks after the procedure, keep your heating pad set to low and don’t apply heat directly over the incision. Additionally, never fall asleep with a heating pad on!

• Ice packs

Applying ice packs can help bring down pain and inflammation, especially in the early recovery stages. Make sure to wrap the ice pack in a cloth or towel before using it, and ice for 15 to 20 minutes at a time. Never apply ice directly to your skin, as it can cause skin damage. 

• Gentle movement

While you may assume that bedrest will help with your pain after laminectomy, the opposite is actually true. Bedrest causes muscle stiffness and reduces blood flow to the damaged tissue. This can lead to worsened pain and a slower recovery. 

Don’t attempt any exercises until your doctor clears you to do so. However, you can get up and take short walks soon after a lumbar laminectomy, which can help reduce pain. Additionally, targeted stretches and strengthening exercises from a physical therapist offer pain relief. 

• Relaxation

Many people feel tense and stressed out after lumbar laminectomy. After all, it is a major surgery that puts your body through significant trauma. Therefore, relaxation techniques, like deep breathing, meditation, and gentle stretches may help lower your pain (and stress) levels after a laminectomy. 

How Long Does It Take to Recover From Laminectomy Surgery?

It takes between two to six months to fully recover from laminectomy surgery. Recovery times vary depending on the patient’s age, medical history, and how many spinal levels are operated on. 

The recovery process for laminectomy involves several stages, including:

• Early recovery: After staying in the hospital for up to a few days, you’ll have significant activity restrictions for one to two weeks. During this time, your movements may be limited to walking around the house, and you won’t be able to lift objects weighing more than a few pounds. 
• Return to work: If your job doesn’t involve physical labor, you may be able to return to work after two to four weeks. If your job is moderately physically demanding, you may need to wait six to eight weeks. For physically strenuous jobs, you may need to wait up to 12 weeks to return to work after a laminectomy. 
• Return to exercise: Patients are generally cleared to return to gentle, low-impact exercise four to six weeks after laminectomy surgery. Your doctor will likely recommend working with a physical therapist during this period. A PT can work with you to regain muscle strength and mobility without damaging the healing tissue. 

Also, laminectomy with spinal fusion has a longer recovery period than laminectomy without fusion. If fusion is performed to stabilize the affected vertebrae, you’ll likely have a longer hospital stay, and you may need to wait longer to return to work and exercise. This is because bone healing is an involved, demanding process for the body. 

What Are the Do’s and Don’ts After Laminectomy?

The do’s and don’ts after laminectomy include:

• Do: Follow all of your doctor’s aftercare instructions.

This is an absolute must after laminectomy! Every patient is different, and your physician will provide personalized aftercare instructions according to your condition, medical history, family history, and unique needs. Aftercare requirements can also differ based on the details of your laminectomy, like how many spinal levels are affected and whether or not spinal fusion is performed. 

• Don’t: Return to work or physical activity without being cleared by your doctor first. 

It can be tempting to return to work and exercise as soon as possible after spinal surgery. But, even if you’re starting to feel better, doing so without clearance from your doctor may hinder your recovery process. So, always play it safe and check with your physician. 

• Do: Stay mobile with short walks, gentle stretches, and strengthening exercises.

Taking short walks and completing PT-recommended stretches and strengthening exercises after laminectomy can accelerate the healing process. Gentle movements prevent muscle tension, preserve your mobility, and boost blood flow throughout the body. 

• Don’t: Stay in bed for days or weeks on end. 

Some rest is necessary after a laminectomy, but don’t stay in bed longer than you have to. Bedrest can tighten up your muscles, reduce your mobility, and even lead to muscle atrophy. 

• Do: Eat a healthy, nutrient-rich diet.

Eating a nutritious, well-rounded diet after a laminectomy can help manage inflammation and support the body’s healing process. Your body needs nutrients to recover effectively, and your diet in the weeks after the surgery can have a significant impact on your ability to heal. 

• Don’t: Smoke or drink alcohol. 

Smoking and drinking alcohol are detrimental to your spine’s recovery. Nicotine curbs blood flow throughout the body, while alcohol weakens the immune system.

Can You Live a Normal Life After a Laminectomy?

