Nowadays, of all diseases, pathologies of the spinal column are the most common. Some of these diseases are treated with special massages, and almost all of the rest are treated with appropriate therapy.
Laminectomy of the spine
“Almost” is because some spinal pathologies can be treated with only one known method: through surgery. Moreover, the most common type of surgical intervention on the human spinal column is spinal laminectomy.
Something about the structure of this part of the body
The spine of each person is a kind of chain of 33-34 vertebrae. Each such “link” has a body (it has the task of being a support), as well as a semicircular arc. Processes extend from the latter. Of these, the largest is the spinous one, palpable by pressing on the back. The arch also has a pair of transverse and four articular processes. The joints are located two at the top and bottom, and so that there are also two on the right and left.
It is important to know. Between the vertebrae there are intervertebral discs. This is the fibrous ring, which contains the nucleus pulposus.
The arrangement of the vertebral arches forms a canal, also called the vertebral canal. This is where a very important organ is located - the spinal cord. This is where the nerve roots begin. They extend through the foraminal openings located in the spaces between the articular processes of adjacent vertebrae.
The structure of the spine is quite complex, and all its components “work” harmoniously
Of course, in order to provide the nerve with good access to the spinal canal during any pathological changes, the spinal arch should be removed from the patient’s body. Moreover, it is often necessary to remove several adjacent arches.
The spine is a rather complex part of the body, so each element in it is of great importance: it is enough to remove just one of its parts, and all neighboring parts will work significantly worse.
For this simple reason, operations are never performed here unless absolutely necessary. It arises only if it becomes obvious that there is no longer a single method of getting rid of the pathology.
Removal of tumors of the spine and spinal cord
Recurrent back pain is a common problem. Most cases of pain are the result of normal strains and strains or degenerative changes that occur with age. But sometimes the cause of pain can be a spinal tumor - a malignant or benign neoplasm that develops in the spinal cord, its membranes or in the bones of the spine.
In most organs, benign tumors do not pose much of a threat. But with regard to the spinal cord, things can happen differently. A spinal tumor or any type of tumor can affect the nerves, resulting in pain, neurological damage, and sometimes paralysis.
A spinal tumor, benign or malignant, can be life-threatening and disabling. However, advances in the treatment of spinal tumors offer treatment options not previously available to patients with this disease.
Symptoms
Back pain is the most common symptom of both benign and malignant spinal tumors. The pain can often be worse at night or upon waking. It can also spread through the spine to the hips, legs, feet or arms and can get worse over time despite treatment.
Depending on the location and type of tumor, other signs and symptoms may develop, especially as the cancer grows and affects the spinal cord or nerve roots, blood vessels, or bones of the spine.
Spinal tumors progress at different rates. In general, malignant tumors grow quickly, while benign tumors can grow slowly, sometimes existing for several years before problems arise.
Types of spinal tumors
Spinal tumors are classified according to their location in the spine.
Epidural tumors
Most tumors that affect the vertebrae spread (metastasize) to the spine from another location in the body, often the prostate, breast, lung, or kidneys. Although primary cancer is usually diagnosed before significant back problems develop, back pain may be the first symptom of the disease in patients with metastatic spinal tumors.
Cancers originating in the bones of the spine are less common. These include osteosarcomas (osteogenic sarcomas), the most common type of bone cancer in children, and Ewing's sarcoma, a particularly aggressive tumor that affects young people. Multiple myeloma is a cancer of the bone marrow—the porous interior of bone that produces blood cells—that most often develops in adult patients.
Benign tumors such as osteoid osteomas, osteoblastomas, and hemangiomas can also develop in the bones of the spine, causing long-lasting pain, curvature of the spine (scoliosis), and neurological impairment.
Subdural tumors
These tumors develop in the dura mater of the spinal cord (meningiomas), in the nerve roots emerging from the spinal cord (schwannomas and neurofibromas), or at the base of the spinal cord (ependymomas). Meningiomas most often develop in women aged 40 years and older. They are almost always benign and are easy to remove, but sometimes they can recur. Nerve root tumors are usually benign, although neurofibromas, with prolonged growth and large tumor sizes, can develop into malignant ones. Ependymomas located at the end of the spinal cord are often large in size; their treatment can be complicated by fusion of the tumor with the roots of the cauda equina located in this area.
Intramedullary tumors
These tumors originate inside the spinal cord. Most are astrocytomas (which most often develop in children and adolescents) or ependymomas, the most common type of spinal cord tumor in adults. Vascular hemangioblastomas of the spinal cord are often intramedullary tumors. Intramedullary tumors can be either benign or malignant and, depending on their location, they can cause numbness, loss of sensation, or changes in bowel or bladder function. In rare cases, tumors from other parts of the body can metastasize to the spinal cord.
