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Laminectomy
Laminectomy with Fusion
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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.
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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.
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.
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.
Lumbar Hemilaminectomy Surgery: What’s The Difference From Laminectomy?
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Many different procedures fall under the umbrella of spinal decompression surgery. Designed to ease compression on the spinal cord and nerves, spinal decompression is widely used to treat spinal stenosis, spondylolisthesis, slipped discs, and related conditions.
A lumbar hemilaminectomy is one type of spinal decompression surgery. Although this procedure is similar to lumbar laminectomy, it has a few key differences.
In this article, we’ll discuss how lumbar hemilaminectomy and laminectomy are different. We’ll also go over the non-surgical and minimally-invasive alternatives to hemilaminectomy that are available to patients.
What Are The Lamina of The Spine?
Before we explain lumbar hemilaminectomy surgery, it’s crucial to explain the role of the laminae in the spine. Each spinal bone, called a vertebra, contains two laminae. The laminae form a protective cover for the spinal canal.
The lamina also links the spinous process to the transverse process within a vertebra. The spinous process is a small section of bone that protrudes from the back of the spinal cord; the transverse process is another section of bone that serves as a connection point for the back muscles and ligaments to the spine.
Lumbar Hemilaminectomy vs. Laminectomy
Lumbar hemilaminectomy and laminectomy are both types of spinal decompression surgery. While these procedures are very closely related, there’s one key difference between them.
What is a Hemilaminectomy?
In a laminectomy, the surgeon removes both of the laminae from the targeted vertebrae. However, in hemilaminectomy, the surgeon discards just one lamina from each vertebra. Specifically, the surgeon will only remove the lamina on the side of the spinal canal that’s experiencing nerve compression.
Lumbar hemilaminectomy and lumbar laminectomy are both performed on the lumbar (lower) spine. Although it’s less common, thoracic and cervical hemilaminectomy and laminectomy can also be performed.
Note that patients who require decompression on both sides of the spinal canal will likely require a laminectomy, rather than a hemilaminectomy.
The Goal of Lumbar Hemilaminectomy
Lumbar hemilaminectomy and laminectomy share a common goal: To open up additional space in the spinal canal and resolve nerve compression. By releasing the pressure on spinal nerves, lumbar hemilaminectomy can give patients relief from back pain and stiffness, along with tingling and numbness in the legs.
Conditions That Can Require Lumbar Hemilaminectomy vs. Laminectomy
Laminectomy
The predominant indication for laminectomy is spinal stenosis.
Spinal stenosis is a condition that’s characterized by the gradual reduction of space in the spinal canal. With nerves and the spinal cord located in the spinal canal, this condition can trigger nerve compression.
Key signs and symptoms of spinal stenosis include:
- Back pain
- Cramping in the legs
- Sciatica, which refers to nerve pain that moves from the back to the buttocks and legs
- A pins and needles sensation in the legs, feet, or buttocks
- A heavy sensation in the legs
- In instances of severe spinal stenosis, lost bladder or bowel control
Laminectomy helps relieve symptoms of spinal stenosis by removing pressure from the spinal nerves. Additionally, by creating more space in the spinal canal, a laminectomy can provide a better environment for damaged tissue to heal.
Hemilaminectomy
Hemilaminectomy is most often performed to treat a herniated disc. Also known as a slipped or ruptured disc, this common spinal injury can cause pain, stiffness, and tingling or weakness in the legs.
In between each of the spine’s vertebrae, there’s a cushion-like disc. The intervertebral discs protect the vertebrae from damage by absorbing impact and facilitating motion.
Whether due to age-related changes to the spinal discs, a sudden injury to the spine, or repeated strain on the spine, intervertebral discs can become damaged. The soft interior of the disc can protrude from a break in the disc’s tough outer layer, causing a herniated disc.
To cure the symptoms of a herniated disc that isn’t resolved with non-invasive treatment methods, patients may require both hemilaminectomy and discectomy.
Hemilaminectomy and Discectomy
A discectomy is a surgical procedure that’s performed to treat a herniated disc. It involves removing some or all of a damaged intervertebral disc to alleviate pressure on the adjacent spinal nerves.
During a discectomy, surgeons aim to leave as much of the disc as possible alone. However, in severe cases, the full spinal disc may need to be removed to fully alleviate the patient’s symptoms.
Lumbar hemilaminectomy and discectomy are often performed together in a single procedure to treat a herniated lumbar disc. By removing both the damaged disc and the lamina, the procedure can effectively resolve nerve compression caused by a slipped disc.
Spinal Fusion With Lumbar Hemilaminectomy
To avert spinal instability after lumbar hemilaminectomy, spinal fusion may be performed. This spinal procedure involves placing bone graft material between the affected vertebrae. Over time, the graft will stimulate bone growth and fuse the vertebrae, forming one bone.