Yes, you can live a normal life after a laminectomy! However, you’ll need to make lifestyle adjustments during the recovery process. 

Many patients can return to all of their normal activities pain-free after a laminectomy. Your physician will provide aftercare instructions to ensure a healthy recovery, while your PT can provide exercises to restore your mobility. By implementing your care team’s recommendations, you can ensure the best possible recovery from a laminectomy and support your spinal health for years to come.

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Before undergoing laminectomy, it’s important to understand the extent of the recovery process. While healing varies from patient to patient, managing your expectations, clearing your schedule, and preparing your home can facilitate an effective recovery. 

Read on to learn about laminectomy surgery recovery and what you can do to bounce back faster. 

Table of Contents

• What is Laminectomy Surgery?
• How Serious Is Laminectomy Surgery?
• How Long Does It Take To Recover From Laminectomy?
• Can You Walk Normally After Laminectomy?
• How Bad Is the Pain After a Laminectomy?
• Does the Bone Grow Back After a Laminectomy?
• Can You Climb Stairs After Laminectomy?

What is Laminectomy Surgery?

Laminectomy surgery is a type of spinal decompression surgery involving the full or partial removal of the lamina. 

The lamina is the part of the vertebra that links the spinous process to the transverse process. It encloses the back of the spinal cord, offering protection and support. 

In individuals with spinal stenosis, spondylolisthesis, or related spinal conditions, removing some or all of the lamina alleviates pain and neurological symptoms from nerve impingement. This makes laminectomy a widely performed procedure for spinal nerve compression. 

How Serious Is Laminectomy Surgery?

Laminectomy surgery is a serious procedure performed under general anesthesia. 

Laminectomy poses the risk of surgical complications, including:

• Bleeding
• Blood clots
• Wound infection
• Adverse reactions to anesthesia

Additionally, as laminectomy requires the surgeon to access the spine, it poses the risk of nerve damage. Though rare, nerve damage in laminectomy surgery may lead to lasting neurological pain, sometimes referred to as post-decompressive neuropathy. 

Since laminectomy is a major, serious surgery, consulting with an experienced, qualified surgeon is crucial. Factors to consider while choosing a spine surgeon include:

• Training and education (a spine surgeon should have undergone premedical school, medical school, and a residency in the field)
• State licensure, and board certification 
• A focus on spinal surgery within their practice
• Many positive online reviews
• The ability to provide testimonials from past patients who underwent a laminectomy
• Good rapport, with the ability to clearly explain the procedure, their success rates, and potential risks during the consultation

How Long Does It Take To Recover From Laminectomy?

It can take one to two months to recover from a laminectomy. 

The recovery period for laminectomy differs based on the age and overall health of the patient. Additionally, the recovery period is longer for laminectomy with spinal fusion compared to procedures without fusion. 

Stages of Laminectomy Recovery

The recovery process after a laminectomy tends to occur in the following stages:

1. Hospital Stay: Patients may need to stay in the hospital for one to four days after laminectomy surgery. Remaining in the hospital allows the staff to monitor the patient for complications. 
2. Home Care: Patients generally need to wait for a few days or weeks to return to light physical activity. In this early stage of recovery, the patient may need assistance around the house. However, the patient is usually advised to practice walking the halls, then up and down the stairs, to begin the recovery process. 
3. Physical Therapy: Physical therapy is an important step in recovering from laminectomy. As soon as your surgeon determines you’re ready, you can begin PT sessions to build strength and regain mobility. 
4. Return to Work: Depending on your profession, you can return to work a few weeks or months after laminectomy. 
5. Complete Recovery: Patients may return to all of their normal activities three months to a year after laminectomy. For laminectomy with spinal fusion, a complete recovery typically takes six to 12 months, with significant restrictions on physical activity.  

Can You Walk Normally After Laminectomy?

You can walk normally a few days or weeks after laminectomy. 

Immediately after laminectomy, you may need assistance from another person or a wheeled walker to walk, stand up, or sit down. However, most patients regain the ability to complete the motions alone within a few days or weeks. Additionally, patients are advised to walk and move around gently after laminectomy to avoid the complications of prolonged bed rest. 

While some bed rest after laminectomy is good to help the body heal, excessive bed rest can hinder the healing process. Gentle movement after the surgery promotes blood flow to the treatment site, prevents muscle atrophy, and builds strength. 