When to see a doctor
Most often, back pain is not associated with a spinal tumor. But because early diagnosis and treatment are important aspects of back problems, see your doctor if you have persistent back pain that is unrelated to your activity, gets worse at night, and doesn't get better with pain relievers. Signs and symptoms such as progressive muscle weakness or numbness in the legs or changes in bowel or bladder habits require immediate medical attention.
Examination and diagnosis
Spinal tumors can sometimes go undiagnosed because they are rare and their symptoms resemble those of more common diseases. For this reason, it is especially important that the doctor obtain a complete history and perform a physical and neurological examination. If a spinal tumor is suspected, your doctor may order one or more of the following tests to confirm the diagnosis and identify the location of the tumor:
Magnetic resonance imaging (MRI). Instead of radiation, MRI uses powerful magnetic and radio waves to produce cross-sectional images of the spine. MRI clearly shows the spinal cord and nerves and provides better images of bone tumors than computed tomography (CT). You may have a contrast agent injected into a vein in your hand or forearm, which can help identify some tumors. In addition, scanners with high signal intensity are used to detect small tumors that may be missed.
Computed tomography (CT). This test uses narrow X-ray beams to produce a detailed cross-sectional image of the spine. Sometimes a contrast agent is injected to more clearly identify pathological changes in the spinal canal or spinal cord. Although the test is not invasive, it exposes the patient to more radiation than a regular X-ray.
Myelography. During myelography, a contrast agent is injected into the patient's spinal canal. The contrast agent then travels through the spinal cord and spinal nerves and appears white on X-rays and CT images. Because this test carries more risks than an MRI or traditional CT scan, myelography is not usually the first choice for diagnosis, but it may be used to identify compressed nerves.
Biopsy. The only way to determine whether a tumor is benign or cancerous is to examine a small sample of tissue (biopsy) under a microscope. How the sample is obtained depends on the patient's health and the location of the tumor. The doctor may use a thin needle to remove a small amount of tissue, or a sample may be obtained during surgery.
Treatment
Ideally, the goal of treating a spinal tumor is complete removal, but this goal is complicated by the risk of permanent damage to surrounding nerves. Doctors must consider the patient's age, general health, type of tumor, and whether it is primary or has spread to the spine from other organs (metastasized).
Treatment options for most spinal tumors include:
Operation
This is often the first step in treating a tumor that can be removed with an acceptable risk of nerve damage.
New techniques and tools are allowing neurosurgeons to access tumors that were previously inaccessible. Powerful microscopes used in microsurgery make it possible to differentiate between tumor and healthy tissue. Doctors can probe various nerves during surgery using electrodes, reducing the possibility of neurological damage. In some cases, doctors may use an ultrasonic aspirator, a device that uses ultrasound to destroy the tumor and remove remaining fragments.
Even taking into account modern advances in the treatment of tumors, not all of them can be completely removed. Surgical removal is the best option for many intramedullary and subdural tumors, but large ependymomas located in the terminal spine may not be removed due to the large number of nerves in this area. Although benign tumors in the vertebrae can usually be completely removed, metastatic tumors are usually not resectable.
Recovery from spine surgery can take weeks or months, depending on the surgery. You may have temporary loss of sensation or other complications, including bleeding and damage to nerve tissue.
Radiation therapy
This therapy is used after surgery to destroy remaining tissue that cannot be removed or to treat inoperable tumors. This treatment is usually the first-line treatment for metastatic tumors. Radiation may also be used to relieve pain or if surgery carries too many risks.
Chemotherapy
The standard treatment for many types of cancer, chemotherapy has not proven beneficial for many spinal tumors. However, there may be exceptions. Your doctor will determine whether chemotherapy alone or chemotherapy plus radiation therapy will help you.
What is a laminectomy?
This is the removal of the vertebral arch. Moreover, it can be done separately or as a preparatory stage for some other operation, in which this allows access to where the main operation will be carried out. However, the second option is not at all common, since now medicine and technology are well developed and the need for something like this arises quite rarely. During a laminectomy, either spinal stenosis, compression of the spinal cord nerves, or both are corrected.
Laminectomy is a type of surgery on the spinal column.
In the lower back, laminectomy is performed in most cases to free the nerve root that is compressed due to lumbar stenosis. In the process, the muscles are stretched and tissue incisions are made longer than during a discectomy - from forty to one hundred millimeters along the midline. In the process, the lateral muscles are cut off from the vertebral arches.
