Laminectomy with Fusion

When spinal conditions don’t improve despite ongoing non-surgical treatment, surgery may be the logical next step. Laminectomy with fusion is one of the most prominent spinal decompression procedures for conditions like spinal stenosis, spondylolisthesis, and herniated disc. 

But, what exactly does laminectomy with fusion involve, and is it the right choice for you? Read on to learn more about this topic and how it may impact your spinal recovery. 

Table of Contents

What is Laminectomy with Fusion?

Laminectomy is a form of spinal decompression that’s commonly done with fusion to stabilize the spine. During a laminectomy, the surgeon removes the smallest quantity of the lamina possible while effectively resolving the nerve compression. 

The lamina is a piece of bone that forms part of the vertebral arch. It acts like a roof over the posterior side of the spinal canal. 

Conventionally, spinal fusion is performed after a laminectomy (and most other forms of spinal decompression). During spinal fusion, the surgeon places an implant containing bone graft material between the vertebrae. Over time, this graft stimulates bone tissue fusion, creating a single vertebra. 

Fusion after laminectomy effectively lowers the risk of injuries due to spinal instability. However, it also eliminates all motion at the fused segment, which may permanently limit the patient’s mobility.  

How Successful Is a Laminectomy With Fusion?

Laminectomy with fusion is widely considered a successful procedure for disorders like spinal stenosis and spondylolisthesis. A study published in The New England Journal of Medicine concluded that lumbar laminectomy with spinal fusion provided a slightly greater improvement in overall physical health when compared to laminectomy alone. This study included 66 patients with degenerative grade 1 spondylolisthesis. 

However, laminectomy alone is considered safer than spinal fusion. According to Dr. Steven Atlas, an associate professor of medicine at Harvard Medical School, laminectomy provides 80% to 90% pain relief for spinal stenosis, without the risks associated with fusion.  

What Is the Success Rate of a Laminectomy and Fusion?

The success rate of a laminectomy and fusion is around 85% to 90% according to a study published in The New England Journal of Medicine. The remaining 10% to 15% of cases require reoperation. 

Success rates of this procedure indicate the percentage of cases that result in successful spinal decompression and bone fusion, without the need for reoperation. This differs from the patient satisfaction rate, which is based solely on how happy the patient is with the procedure’s results. Patient satisfaction rates range from 53% to 90%, according to a study published in The Spine Journal.   

What Affects The Success of Laminectomy with Fusion?

Many factors can impact the success rate of a laminectomy and fusion, including:

  • The patient’s age: Older patients are at a higher risk of failed spinal surgery. With age, the body’s ability to regenerate cells and tissue declines, which can compromise the procedure’s results. 
  • Underlying medical conditions: Certain underlying medication conditions can increase the risk of failed fusion and surgical complications, including hypertension, heart disease, and diabetes. 
  • Smoking and alcohol consumption: Smoking before and after laminectomy with fusion can hinder the procedure’s success. Nicotine restricts blood flow – a crucial aspect of the body’s healing process. This can reduce the flow of healing nutrients and oxygen to the surgical site, potentially compromising tissue healing and bone fusion. 
  • Being overweight or obese: Obesity increases the risk of blood clots, cardiovascular issues, and infection after any surgical procedure. It can also make it more difficult to get out of bed and walk around after surgery. Prolonged bed rest slows the recovery process for laminectomy with fusion. 
  • Previous spinal surgeries: If you’ve previously undergone spinal surgery, you likely have scar tissue in the area, which can make future spinal procedures more complicated. Research shows that repeat lumbar procedures are linked to worsened clinical outcomes. 

Do You Need Fusion with Laminectomy?

You may need fusion with laminectomy if a part of the spine is unstable after laminectomy. Spinal instability creates the risk of further injury.

However, innovations in spinal medicine have produced alternatives to fusion for stability after decompressive laminectomy. We’ll discuss these innovations, including the TOPS System from Premia Spine, in a later section. 

What Is the Recovery Time for a Lumbar Laminectomy With Fusion?

The recovery time for a lumbar laminectomy with fusion can last between two months and a full year. Many factors can affect this recovery period, including the patient’s age and overall health, as well as the severity of the spinal condition. 

