Updated: Nov 26, 2020
Micro-laminectomy procedure decompresses low back nerves
Written by Bansal Gaurav, MBBS, MS, MCh (AIIMS), IFAANS (USA)
If you experience low back and leg pain and haven’t found relief through nonsurgical treatments like medication or physical therapy, your spine doctor or surgeon may recommend lumbar laminectomy. Lumbar laminectomy is a common spine surgery performed to decompress, or take pressure off specific nerves in the spine that cause low back and leg pain. Now many patients have the option of undergoing lumbar laminectomy that utilizes modern advances in minimally invasive spine surgery performed in an advanced spine center.
In short, a minimally invasive lumbar laminectomy—also known as a micro-laminectomy—takes the pressure off the spinal nerve roots to help relieve pain and related symptoms, such as numbness, tingling and weakness. This procedure accomplishes the same as the traditional open low back laminectomy, except the minimally invasive version offers the patient and surgeon many benefits, including tiny incisions and a faster recovery.
Outpatient Spine Surgery: Minimally Invasive Lumbar Laminectomy
A minimally invasive lumbar laminectomy involves removing a portion of the lamina; a thin piece of bone located at the back of each vertebral body that covers the spinal canal. A micro-laminectomy may include removing bony overgrowths (ie, osteophytes) and ligament tissue compressing spinal nerves at one or more levels of the spine.
Similar to other types of minimally invasive spine surgery (MISS) procedures, a minimally invasive lumbar laminectomy utilizes surgical instruments expressively designed and made for MIS surgery. These small instruments allow the surgeon to separate soft tissues (eg, muscles) instead of cutting. This means less postoperative pain and fewer tissues to heal after surgery and therefore, a speedier recovery and return to activity. MISS procedures are typically safer, quicker, and promote a faster recovery than traditional spine surgery.
The hallmark benefits of minimally invasive spine surgery include:
Less blood loss
Lower risk of muscle and soft-tissue damage
Lower risk of infection
Reduced postoperative pain
Reduced pain medication use
When you talk to surgeons about MISS, the focus is often on the size of the incision, but this type of surgery has a greater aim of being minimally traumatic to the body. The ultimate goal is to improve your quality of life quickly and with less pain as soon as possible. The MISS technological advances have not only given spine surgeons a new way to perform lumbar laminectomy, but they’ve also enabled the surgery to be performed on an outpatient basis in a specialized surgery center.
Patients who undergo MISS in an outpatient setting report a more comfortable experience that allows them to go home the same day as surgery and begin recovery sooner—as contrast to the two to three-day hospital stay for a traditional open laminectomy in a hospital.
Conditions Treated Using Minimally Invasive Lumbar Laminectomy
Your surgeon may recommend a minimally invasive lumbar laminectomy if you have been diagnosed with spinal conditions that cause both low back and leg pain:
Lumbar synovial cyst
What Happens During an Outpatient Minimally Invasive Lumbar Laminectomy?
The goal of lumbar laminectomy is to decompress (remove compression) the spinal nerves at one or more levels of the low back; the lumbar spine. In a traditionally performed open lumbar laminectomy, this usually means removing the entire lamina. The disadvantage of this type of laminectomy is if the entire lamina is removed, the surrounding muscles have nothing to reattach to. Traditional laminectomy is unnecessary given the technology available today.
A minimally invasive low back laminectomy is more targeted and removes only the portion of the lamina causing compression. Therefore, the majority of the lamina can be spared.
Prior to surgery, general anesthesia specific to outpatient surgery is administered. Throughout surgery, the surgeon utilizes real-time x-ray images known as fluoroscopy. The images captured in real-time enable the surgeon to navigate and precisely guide his surgical instruments.
The surgeon makes a small skin incision (almost puncture-like), about 1-inch long directly over the level(s) in the low back where surgery will be performed. Next, the surgeon slides sequentially-sized tubular retractors through the incision and separates soft tissues (eg, muscles). The tubular retractor holds the tissues apart. While operating, the surgeon may wear special eyeglasses (loupes) or may use a specialized surgical microscope that gives him/her microscopic vision of the surgical field. The loupes’ or microscope’s ability to magnify and illuminate enables the surgeon to see small tissues that may be compressing spinal nerves.
In addition, bone drills and other instruments specially designed for MISS are utilized to remove bone spurs (ie, osteophytes) or ligament tissue causing nerve compression while preserving the lamina and sometimes the interspinous ligament.
When the procedure is finished, the surgeon removes the tubular retractors allowing the soft tissues to move back into their natural places. The surgeon closes the tiny incision using sutures that dissolve within 2-4 weeks.
From start to finish, a minimally invasive lumbar laminectomy in an outpatient spine center takes about 90 minutes.
Minimally Invasive Lumbar Laminectomy Considerations
Minimally invasive lumbar laminectomy has many benefits over its traditional surgical counterpart—less blood loss, tiny incision(s), and quicker recovery time to name a few. However, not every patient is a candidate for this type of procedure, particularly in an outpatient setting.
Although two patients may receive the same diagnosis, no two patients are the same. While both patients may be eligible for minimally invasive lumbar laminectomy, one may have a serious health problem, such as cardiovascular disease. Depending on the patient’s overall condition, which includes preexisting medical issues, the surgeon may recommend the MISS procedure to be performed in the hospital. If you cannot have your surgery at an outpatient spine center, understand your surgeon is making the recommendation with your safety and health in view.
Prior to surgery, your surgeon will explain all potential risks and benefits of undergoing minimally invasive low back laminectomy. The anesthesiologist will explain risks related to anesthesia, and be available to answer all of your questions.
When you’ve exhausted all nonsurgical treatment options for your low back and leg pain, MIS lumbar laminectomy in an outpatient setting may be an option for you. Technological advances in minimally invasive spine surgery have helped to transform many traditional open and complex spine surgical procedures into those with less impact on your body. Tiny incisions, less postsurgical pain/discomfort, quicker recovery and the added convenience of having the surgery at an outpatient spine clinic are just a few of the many benefits of a minimally invasive lumbar laminectomy.