Contraindications
This operation is not prescribed in the following situations:
- on the appointed day the patient has any infections or inflammations. Laminectomy should be done no earlier than the sixteenth day after complete recovery from these pathologies;
- pregnancy;
- decompensated heart failure;
- diabetes in the extreme stages of development of pathology;
- severe disease of any organ other than the spine;
- hemophilia.
This type of spinal surgery has some contraindications
Surgical procedures on the thoracic spine
The list of surgical procedures on the thoracic spine is almost no different from traditional ones, but the operation can be done in a slightly different way, since the chest is protected by the ribs in front, and vital organs (heart and lungs) are nearby. Typically, surgeries on the thoracic spine are performed through a posterior approach, but the results are unsatisfactory because some areas cannot be accessed from the rear.
In recent years, surgeons have begun to use an anterior transthoracic approach along with a posterolateral (posterior and lateral) approach. Although the anterior approach is more complex, it allows for more positive results in the treatment of herniated discs and degenerative back diseases.
What types of laminectomy are there?
This operation on the spinal column is performed according to one of several existing options. It is chosen based on the current state of the spine and the type and characteristics of the pathology. Here are the techniques that are now used in orthopedics, vertebrology, and neurosurgery.
Table No. 1. Laminectomy methods.
| Name | Description |
| Hemilaminectomy | It is an operation to remove the arch of one vertebra from one side or the arches on the right and left simultaneously. In this case, the doctor leaves the spinous processes. For some diseases of the spinal column, it may be advisable to divide the operation into two stages: in the first stage, decompression of the most affected spinal cord roots is performed, and a course of intensive drug and physiotherapeutic therapy is carried out. If, as a result, the patient’s condition does not improve, a second stage of surgical intervention is proposed - wider decompression (bilateral hemilaminectomy) and the creation of additional reserve spaces, for example, if it concerns spinal canal stenosis. |
| Interlaminar laminectomy | A technique that allows you to remove part of the yellow ligament, as well as the arch of the patient and neighboring vertebrae. |
| Total surgery | An operation in which both the vertebral arch and its spinous process are removed. |
| Osteoplastic laminectomy | This option is an operation after which a laminectomy is performed, and then the defects are closed using autologous bone material, artificial tissue, or, alternatively, an allograft. |
There are several types of laminectomy
Whatever method is chosen, before proceeding with the actual operation, doctors perform skeletonization on the side from which access is open. The term “skeletonization” means the exposure of parts of the diseased vertebra to be removed from the patient’s body: arches, processes, and facets. If you skeletonize the arches and processes of the neck, some difficulties arise. Here the tops bifurcate; moreover, they are buried quite deeply and there is a large muscle mass on top of them. The processes in this section are quite fragile and very mobile. So it is quite natural that the benefit here can only come from a top-class professional who has enormous experience, is extremely careful, and also does everything with colossal precision. If the surgeon does not meet any of these requirements, the patient may be in serious danger.
Of course, all these are important qualities for any surgeon, regardless of the location being operated on. The tiniest and seemingly insignificant mistake in the surgical process, and the patient is doomed to suffer from its results for the rest of his life. These include, for example, irreversible damage to the peripheral nervous system and spinal cord, chronic pain, and paralysis. This means that you should not blindly trust the first surgeon you come across - you must first take a closer look at the doctor, and then decide whether to deal with him.
Most patients are sent to other countries specifically for treatment in order to trust truly highly professional specialists in neurosurgery, traumatology, and orthopedics. Of course, treatment abroad takes a serious toll on the wallet, but saving on health, especially when it comes to the spine, is the last thing.
Indications for use
In the vast majority of cases, laminectomy is performed for spinal stenosis. In almost 75% of situations, narrowing is observed in the lumbar region. Most often, a decrease in the diameter of the canal occurs at the level of L4-L5, somewhat less often in the area of L3-L4.
Therefore, it is in the area from 3 to 5 lumbar vertebrae that laminectomy is most often performed. Only in 25% of cases does stenosis occur in the cervical region. And the thoracic region is almost never affected by spinal canal pathology.
Thus, surgery is indicated for compression of the nerve roots or spinal cord due to:
- formation of large intervertebral hernias;
- tumors of the spine and spinal cord;
- formation of intra-articular or vertebral osteophytes;
- congenital anomalies;
- severe curvatures and deformations of the ridge;
- formation of arachnoid cysts or subarachnoid adhesions;
- getting injured.
