Laminectomy and spinal fusion
Laminectomy and spinal fusion are surgical procedures aimed at addressing severe back pain and spinal conditions. Laminectomy involves removing one or more laminae, the flattened sections of the vertebral arch, to relieve pressure on the spinal cord, which can alleviate pain and associated bowel or bladder issues. This procedure is often performed when conditions like osteoarthritis, scoliosis, or spondylolisthesis cause significant discomfort and dysfunction.
Spinal fusion, which is sometimes indicated after laminectomy, aims to immobilize the spine using steel rods or bone grafts to stabilize areas with abnormal motion between vertebrae. Both surgeries are major procedures performed under general anesthesia and involve certain risks, including blood loss and potential complications related to spinal cord exposure.
Recovery can be lengthy, often requiring several weeks of rest followed by the use of a plaster cast to support the healing spine, which may take up to six months. While many patients experience relief from pain post-surgery, some may face new discomfort in different areas of the spine due to the added stress on surrounding structures, potentially necessitating further surgical intervention.
Subject Terms
Laminectomy and spinal fusion
Anatomy or system affected: Back, bones, spine
Definition: Surgical procedures that join two or more vertebrae, the arching bones that make up the spine.
Indications and Procedures
Laminectomies, which are designed to relieve pressure on the spinal cord, are often performed as the initial surgery in cases of extreme back pain caused by the compression of the spinal canal. An incision is made in the patient’s back to expose the laminae, the flattened portions of the vertebral arch, and one or more adjacent laminae are chipped away. On occasion, several laminae are excised.
In such cases, spinal fusion, which involves the immobilization of the spine with steel rods or bone grafts, is indicated. Spinal fusion, like laminectomy, a major surgery done under general anesthesia, is performed if X-rays reveal unusual motion between adjacent vertebrae.
The causes of the severe back pain that usually precedes laminectomy or spinal fusion may be related to three conditions: osteoarthritis, which causes deterioration of the spinal joints; scoliosis caused by an injury or tumor that is destroying vertebrae; or spondylolisthesis, the dislocation of facet joints. In spinal fusion, when the damaged vertebrae are exposed, joint fusion is sometimes performed by using bone chips from the patient’s pelvis. Following surgery, the vertebrae are held in place with plates or screws.
Uses and Complications
Both laminectomy and spinal fusion usually relieve the persistent back pain that has caused patients to seek treatment. Laminectomy may also be used to relieve bowel and bladder problems caused by the pressure and pain. Such surgery involves distinct risks since the spinal cord is exposed, and there is often considerable blood loss. In the hands of a seasoned orthopedic surgeon, however, the risk is minimized.
Recovery from the surgery can be slow and often involves up to six weeks of confinement in bed. After this confinement, patients are usually required to wear a plaster cast until final vertebral fusion has occurred. This process can take half a year.
Fusion sometimes places an additional burden on the rest of the spinal column. In some cases, this pressure results in renewed back pain in other areas of the spine. Additional surgery may be indicated to control this pain.
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