Lumbar Hemilaminectomy Surgery: What’s The Difference From Laminectomy?
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
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 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:
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.
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.
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
- 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.
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.