Although spinal fusion can provide stability in lumbar hemilaminectomy, it has downsides including:
Recovery Period
Spinal fusion can prolong your lumbar hemilaminectomy recovery by a significant margin. Alone (without fusion), the hemilaminectomy recovery period typically lasts a total of around 4 to 6 weeks.
Patients can require a year or more to make a full recovery from spinal fusion. Additionally, it may take as long as 4 to 6 weeks for young, healthy individuals with sedentary professionals to return to work after the procedure. For older patients, it can take up to 6 months to get back to work after fusion.
Spinal Flexibility
Though spinal fusion can effectively prevent instability after hemilaminectomy, it presents a large risk of reduced mobility. Patients who undergo fusion often lose flexibility in the spine and aren’t able to bend or flex the spine like they used to.
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To gain spinal stability after hemilaminectomy without compromising your spinal flexibility, you may want to consider a spinal fusion alternative. Spinal devices like the TOPS System can stabilize the spine while retaining the motion of the affected vertebrae.
Alternatives to Lumbar Hemilaminectomy
While hemilaminectomy can successfully resolve nerve compression for many patients, it’s rarely the only treatment option. Patients can also consider non-surgical treatments and minimally-invasive spine surgery.
Non-Invasive Treatments
There are a variety of non-invasive treatments that can help alleviate pain and promote healing for patients with a herniated disc. Options include:
- Physical therapy
- Chiropractic care
- Massage therapy
- Acupuncture
- Rest and lifestyle modifications
- Pain medications
- Epidural steroid injections
Note that certain non-invasive treatments, including pain medications and epidural steroid injections, often aren’t considered long-term solutions for chronic back pain. Steroid injections should only be administered a few times per year to avoid tissue damage.
Minimally-Invasive Hemilaminectomy
Spinal implants such as the TOPS spinal implant can support minimally-invasive hemilaminectomies. Minimally-invasive surgery, or MIS, typically involves a smaller incision, less blood loss, and less anesthesia.
Minimally-invasive procedures are always preferable to conventional procedures because they provide a reduced risk of complications, shorter recovery period, and less postoperative pain. By reducing the need for fusion, MIS spinal implant systems offer these benefits for hemilaminectomy patients.
If you’re suffering from symptoms of a chronic spinal condition, talk to your doctor about the range of treatment options available to you.
Laminotomy vs Laminectomy: Procedures for Curing Spinal Conditions
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Laminotomy and laminectomy are both surgical procedures that can treat spinal conditions (namely spinal stenosis). Although these procedures both involve the lamina of the vertebrae, each is a unique treatment.
Here, we’ll discuss the key differences between laminotomy and laminectomy, including when each procedure may be implemented and how to determine the right treatment for your needs.
Laminotomy and Laminectomy: What’s The Difference?
Laminotomy and laminectomy are both considered spinal decompression surgeries. Both affect the lamina of the spine, which creates the roof of the spinal canal. The procedure is intended to increase the amount of space around the spinal cord to relieve compression and the symptoms that it causes.
In laminotomy or laminectomy, your surgeon will make an incision along the back and remove some, most, or all of the lamina. If required, your surgeon may also perform a discectomy (removal of a spinal disc) and/or foraminotomy (enlargement of the passageway for a spinal nerve root).
Spinal fusion is another common step in laminotomy and laminectomy to restore spinal stability. However, spinal implants like the TOPS System can be used as a safer, more effective alternative to spinal fusion in spinal decompression surgery. We’ll discuss this in greater detail below.
Understanding Laminectomy
During a laminectomy, a surgeon takes out most or all of the lamina. This is considered major surgery and typically isn’t performed unless more conservative treatment options have failed. Laminectomy may be performed on the cervical, lumbar, sacral, or thoracic spine.
Understanding Laminotomy
In laminotomy, the surgeon takes out a small piece of the lamina. This differentiates it from laminectomy, during which most of the lamina is removed.
The goal of laminotomy is generally to remove just enough of the lamina to lessen the pressure on a specific part of the spine. Like laminectomy, laminotomy can be done on the cervical, lumbar, sacral, or thoracic spine.
Laminotomy may involve one or multiple vertebrae. When it affects just one vertebra it’s referred to as single-level laminotomy; when it affects multiple vertebrae, it’s known as multilevel laminotomy.
Reasons to Undergo Laminotomy vs. Laminectomy
Since laminotomy and laminectomy are types of spinal decompression surgery, both are generally recommended for patients with spinal cord compression from conditions like spinal stenosis, herniated disc, and bone spurs.
