Overview
A lumbar hemilaminectomy surgery is a minimally invasive surgical procedure performed to widen the spinal cord by removing a part of one or both laminae on a vertebra. It helps patients in alleviating neck and back pain. Here in this blog, we will discuss the types, causes, and steps of performing hemilaminectomy.
Summary
● Hemilaminectomy surgery is performed to remove lamina that may get thickened because of a traumatic injury or degeneration.
● The most common hemilaminectomy and microdiscectomy types include bilateral hemilaminectomy and unilateral hemilaminectomy.
● There may be several causes to suggest a hemilaminectomy surgery, including acute neck pain, radicular pain, and shooting leg pain due to pinched nerves in the spinal cord.
● Lumbar hemilaminectomy recovery time depends on the type of surgery performed by the doctor.
● Laminectomy is used to narrow the spinal canal, whereas your damaged or herniated disc is removed or repaired by the doctor in the microdiscectomy procedure.
● Several studies suggest that 85-90% of patients with lumbar central spinal stenosis get relief from leg pain after hemilaminectomy surgery.
● Hemilaminectomy’s primary objective is to relieve neural tissue compression and improve the leg’s functionality.
Define Hemilaminectomy
A Hemilaminectomy, also known as Laminotomy, is one of the most common back surgeries. Neck or back pain that affects routine activities may require surgery for treatment. The lamina may get thickened because of a traumatic injury or degeneration, compressing the spinal nerves leading to severe pain or disability. A hemilaminectomy is a minimally invasive surgical procedure of the spine performed by a neurosurgeon to widen the spinal cord by removing a part of one or both laminae on a vertebra.
Types of Lumbar Laminectomy for Spinal Stenosis
Neurosurgeons may utilize one of the following types for hemilaminectomy surgery depending upon the lamina’s amount that needs to be removed:
● Bilateral Hemilaminectomy
In bilateral hemilaminectomy, both sides of the affected vertebra’s lamina are removed by the surgeon. He performed this procedure with or without widening of the intervertebral foramina or removal of adjacent bone and tissue.
● Unilateral Hemilaminectomy
In unilateral hemilaminectomy, the neurosurgeon removed a part of the complete lamina with or without adjacent tissues.
The surgeon may also perform unilateral hemilaminectomy by utilizing an endoscope (a small tube) that is minimally invasive and needs a smaller incision than open surgery.
When You Need a Laminectomy?
One of the primary reasons for having hemilaminectomy surgery is a herniated disk in the spine. Patients suffering from acute neck pain, radicular pain, numbness in legless, and shooting leg pain due to pinched nerves in the spinal cord need laminectomy. Loss of bladder control from pressure in the cervical or lumbar spine also usually requires surgery.
Additionally, if conventional treatment options, including spinal injections, physical rehabilitation or physical therapy, occupational therapy, weight loss (if overweight), and smoking cessation, have failed to relieve pain, the last available option is hemilaminectomy.
Comparison Between Microdiscectomy & Laminectomy
Laminectomy is utilized to narrow the spinal canal for relieving the symptoms that occur due to nerve root compression. In comparison, microdiscectomy is a minimally invasive procedure used to repair or remove a damaged or herniated disc in your spine. Microdiscectomy usually takes less recovery time than a traditional discectomy and helps the patient quickly return to daily routine activities.
Step-By-Step Process for Hemilaminectomy Surgery
Neurosurgeons perform laminectomy surgery from the back. The patient is instructed to lie down during the whole procedure, generally on a Jackson table. A Jackson table keeps the stomach free and the hip slightly raised, recreating a standing position. During the process, the free abdomen helps prevent the blood vessel’s compression and epidural bleeding throughout the surgery, while bending the hip helps the doctor better evaluate the degree of neural compression from spinal stenosis.
Generally, the neuro spine surgeon performs the below-mentioned steps while performing the surgery.
● A patient is instructed to lie in a face-down position, and general anesthesia is given to him.
● A 2-5 inch long incision is made in the back’s midline.
● The neuro spine surgeon pulls the left and right muscles gently to get entrance to the laminae.
● Intraoperative radiographs are utilized for identifying the exact vertebral level.
● Now the laminae are cut or removed by the doctor depending on the condition’s severity. This procedure increases the spinal canal space for the neural elements.
● The next upper level follows the same set of steps if needed.
● After completing all the steps, the muscles come back to their original position.
If you had a minor hemilaminectomy surgery, lumbar hemilaminectomy recovery time might start within a few days or weeks. But recovery time may prolong for the patient undergoing a spinal fusion with laminectomy, i.e., two to four months.
Goals of Lumbar Laminectomy Surgery
The primary purpose of laminectomy surgery is to accomplish the below-mentioned goals:
● Relieve Neural Tissue Compression
The patient may experience compression in the spinal cord, spinal dura, cauda equina, and thecal sac. Neurogenic claudication (leg agony while walking or bending the spine backward) may occur due to the compression of any of these structures, usually affecting both legs. Laminectomy helps alleviate these neural tissues’ compression by widening the spinal canal.
● Improve Leg’s Functionality
You may have decreased mobility due to pain and weakness in one or both legs. Laminectomy helps decrease pressure on the nerves, reduces leg pain, and potentially improves the lower back and legs’ functionality.
It is essential to understand that hemilaminectomy’s primary purpose is to treat leg pain symptoms instead of lower back pain. Patients may experience back pain even after the surgery because of the agony from the ongoing degenerating process or due to unrelated reasons that may cause nerve or spinal cord compression.
Success Rate of Lumbar Laminectomy for Spinal Stenosis
To relieve leg pain resulting from spinal stenosis, the most recommended neurosurgery with a high success rate and guaranteed results is a lumbar laminectomy.
According to numerous studies:
● 85-90% of patients with lumbar central spinal stenosis get relief from leg pain after hemilaminectomy surgery.
● Research suggests that 75% of patients are satisfied with the surgery results.
● About 10-20% of patients may undergo surgery again due to postoperative complications.
Before recommending laminectomy, your doctor should consider a wide range of options for preventing future complications. Some of the most common reasons for hemilaminectomy surgery failure may include improper diagnosis, smoking, and physical deconditioning before and after surgery.
