Neuro Surgery

Laminectomy is a spine operation to remove the portion of the vertebral bone called the lamina. There are many variations of laminectomy, in the most minimal form small skin incisions are made, back muscles are pushed aside rather than cut, and the parts of the vertebra adjacent to the lamina are left intact. The traditional form of laminectomy (conventional laminectomy) excises much more than just the lamina, the entire posterior backbone is removed, along with overlying ligaments and muscles. The usual recovery period is very different depending on which type of laminectomy has been performed: days in the minimal procedure, and weeks to months with conventional open surgery.

The lamina is a posterior arch of the vertebral bone laying between the spinous process, which juts out in the midline, and the more lateral of each vertebra. The pair of lamina, 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, the operation called conventional laminectomy, which is a standard spine procedure in neurosurgery and orthopedics, removes the lamina, spinous process and overlying connective tissues and ligaments, cutting through the muscles that overlie these structures. Minimal surgery laminectomy is a tissue preserving surgery that leaves the muscles intact, spares the spinal process and takes only one or both lamina. Laminotomy is 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: (1) break the continuity of the rigid ring of the spinal canal to allow the soft tissues within the canal to expand (decompression), or (2) as one step in changing the contour of the vertebral column, or (3) in order to allow the surgeon access to deeper tissues 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.

Conventional open laminectomy often involves excision of the posterior spinal ligament, and some or all of the spinous process, and facet joint. Removal of these structures, in the open technique, requires cutting the many muscles of the back which attach to them. Laminectomy performed as a minimal spinal surgery procedure, however, allows the bellies of muscles to be pushed aside instead of transected, and generally involves less bone removal than the open procedure.

The success rate of laminectomy depends on the specific reason for the operation, as well as proper patient selection and technical ability of the surgeon. Indications for laminectomy include (1) treatment of severe spinal stenosis by relieving pressure on the spinal cord or nerve roots, (2) access to a tumor or other mass lying in or around the spinal cord, or (3) a step in tailoring the contour of the vertebral column to correct a spinal deformity such as kyphosis. The actual bone removal may be carried out with a variety of surgical tools, including drills, rongeurs, and laser.

The recovery period after laminectomy depends on the specific operative technique; minimally invasive procedures having a significantly shorter recovery period than open surgery. Removal of substantial amounts of bone and tissue may require additional procedures to stabilize the spine, such as fusion procedures, and spinal fusion generally requires a much longer recovery period than simple laminectomy.

Most commonly, laminectomy is performed to treat spinal stenosis.

Spinal Instrumentation utilizes surgical procedures to implant Titanium, Titanium-alloy, Stainless Steel, or non-metallic devices into the spine. Instrumentation provides a permanent solution to spinal instability. Medical implants are specially designed to come in many shapes and sizes. Typically these include rods, hooks, braided cable, plates, screws, and more recently - threaded interbody cages.

Spinal Fusion is a process using bone graft to cause two opposing bony surfaces to grow together. In medical terminology, this is called Arthrodesis. Bone graft can be taken from the patient's pelvis (termed autogenous bone) during the primary surgical procedure or harvested from other individuals (termed allograft bone). Another option for some patients is Bone Morphogenetic Protein (BMP). BMP stimulates the body to make bone. The patient is usually positioned face down on an operating frame. A small incision (usually about 3-4 inches, though it may be longer depending on how many levels of the spine are affected) is made in the lower back.

The surgeon uses a retractor to spread apart the muscles and fatty tissue of the spine and exposes the lamina. A portion of the lamina is removed to uncover the ligamentum flavum - an elastic ligament that helps connect two vertebrae.

Next an opening is cut in the ligamentum flavum in order to reach the spinal canal. Once the compressed nerve can be seen, the cause of compression can be identified. Most cases of spinal compression are caused by a herniated disc. However, other sources of pressure that can cause compression may include:

1 - A disc fragment (this will often cause more severe symptoms)
2 - An osteophyte or bone spur (a rough protrusion of bone)
3 - Protruding/degenerating discs
4 - Facet arthritis and/or cysts
5 - Tumors

The surgeon retracts the compressed nerve and the source of the compression is removed and pressure on the spinal nerve or nerve components is relieved

If necessary, the surgeon will perform a spinal fusion with instrumentation to help stabilize the spine. This occurs when a lot of bone needs to be removed and/or when multiple levels are operated on. A spinal fusion involves grafting a small piece of bone (usually taken from the patient's own pelvis) onto the spine and