How Bad Is the Pain After a Laminectomy?

The pain after a laminectomy is often described as stiffness or soreness. Surgeons generally prescribe medications to manage the pain after a laminectomy, so the discomfort is tolerable.

You can prevent and reduce the pain after a laminectomy by:

• Closely following all of your physician’s aftercare instructions
• Preparing your home before the surgery so that you don’t have to reach for essential items
• Using a heating pad, warm water bottle, or warm cloth to ease soreness around the surgical site (don’t apply heat directly over the site)
• Taking all prescribed medications as advised
• Moving around gently after the procedure, as soon as you’re able
• Attending all physical therapy appointments after the surgery
• Wearing a brace, if prescribed, particularly while walking or sitting

Does the Bone Grow Back After a Laminectomy?

The bone can grow back after a laminectomy. 

According to a 2019 study published in Interdisciplinary Neurosurgery, bone regrowth after laminectomy and laminotomy most commonly occurs in the lumbar laminae and facets. Bone regrowth has been reported in up to 94% of laminectomy and laminotomy patients. 

With that said, the lamina won’t fully regrow after a laminectomy. While some bone regrowth may occur, it won’t replace the lamina that has been removed. 

In laminectomy with spinal fusion, bone must grow around the graft to fuse the vertebrae. If this growth doesn’t occur, it’s known as failed fusion or pseudoarthrosis, and revision surgery may be required. 

Can You Climb Stairs After Laminectomy?

You can climb stairs a few days or weeks after laminectomy. 

It’s advised to take it easy when climbing stairs after spinal surgery. Don’t attempt to climb stairs until you’ve been comfortably walking around for a few days. Only climb stairs once or twice daily in the first few weeks after the surgery.

Climbing stairs too often in the early stages of your laminectomy recovery may place excess stress on the spine and hinder the body’s healing process. 

Laminectomy and TOPS System

Laminectomy and the TOPS System is a modern treatment option for spondylolisthesis and lumbar spinal stenosis. 

The TOPS System is an alternative to spinal fusion with laminectomy. Spinal fusion permanently fuses the affected vertebrae, which can limit the patient’s mobility and cause adjacent segment degeneration. Spinal fusion also significantly slows down the recovery process and requires a longer hospital stay. 

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TOPS is a dynamic implant that stabilizes the spine without rigid spinal fixation. It creates a controlled range of motion in all directions, allowing patients to return to physical activity much faster and more successfully. In preserving spinal mobility, TOPS also prevents imbalanced stress on the vertebrae, which can lead to adjacent segment degeneration.

The FDA has approved the TOPS System (for lumbar spondylolisthesis and spinal stenosis) and granted it a superiority-to-fusion claim. Combined with laminectomy, the TOPS System can effectively alleviate lower back pain, tingling, numbness, and weakness.

Find a provider near you today to learn more about laminectomy with TOPS for lumbar spondylolisthesis and spinal stenosis. 

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Many different procedures fall under the umbrella of spinal decompression surgery. Designed to ease compression on the spinal cord and nerves, spinal decompression is widely used to treat spinal stenosis, spondylolisthesis, slipped discs, and related conditions. 

A lumbar hemilaminectomy is one type of spinal decompression surgery. Although this procedure is similar to lumbar laminectomy, it has a few key differences. 

In this article, we’ll discuss how lumbar hemilaminectomy and laminectomy are different. We’ll also go over the non-surgical and minimally-invasive alternatives to hemilaminectomy that are available to patients. 

What Are The Lamina of The Spine?

Before we explain lumbar hemilaminectomy surgery, it’s crucial to explain the role of the laminae in the spine. Each spinal bone, called a vertebra, contains two laminae. The laminae form a protective cover for the spinal canal.

The lamina also links the spinous process to the transverse process within a vertebra. The spinous process is a small section of bone that protrudes from the back of the spinal cord; the transverse process is another section of bone that serves as a connection point for the back muscles and ligaments to the spine. 

Lumbar Hemilaminectomy vs. Laminectomy

Lumbar hemilaminectomy and laminectomy are both types of spinal decompression surgery. While these procedures are very closely related, there’s one key difference between them. 