However, the decision to perform a laminectomy is considered individually for each patient. It is influenced by the degree of stenosis, the severity of neurological deficit and pain.
At the same time, this operation is also used when conservative therapy carried out for several months is absolutely ineffective or when there is a serious threat to the patient’s life or its quality.
How is decompression surgery performed?
The patient's last meal should be no later than six hours before the procedure. He should neither chew gum nor smoke. He must undress completely and also remove jewelry and false teeth. On the operating table, he will be given a drip with sleeping pills for anesthesia.
If the patient has any other pathologies, he is scheduled for a consultation with a doctor of the required specialization, depending on the pathology, to prepare for the operation. In the preoperative week, the patient should not enter the patient's body with coagulants such as aspirin or Comadine. If necessary, they can be replaced, but the patient should consult a surgeon about this. The patient is also examined for allergies to the medications that doctors are going to use when performing the operation.
At the same time, such an approach to surgical intervention can easily lead to a violation of the stability of the operated parts of the spinal column. So, it is often necessary to fix the vertebrae at the same time - that is, perform spinal fusion. Therefore, after the surgeon performs the main operation, he can fasten the vertebrae with a special metal plate. Moreover, it may also be necessary to transplant bone tissue from the ilium. Such procedures will ensure fixation of the bones, but will not add any serious inconvenience to the patient.
It was already mentioned above that the most important indication for laminectomy is that the spinal canal is too narrow, the nerve roots suffer from compression, and the spinal cord is pinched. How exactly is this operation performed? So, below the process is described so as to be understandable to the average person.
Important! In the vast majority of cases, the operation is performed under general anesthesia. The patient is placed on his side or stomach. During the procedure, the process is monitored using x-rays.
This operation is most often performed under general anesthesia.
Next, the surgical field is treated with antiseptic drugs, and then marked where the incision will be made.
Now the doctor, where the markings were, linearly cuts the skin, subcutaneous fat, and muscle fascia along the processes to the apexes with a scalpel. In this case, the incision begins on the vertebra above the operated site, and ends below, also on the vertebra from it.
Microsurgical hernia removal: how is this spinal surgery performed?
Microsurgical removal of a spinal hernia (microdisectomy) is performed under general anesthesia. After X-ray marking, which allows you to most accurately determine the area of localization of the hernia, the neurosurgeon makes an incision of up to 3 cm in the skin and, also under X-ray navigation, installs a special gentle retractor in the projection of the location of the intervertebral hernia or stenosis.
Surgery is performed using magnifying optics and micro-instruments, which allows you to carefully bypass muscles, ligaments and spinal nerves without damaging them. The hernia is removed with micronippers, and after the intervention the wound is sutured. The duration of the operation is 30–90 minutes.
Recovery of the body after surgery
Such a procedure will be successful only if the postoperative period is organized at the highest level. Even a flawlessly performed operation will not give a good result if the rehabilitation is poor. The main thing in this case is the complete return to normal of the musculoskeletal function of not only the spinal column, but also of all components of the skeleton without exception.
If the operation was independent, the patient can be discharged after two days. But, given that such a surgical intervention is performed in combination with some other operations, it is quite possible that the patient will have to spend a little longer in the clinic. Be that as it may, after discharge he will have to check into a decent rehabilitation center, where he will be provided with a good recovery after surgery.
After the operation, the patient will have to spend some time under the supervision of a doctor.
How long is the recovery period after a patient undergoes decompressive laminectomy? Here everything is determined by the initial pathology, the number of resection procedures, as well as the characteristics of the patient’s body. It usually takes two to four months to completely restore everything. However, if the patient’s profession is doing something fairly simple and physically easy, he can return to work within three weeks. With all this, a date for control diagnostics is certainly set, approximately 12 days after the operation.
Regarding the distinctive aspects of the beginning of the rehabilitation period. The patient spends the period of time from the operation until returning to consciousness, as well as several more hours, in the intensive care unit. He will remain under the careful supervision of professional doctors all this time. They will continuously monitor how the patient’s internal organs and systems work using special instruments. In the very first hours after surgery, antibiotics are started to be introduced into the patient’s body to prevent infectious pathogenesis. He is on strict bed rest for about a day. If everything goes smoothly, the patient is transferred to the general ward one day after the operation.
Features of the rehabilitation period
The success of laminectomy and the likelihood of complications directly depend on the correct course of the postoperative period.
Even with a technically ideal surgical intervention, properly organized rehabilitation is extremely important.
Only in this case can you count on the absence of undesirable consequences, restoration of the spine and its functions, as well as all other components of the musculoskeletal system.