When spinal cord compression leads to myelopathy or impaired spinal cord function, laminotomy or laminectomy may be suggested. Symptoms of myelopathy include:
- Weakness, tingling, or numbness
- Difficulty walking
- Poor balance
- Trouble with fine motor skills
- Lost urinary or bowel control
- Pain in the lower back, arm, leg, or neck
Laminotomy involves a smaller incision and causes less damage to surrounding tissues than a laminectomy. So, surgeons generally try to perform laminotomy over laminectomy whenever possible. However, if the degree of spinal compression is too severe to be resolved with laminotomy, laminectomy may be required.
Alternatives to Laminotomy and Laminectomy
Patients struggling with symptoms of myelopathy will typically undergo non-surgical treatments before spinal surgery is considered. These may include:
- A healthy lifestyle
An exercise regimen and a balanced diet can help patients manage spinal discomfort.
- Physical therapy
Physical therapy may also be suggested to reduce pain and improve balance within the body. A physical therapist can give patients exercises to release pressure in the spine without surgery.
- Medications
Medications may be recommended for patients with severe pain from spinal compression. This can help with day-to-day pain management, but may not be a long-term solution.
When non-surgical treatment methods fail to offer relief from symptoms of spinal compression, doctors often recommend spinal decompression surgery so that patients can attain a higher quality of life.
Conditions That May Require Laminotomy or Laminectomy
As aforementioned, some of the most common procedures that lead to spinal decompression surgery include spinal stenosis, herniated spinal disc, and bone spurs.
- Spinal stenosis
Spinal stenosis is a condition that occurs when the spaces in the spine narrow. This can place added stress on the spinal nerves, leading to symptoms like numbness, tingling, muscle weakness, pain, and sciatica.
Laminotomy or laminectomy can help treat spinal stenosis by opening up space in the spine.
- Herniated spinal disc
A herniated disc (or slipped disc) develops when the soft interior of one of the spinal discs presses out through a crack in the disc’s tough exterior. The protruding center of the disc can press on nearby nerves, leading to pain, weakness, and numbness.
Spinal decompression surgery can release the pressure on the affected nerves for symptom relief.
- Bone spurs
Bone spurs are bony lumps that form off of an existing bone. Osteoarthritis is the most prevalent cause of bone spurs, and symptoms of them include pain, stiffness, weakness, numbness, tingling, and muscle spasms.
During spinal decompression surgery, bone spurs can be removed to relieve the added pressure on the spinal cord or nerves.
Recovering from Laminotomy and Laminectomy
Since laminotomy is a moderately less involved procedure than laminectomy, it can have a faster recovery period. However, most patients need several weeks (often between four and six weeks) to fully recover from laminotomy or laminectomy.
Laminotomy and laminectomy can both be outpatient procedures, meaning that you can return home on the same day as the surgery. That said, if spinal fusion is performed along with spinal decompression surgery, patients may need to remain in the hospital for up to four days.
After you return home from laminotomy or laminectomy, get plenty of rest. In the first several days after your spinal procedure, ask for help from loved ones for chores around the house and other essentials, like grocery shopping.
You should also take a break from work for a few weeks following spinal decompression surgery. Taking time off now will ultimately speed up your recovery and ensure optimal results from the procedure. Your doctor will also likely recommend physical therapy to support your recovery process
Spinal Fusion in Laminotomy and Laminectomy
Spinal fusion is commonly performed with laminotomy or laminectomy. In spinal fusion, the doctor permanently connects, or fuses, two vertebrae. Eventually, the vertebrae will form one bone, which can counter instability.
Although spinal fusion is commonly performed, it can make either laminotomy or laminectomy a more traumatic procedure. Spinal fusion slows down the recovery process and can limit the patient’s range of motion in the spine.
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Spinal Implants: An Alternative to Spinal Fusion in Laminotomy and Laminectomy
Spinal implants like the Premia Spine TOPS System can reduce the trauma and recovery period associated with laminotomy and laminectomy. The TOPS system is implanted into the treatment area after spinal decompression surgery to provide stability while preserving the patient’s range of motion in the spine.
While spinal fusion prevents motion in the affected vertebrae, TOPS implants move with the body. It stabilizes the spine so that the patient can move comfortably. With the TOPS device, it’s possible to secure the spine without compromising the patient’s flexibility.
Improved Recovery With The TOPS System
A TOPS System Implant allows for an easier recovery period after laminotomy or laminectomy. Compared to conventional spinal fusions, surgery with the TOPS device allows patients to return to their normal activities faster.
If you’re suffering from debilitating pain due to spinal compression, laminotomy or laminectomy may be your path to a more comfortable, pain-free life. The TOPS spinal implant can make either of these spinal decompression procedures less traumatic. For more information, reach out to Premia Spine.