What is a Hemilaminectomy?

In a laminectomy, the surgeon removes both of the laminae from the targeted vertebrae. However, in hemilaminectomy, the surgeon discards just one lamina from each vertebra. Specifically, the surgeon will only remove the lamina on the side of the spinal canal that’s experiencing nerve compression. 

Lumbar hemilaminectomy and lumbar laminectomy are both performed on the lumbar (lower) spine. Although it’s less common, thoracic and cervical hemilaminectomy and laminectomy can also be performed. 

Note that patients who require decompression on both sides of the spinal canal will likely require a laminectomy, rather than a hemilaminectomy. 

The Goal of Lumbar Hemilaminectomy

Lumbar hemilaminectomy and laminectomy share a common goal: To open up additional space in the spinal canal and resolve nerve compression. By releasing the pressure on spinal nerves, lumbar hemilaminectomy can give patients relief from back pain and stiffness, along with tingling and numbness in the legs. 

Conditions That Can Require Lumbar Hemilaminectomy vs. Laminectomy

Laminectomy

The predominant indication for laminectomy is spinal stenosis. 

Spinal stenosis is a condition that’s characterized by the gradual reduction of space in the spinal canal. With nerves and the spinal cord located in the spinal canal, this condition can trigger nerve compression. 

Key signs and symptoms of spinal stenosis include:

• Back pain
• Cramping in the legs
• Sciatica, which refers to nerve pain that moves from the back to the buttocks and legs
• A pins and needles sensation in the legs, feet, or buttocks
• A heavy sensation in the legs
• In instances of severe spinal stenosis, lost bladder or bowel control

Laminectomy helps relieve symptoms of spinal stenosis by removing pressure from the spinal nerves. Additionally, by creating more space in the spinal canal, a laminectomy can provide a better environment for damaged tissue to heal. 

Hemilaminectomy

Hemilaminectomy is most often performed to treat a herniated disc. Also known as a slipped or ruptured disc, this common spinal injury can cause pain, stiffness, and tingling or weakness in the legs. 

In between each of the spine’s vertebrae, there’s a cushion-like disc. The intervertebral discs protect the vertebrae from damage by absorbing impact and facilitating motion. 

Whether due to age-related changes to the spinal discs, a sudden injury to the spine, or repeated strain on the spine, intervertebral discs can become damaged. The soft interior of the disc can protrude from a break in the disc’s tough outer layer, causing a herniated disc. 

To cure the symptoms of a herniated disc that isn’t resolved with non-invasive treatment methods, patients may require both hemilaminectomy and discectomy. 

Hemilaminectomy and Discectomy

A discectomy is a surgical procedure that’s performed to treat a herniated disc. It involves removing some or all of a damaged intervertebral disc to alleviate pressure on the adjacent spinal nerves. 

During a discectomy, surgeons aim to leave as much of the disc as possible alone. However, in severe cases, the full spinal disc may need to be removed to fully alleviate the patient’s symptoms. 

Lumbar hemilaminectomy and discectomy are often performed together in a single procedure to treat a herniated lumbar disc. By removing both the damaged disc and the lamina, the procedure can effectively resolve nerve compression caused by a slipped disc. 

Spinal Fusion With Lumbar Hemilaminectomy

To avert spinal instability after lumbar hemilaminectomy, spinal fusion may be performed. This spinal procedure involves placing bone graft material between the affected vertebrae. Over time, the graft will stimulate bone growth and fuse the vertebrae, forming one bone. 

Although spinal fusion can provide stability in lumbar hemilaminectomy, it has downsides including:

Recovery Period

Spinal fusion can prolong your lumbar hemilaminectomy recovery by a significant margin. Alone (without fusion), the hemilaminectomy recovery period typically lasts a total of around 4 to 6 weeks. 

Patients can require a year or more to make a full recovery from spinal fusion. Additionally, it may take as long as 4 to 6 weeks for young, healthy individuals with sedentary professionals to return to work after the procedure. For older patients, it can take up to 6 months to get back to work after fusion. 

Spinal Flexibility

Though spinal fusion can effectively prevent instability after hemilaminectomy, it presents a large risk of reduced mobility. Patients who undergo fusion often lose flexibility in the spine and aren’t able to bend or flex the spine like they used to. 