Spinal fusion extends the recovery period after a lumbar laminectomy. This is because spinal fusion involves bone tissue recovery, which is a lengthy process. 

Returning to Work After a Lumbar Laminectomy with Spinal Fusion

Generally, healthy patients with non-strenuous jobs can expect to return to work following a lumbar laminectomy with spinal fusion after four to six weeks of rest. Older patients or those with strenuous jobs may need four to six months of recovery time before returning to work. 

What Are The Risks of Laminectomy With Fusion?

The risks of laminectomy with fusion include those associated with all surgical procedures, including bleeding, infection, blood clots, and complications from anesthesia. Since this surgery involves the spine, it also presents a low risk of injury to the spinal cord or spinal nerve roots.

In permanently fusing two or more vertebrae of the spine, fusion creates the risk of a few other complications, including:

  • Pain at the graft site

Some patients experience pain at the site of the bone graft. In 2.8% to 39% of patients, this pain has been reported to last for over three months. Graft site pain has been reported to last for up to two years in 15% to 39% of patients. 

  • Pseudoarthrosis

Pseudoarthrosis refers to bone fusion failure. This complication is significantly higher in patients who smoke, as nicotine hinders the bone fusion process. Unfortunately, patients who experience pseudoarthrosis will likely require extra surgeries to reliably fuse the vertebrae. 

  • Adjacent segment disease

Adjacent segment disease, or ASD, occurs when the spinal segments around the fused bone degenerate after fusion. The surrounding segments may undergo additional impact to compensate for the fused bone, leading to degeneration. Regrettably, ASD can lead to re-operation if it causes chronic back pain and neurological symptoms that don’t improve with non-invasive methods. 

Can You Walk Normally After Laminectomy With Fusion?

You can gradually walk normally after laminectomy with fusion, typically with the help of a physical therapist. Walking is actually highly beneficial after spinal surgery, as it’s a low-impact activity that promotes circulation and mobility.

Typically, surgeons recommend that patients stand up and gently walk (with assistance) the day after laminectomy with fusion to prevent muscle stiffness and atrophy. For the first six weeks or so after the procedure, walking may be the sole physical activity that you can safely complete. Many physicians recommend working up to two 30-minute walks per day in this early recovery stage. 

Non-Fusion Implants For Laminectomy

Non-fusion implants provide a solution for laminectomy without fusion. This allows patients to avoid the downsides of spinal fusion while achieving relief from chronic back pain and neurological symptoms. According to a research article published in BMC Musculoskeletal Disorders, walking time in the first week after lumbar spine surgery is one of the factors that predicts notable improvement at six months post-op. 

There are multiple non-fusion implants available to patients today, including artificial discs, expandable rods, and complete implant systems like the TOPS System. These devices (which are also referred to as motion preservation devices) generally fall under one of three categories: total disc replacement, posterior stabilization devices, and prosthetic nuclear implants. 

How Premia Spine TOPS System Cures Spondylolisthesis and Spinal Stenosis Without Fusion

The Premia Spine TOPS System cures spondylolisthesis and spinal stenosis without fusion by establishing a controlled range of motion in the spine. It’s a mechanical implant device designed to be implanted in the L2 to L5 segments of the spine with a posterior surgical approach. 

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The TOPS System facilitates motion in all directions, including axial rotation, lateral bending, extension, and flexion. Unlike fusion, it replaces the vertebral structures extracted in spinal decompression, such as the lamina removed during laminectomy. It also features a patented crossbar configuration, which imparts less stress on the screws than fusion implants. 

After nerve compression in spondylolisthesis and spinal stenosis patients is resolved during a laminectomy, the TOPS System can be placed to prevent instability. This technique effectively cures spondylolisthesis and spinal stenosis without fusion, with the TOPS system providing an average improvement of 81% in a clinical study published in the Operative Neurosurgery journal. 

Though the TOPS System has been used successfully for many years in Europe and other regions, it’s currently being tested in clinical trials across the United States. The device was awarded the FDA’s Breakthrough Device Designation in 2021, which will prioritize its process of obtaining FDA approval. 

If you’re interested in the TOPS System as an alternative to laminectomy with fusion, find a doctor in your area to learn more about this treatment option.