If on the first day the patient is given strict bed rest, then on the second day he is allowed to carefully get up and move around the ward little by little. To relieve postoperative pain, patients are recommended to sleep on their side with pillows under their knees and head, and a special soft cushion under their back.
Be sure to carry out exercise therapy according to a simplified program from the first days. The first classes are performed in a lying position and only over time they move on to classes in an upright body position and increasing the load.
Patients are advised to diet and wear orthopedic devices. This could be a corset, a cervical collar or a bandage. The choice depends on the level of the vertebra at which the intervention was performed and its volume.
A course of physiotherapeutic treatment and a number of medications are also required, including:
- antibiotics - prevent the development of infectious and inflammatory complications;
- drugs from the NSAID group – relieve pain and help eliminate the inflammatory process;
- antithrombosis drugs - reduce the risk of blood clots;
- calcium supplements – help strengthen bone tissue.
Only an integrated approach to rehabilitation, combining exercise therapy, physiotherapy, medication, and scrupulous implementation of all medical recommendations ensures high-quality restoration of the spine.
If only laminectomy was performed, in the absence of complications the patient can be discharged on the 3rd day. But this operation is rarely performed in isolation. More often it becomes a preparatory stage for other interventions, sometimes very complex. Therefore, in such cases, the patient may be forced to stay in the hospital for a longer period of time.
But in any case, after discharge he will need long-term rehabilitation. How long it takes to fully recover depends on:
- diagnosis;
- the volume of the intervention performed;
- age and other individual characteristics.
In most cases, the recovery period lasts 2–4 months, although only 3 weeks are considered incapacitated for patients. After this time and normal health, patients can return to simple work that does not require serious physical exertion.
For several weeks you should refrain from lifting heavy objects, sharp turns of the body and bending. It is also not recommended to sit for more than an hour. Therefore, long car trips should be postponed for the future, and when working in an office, get up from your desk and walk regularly.
During the rehabilitation period, the patient must undergo regular follow-up examinations. The first is usually planned for 10–14 days after laminectomy, the dates of subsequent visits are agreed upon individually.
What are the consequences of a laminectomy?
Absolutely any type of invasive treatment has at least some risks before or after it is carried out. For this operation they are:
- the surgeon may accidentally touch a nerve root. This can lead to all sorts of problems. For example, central nervous system dysfunction, insensitivity anywhere, problems with internal organs. It’s good that this happens no more than once every thousand operations;
- the risk that a patient will bleed to death during a laminectomy is about as great. Exactly the same statistics of severe blood loss are observed in other types of surgical intervention;
- most often, in every tenth case, revision surgery occurs. It is caused by a lack of stability in the spine where the surgery took place;
- In approximately every hundredth case of laminectomy, the surgical wound becomes infected. This is quite serious, but quite treatable;
- In approximately every fiftieth case, cerebral leakage of spinal fluid occurs. This can be discounted: just one day is enough for the human body to return the amount lost to normal.
If the doctor was not careful enough during the operation, complications may arise - although this does not happen often
What complications can happen?
After a laminectomy, some problems cannot be ruled out that can seriously harm the patient’s health. This operation may cause the following complications:
- poisoning of the body as a result of anesthesia;
- instability of the spinal column;
- serious infection and subsequent inflammation of the wound or spinal lining;
- formation of blood clots in the deep veins of the legs;
- damage to the nerves during surgery, then the following may occur: paralysis, general weakness, numbness of the arms and legs, as well as disruption of the urinary system and intestines;
- degenerative changes in other parts of the spine, becoming stronger over time;
- curvature of the spine (in common parlance - hunchback), usually in representatives of the younger generation;
- dislocations and subluxations of the vertebrae;
- chronic pain.
How to prevent complications?
The main problem that arises from surgery is the recurrence of the disease and the symptoms starting all over again. Every fifth patient suffers from this. To be among the other four-fifths, you should:
- be examined as thoroughly as possible before surgery. Don’t skimp on money: health is more valuable. The results of the examinations will allow the doctor to better form a picture of the disease;
To prevent complications after surgery, it is important to undergo a thorough examination and discuss everything with a specialist in advance.
- after being examined, consult with several doctors, and then “put together” their opinions;
- If you are offered to use spinal fusion during the operation, do not refuse. Although it will be more expensive, the result will be many times better;
- the operation should be performed exclusively in a good hospital, whose staff has extensive experience in such surgery. Moreover, the professionalism of the doctor plays a huge role here;
- Upon completion of the operation, carefully follow each recommendation and strictly adhere to all restrictions.