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To gain spinal stability after hemilaminectomy without compromising your spinal flexibility, you may want to consider a spinal fusion alternative. Spinal devices like the TOPS System can stabilize the spine while retaining the motion of the affected vertebrae.

Alternatives to Lumbar Hemilaminectomy

While hemilaminectomy can successfully resolve nerve compression for many patients, it’s rarely the only treatment option. Patients can also consider non-surgical treatments and minimally-invasive spine surgery. 

Non-Invasive Treatments

There are a variety of non-invasive treatments that can help alleviate pain and promote healing for patients with a herniated disc. Options include:

• Physical therapy
• Chiropractic care
• Massage therapy
• Acupuncture 
• Rest and lifestyle modifications
• Pain medications
• Epidural steroid injections

Note that certain non-invasive treatments, including pain medications and epidural steroid injections, often aren’t considered long-term solutions for chronic back pain. Steroid injections should only be administered a few times per year to avoid tissue damage. 

Minimally-Invasive Hemilaminectomy

Spinal implants such as the TOPS spinal implant can support minimally-invasive hemilaminectomies. Minimally-invasive surgery, or MIS, typically involves a smaller incision, less blood loss, and less anesthesia. 

Minimally-invasive procedures are always preferable to conventional procedures because they provide a reduced risk of complications, shorter recovery period, and less postoperative pain. By reducing the need for fusion, MIS spinal implant systems offer these benefits for hemilaminectomy patients. 

If you’re suffering from symptoms of a chronic spinal condition, talk to your doctor about the range of treatment options available to you. 

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Here, we’ll discuss the key differences between laminotomy and laminectomy, including when each procedure may be implemented and how to determine the right treatment for your needs. 

Laminotomy and Laminectomy: What’s The Difference?

Laminotomy and laminectomy are both considered spinal decompression surgeries. Both affect the lamina of the spine, which creates the roof of the spinal canal. The procedure is intended to increase the amount of space around the spinal cord to relieve compression and the symptoms that it causes.  

In laminotomy or laminectomy, your surgeon will make an incision along the back and remove some, most, or all of the lamina. If required, your surgeon may also perform a discectomy (removal of a spinal disc) and/or foraminotomy (enlargement of the passageway for a spinal nerve root). 

Spinal fusion is another common step in laminotomy and laminectomy to restore spinal stability. However, spinal implants like the TOPS System can be used as a safer, more effective alternative to spinal fusion in spinal decompression surgery. We’ll discuss this in greater detail below. 

Understanding Laminectomy

During a laminectomy, a surgeon takes out most or all of the lamina. This is considered major surgery and typically isn’t performed unless more conservative treatment options have failed. Laminectomy may be performed on the cervical, lumbar, sacral, or thoracic spine. 

Understanding Laminotomy 

In laminotomy, the surgeon takes out a small piece of the lamina. This differentiates it from laminectomy, during which most of the lamina is removed.

The goal of laminotomy is generally to remove just enough of the lamina to lessen the pressure on a specific part of the spine. Like laminectomy, laminotomy can be done on the cervical, lumbar, sacral, or thoracic spine. 

Laminotomy may involve one or multiple vertebrae. When it affects just one vertebra it’s referred to as single-level laminotomy; when it affects multiple vertebrae, it’s known as multilevel laminotomy. 

Reasons to Undergo Laminotomy vs. Laminectomy

Since laminotomy and laminectomy are types of spinal decompression surgery, both are generally recommended for patients with spinal cord compression from conditions like spinal stenosis, herniated disc, and bone spurs.

When spinal cord compression leads to myelopathy or impaired spinal cord function, laminotomy or laminectomy may be suggested. Symptoms of myelopathy include:

• Weakness, tingling, or numbness
• Difficulty walking
• Poor balance
• Trouble with fine motor skills
• Lost urinary or bowel control
• Pain in the lower back, arm, leg, or neck

Laminotomy involves a smaller incision and causes less damage to surrounding tissues than a laminectomy. So, surgeons generally try to perform laminotomy over laminectomy whenever possible. However, if the degree of spinal compression is too severe to be resolved with laminotomy, laminectomy may be required. 

