Laminectomy for Lumbar Canal Stenosis

What is lumbar canal stenosis?

Lumbar canal stenosis is a condition where the channel running through the lower part of the spine (lumbar canal) becomes excessively narrowed (stenosis). Stenosis is due mainly to degenerative wear-and-tear, over many years, causing a thickening of the various bones, joints and ligaments that form the spinal canal. Degenerative changes are normal in adult life. They are more likely to cause the symptoms of lumbar canal stenosis, however, in someone who is born with a smaller than average lumbar canal.  The narrowing usually affects one or two vertebrae, and sometimes can involve up to five "levels" in the lumbar spine.

What are the symptoms of lumbar canal stenosis?

The usual symptoms of lumbar canal stenosis are a combination of back pain and symptoms in the legs. The symptoms in the legs indicate that there is pressure on the spinal nerves as they pass through the point(s) of narrowing in the lumbar spine, resulting in either sciatica (sharp pains shooting down the back of one or both legs), or claudication (heavy, dull aching, with pins and needles in the feet and legs brought on by standing or walking).

How is lumbar canal stenosis diagnosed?

The diagnosis can be made with a CT scan or MRI scan of the lumbar spine.

An MRI scan is a simple and safe test, similar in many ways to a CT scan. MRI use a technique known as magnetic resonance imaging. No radiation is involved. There is no need to be admitted to hospital and usually no need for injections, although people prone to claustrophobia may find the examination stressful and should discuss their anxiety with medical staff at the time of the test. People with heart pacemakers cannot have an MRI.

Why do I need surgery?

The main reasons for surgery are to relieve the symptoms in your legs and preserve your ability to walk. Surgery is performed on the back, to treat the legs. Surgeons do not usually perform a laminectomy to relieve back pain.

What happens during the operation?

Prior to surgery, you may be taken to x-ray for a ‘marker’. The radiologist places a small mark over the problem area in the spine, usually involving a minor injection just into the skin.

During the operation, the surgeon opens the spinal canal. This immediately relieves the pressure caused by the narrowing. Except in unusual and particular circumstances, a laminectomy does not weaken the structural stability of the spine. The surgery is performed using a variety of fine tools, but much of the work is performed with a very sophisticated and delicate drill, which very gradually whittles away the bone. On average, the operation takes about two hours. If more levels than usual are involved, then the operation takes longer.

What risks and complications are there?

Serious complications are rare and the risk of death is remote. As with any operation, there may be general complications related to age and underlying disease. A 75-year-old with diabetes and heart disease has a greater risk of complications than, for example, a 40-year-old in perfect health. General complications can include stroke, heart attack, bleeding in the wound post-operatively, blood clots in the legs (which can travel to the lungs or heart) and infection.

Possible complications specific to a laminectomy for lumbar canal stenosis include damage to one or more of the nerves travelling through the spinal canal, which could cause permanent numbness or weakness in the legs or feet (or to some part of either leg) and, on rare occasions, affect control of the bladder or bowel.

Failure of the surgery to meet expectations (without anything going wrong) is a possibility. Sometimes, despite the best efforts of the surgeon and patient, symptoms do not respond to surgery as expected. This occurs in up to 10 per cent of cases.

What can I expect after the operation?

There will be some pain around your wound and shooting pains in your legs in the first few days. An intravenous drip inserted during the operation will provide strong pain relief in the first 48 hours or so. After that, you will be given tablets and occasional injections, as required. It will be difficult to roll over in bed for the first few days. You should be able to stand about 48 hours after surgery, although you may feel able to try this sooner. After a few days, most people are able to get in and out of bed unassisted and walk around the ward quite comfortably. Bowel actions normally do not occur until four or five days after surgery.

Will I need physiotherapy?

Most patients see a physiotherapist during their hospital stay, mainly to ensure that they are doing simple movements, like getting out of bed, correctly. Usually, there is no physiotherapy during the first six weeks or so after discharge from hospital, and only a small number of people need on-going physiotherapy after that.

What should I do when I get home?

For six weeks when you get home, the most important thing to do is rest. Your wound needs time to heal, internally as well as externally. Avoid undue bending and lifting. Minimise sitting to essentials such as eating and toileting. It is advisable to avoid driving, and even sitting as a passenger, in a car.

Schedule two good walks of about 15 minutes each per day. Swimming is excellent exercise after spinal surgery but you should wait to begin until after your post-operative review, which is usually six weeks after surgery.

In most cases, the symptoms caused by the disc prolapse will have eased within six weeks of surgery but this varies greatly from person to person.

Will I need rehabilitation?

Many people do not require formal rehabilitation. If, however, it will be difficult for you to cope alone at home, or you were significantly incapacitated prior to surgery, or have complicating medical conditions that might slow your recovery, rehabilitation is advisable. Most people over 70 years old will need some rehabilitation in hospital.

If your back problem is the result of a work injury, you will require a rehabilitation program (as an inpatient or outpatient) that takes account of the nature of your work, the size of your workplace, the duration of symptoms and the details of your surgery. The program may involve input from a number of people, including your family doctor, employer or rehabilitation service providers.

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