Lumbar Laminectomy with and without Fusion

What Is a Lumbar Laminectomy?

Lumbar laminectomy involves removal of the posterior aspect of the vertebrae (lamina) in the lower back, hence enlarging the spinal canal and providing relief of the pressure on the nerves.

Some of the symptoms associated with lumbar stenosis are:

• Back pain
• Pain shooting down the legs
• Difficulty walking
• Leg numbness
• Leg weakness
• Loss of bowel or bladder control

As in most spinal conditions, in the majority of patients the first line of treatment is conservative management including physical therapy and epidural injections. Those patients who continue to be symptomatic despite conservative treatment may benefit from surgical intervention in the form of laminectomy.

The Lumbar Laminectomy Approach and Procedure

This surgery involves a midline incision in the back, over the affected area. The size of the incision depends on the number of levels involved. Then, the muscles are pulled out of the way and nerve decompression is performed which includes the removal of lamina, ligaments and bony spurs.

In some patients, fusion surgery may be required after laminectomy. This depends on different factors, but most commonly, fusion is required if there is spinal instability present OR the surgeon believes that due to severity of the stenosis (pressure on the nerves), performing a thorough laminectomy and decompression will cause instability of the spine (iatrogenic).

The goal of the fusion is to stabilize the area by connecting the two vertebrae together using bone graft. This often requires the utilization of screws, rods, as well as interbody spacers (cages).