Alternatives to Laminotomy and Laminectomy

Patients struggling with symptoms of myelopathy will typically undergo non-surgical treatments before spinal surgery is considered. These may include:

• A healthy lifestyle

An exercise regimen and a balanced diet can help patients manage spinal discomfort.

• Physical therapy

Physical therapy may also be suggested to reduce pain and improve balance within the body. A physical therapist can give patients exercises to release pressure in the spine without surgery. 

• Medications 

Medications may be recommended for patients with severe pain from spinal compression. This can help with day-to-day pain management, but may not be a long-term solution. 

When non-surgical treatment methods fail to offer relief from symptoms of spinal compression, doctors often recommend spinal decompression surgery so that patients can attain a higher quality of life.  

Conditions That May Require Laminotomy or Laminectomy

As aforementioned, some of the most common procedures that lead to spinal decompression surgery include spinal stenosis, herniated spinal disc, and bone spurs. 

• Spinal stenosis

Spinal stenosis is a condition that occurs when the spaces in the spine narrow. This can place added stress on the spinal nerves, leading to symptoms like numbness, tingling, muscle weakness, pain, and sciatica.

Laminotomy or laminectomy can help treat spinal stenosis by opening up space in the spine. 

• Herniated spinal disc

A herniated disc (or slipped disc) develops when the soft interior of one of the spinal discs presses out through a crack in the disc’s tough exterior. The protruding center of the disc can press on nearby nerves, leading to pain, weakness, and numbness.

Spinal decompression surgery can release the pressure on the affected nerves for symptom relief. 

• Bone spurs

Bone spurs are bony lumps that form off of an existing bone. Osteoarthritis is the most prevalent cause of bone spurs, and symptoms of them include pain, stiffness, weakness, numbness, tingling, and muscle spasms.

During spinal decompression surgery, bone spurs can be removed to relieve the added pressure on the spinal cord or nerves. 

Recovering from Laminotomy and Laminectomy

Since laminotomy is a moderately less involved procedure than laminectomy, it can have a faster recovery period. However, most patients need several weeks (often between four and six weeks) to fully recover from laminotomy or laminectomy. 

Laminotomy and laminectomy can both be outpatient procedures, meaning that you can return home on the same day as the surgery. That said, if spinal fusion is performed along with spinal decompression surgery, patients may need to remain in the hospital for up to four days. 

After you return home from laminotomy or laminectomy, get plenty of rest. In the first several days after your spinal procedure, ask for help from loved ones for chores around the house and other essentials, like grocery shopping.

You should also take a break from work for a few weeks following spinal decompression surgery. Taking time off now will ultimately speed up your recovery and ensure optimal results from the procedure. Your doctor will also likely recommend physical therapy to support your recovery process 

Spinal Fusion in Laminotomy and Laminectomy

Spinal fusion is commonly performed with laminotomy or laminectomy. In spinal fusion, the doctor permanently connects, or fuses, two vertebrae. Eventually, the vertebrae will form one bone, which can counter instability. 

Although spinal fusion is commonly performed, it can make either laminotomy or laminectomy a more traumatic procedure. Spinal fusion slows down the recovery process and removes motion at the fused level. 

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Spinal Implants: An Alternative to Spinal Fusion in Laminotomy and Laminectomy

Spinal implants like the Premia Spine TOPS System can reduce the trauma and recovery period associated with laminotomy and laminectomy. The TOPS system is implanted into the treatment area after spinal decompression surgery to provide stability while preserving the patient’s range of motion in the spine. 

While spinal fusion prevents motion in the affected vertebrae, TOPS implants move with the body. It stabilizes the spine so that the patient can move comfortably. With the TOPS device, it’s possible to secure the spine without compromising the patient’s flexibility. 

Improved Recovery With The TOPS System

A TOPS System Implant allows for an easier recovery period after laminotomy or laminectomy. Compared to conventional spinal fusions, surgery with the TOPS device allows patients to return to their normal activities faster.   

If you’re suffering from debilitating pain due to spinal compression, laminotomy or laminectomy may be your path to a more comfortable, pain-free life. The TOPS spinal implant can make either of these spinal decompression procedures less traumatic. For more information, reach out to Premia Spine. 

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