Decompressive Laminectomy, Possible Fusion

 Decompressive Laminectomy is a surgical procedure to remove bony pressure on the spinal canal and/or spinal nerves.  This can also involve a fusion if a lot bone has been removed and the spine would be unstable without support from a fusion.

 Preparing for Surgery

Once you have decided to have surgery, the following events take place:

  • You will be asked to have a medical examination by either your doctor or a doctor associated with Orthopaedic and Spine Institute.
  • You will be scheduled for a chest x-ray, EKG and blood work at Orthopaedic and Spine Institute or the hospital.  You may also be required to obtain a bone mineral density exam.
  • You may be asked to have a neurological or psychological examination.
  • If you take aspirin or anti-inflammatory medications daily, STOP these medications at least one week before your surgery.
  • If you take prescription pain medications or other drugs ask your doctor how soon before surgery you should stop taking them.
  • If you check into the hospital the morning of surgery, it is important that you have nothing to eat or drink after midnight the night before your surgery.
  • You are asked not the eat or drink anything up to 6-8 hours before surgery.
  • Prior to surgery you will be asked to sign permits for surgery and anesthesia.  You will be asked to sign blood and blood product permits.  Blood other than your own (if donated) or blood products will be given only in the event there is a problem during surgery.
  • The cell saver may also be used.  This machine collects any blood loss during surgery, washes it and this solution is given back to you.

During Surgery 

  • An incision is made in the center of your back at the level of your pathology.  The length depends on the number of levels to be explored.
  • Muscles and tissue are separated and the decompression begins.  This is done by removing small pieces of bone and ligament that are causing the pressure on the spinal canal and nerves.
  • If a discectomy is performed, the nerves are gently pulled aside to gain access to the disc space and the disc is removed.
  • Fusions are performed to add strength and stability to your spine.  In this procedure a fusion will be done if your surgeon feels the amount of bone removed to do the decompression will result in your spine being unstable.
  • Fusions involve a bone graft which is usually obtained through the same incision over your iliac crest or may involve the use of a bone morphogenic protein substance instead of your bone.
  • Your back muscles will help hold the bone graft in place.
  • The decision to use instrumentation and what kind of instrumentation is often made at the time of surgery.
  • Facet screws are placed into the facets, locking one to the other.
  • If pedicle screws are needed, they are placed into the body of the bone.
  • Two screws are usually used at each level, one on each side of the spine; rods, clamps or plates are then applied to the screws.
  • A drain may be placed under your back muscles to keep bloody drainage from collecting beneath the incision.  It will be removed the 2nd day depending on the amount of drainage.
  • Your surgery will usually take 2-4 hours or more.

After Surgery

  • You will be in the recovery room for 1-1.5 hrs.
  • Your surgeon will contact your family while you are in the recovery room.
  • You will be able to manage or relieve your pain by using a PCA pump.  This machine controls the amount of medication you can receive.
  • The staff will help get you out of bed shortly after surgery.
  • You may be asked to wear a brace or corset for post-op activities.
  • The therapist will give you exercises to do once you return home.
  • The nurse will give you any prescriptions and special instructions regarding your care.
  • You will be able to ride in a car or plane upon leaving the hospital.

 

 

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