Laminectomy is the surgical removal of part of the bone tissue from the spinal disc of a person in order to release the pinched nerve fiber. In another way, this procedure is called open decompression. It is carried out in cases where conservative treatment, physiotherapy and other methods have been ineffective. Laminectomy is an extreme measure in an attempt to release the nerve root in any part of the spine.
Diagnosis of spinal diseases
Before treatment with any method, it is necessary to determine the nature of the pathology as accurately as possible. Spine disease can occur at any age, being a congenital factor, a consequence of another disease or injury.
The patient is examined by a surgeon, which fixes the curvature of the spine visually.
Vertebral damage is confirmed by radiography. For a more accurate diagnosis and visual confirmation, magnetic resonance imaging is used.
Ultrasound scanning of the soft tissues of the spine allows you to see next to the last accumulation of fluids or inflammation.
An important aspect of diagnosis is epiduroscopy. During this procedure, the epidural space of the spine is studied, which allows you to visually observe all pathological growths on the vertebrae, as well as the condition of the yellow ligaments. This study is conducted through endoscopic instruments inserted through the skin.
The uniqueness of the method lies in the fact that it is not limited to diagnostics. If there is a need, then right during the diagnostic examination, the doctor can proceed to therapeutic measures. For example, place a catheter for chemotherapy, if the patient has an oncological disease, or electrodes for coagulation of the nucleus. With the help of endoscopy tools, you can immediately remove scars and adhesions, inject anesthesia directly into the spine. It is also possible to immediately take a tissue sample for a biopsy.
This diagnostic method is preferable to the others, as it allows you to quickly put the patient on his feet, for example, with severe pain due to a pinched nerve.
Procedure
Decompression laminectomy of the vertebrae is carried out only under general anesthesia. The procedure takes from 1 to 3 hours. During the operation, access to the vertebral arches and intervertebral discs in the problem area is opened. The surgeon removes the vertebral arch in whole or in part. Part of the intervertebral disc that has clamped the nerve is also removed.
The second stage of the operation is the liberation of the space around the bundle of nerve fibers by cutting joints.
During the operation, osteophytes, hernias and other formations on the vertebrae and vertebral discs are removed, which reduce the mobility of the spine and increase the risk of developing pathologies.
Decompressive laminectomy can be simplified, it consists only in making a small hole that relieves decompression in the ligaments of the spine. This procedure is called fenestration of the spine and is often carried out as a measure of prevention of the curvature of the spine.
Operations Techniques
The laminectomy operation is performed by various methods, it depends on the condition of the spine, group of vertebrae, severity and form of pathology:
- Removal of the arches of the 1st vertebra is called hemilaminectomy.
- During interlaminar laminectomy, the yellow ligament is cut and the arches of the damaged vertebra are removed.
- In total surgery, both the vertebral arches and its spinous processes are removed .
- In case of osteoplastic laminectomy, the removed parts of the vertebra are replaced by overlays made of artificial materials.
Type of operation
Laminectomy is a surgical operation. And depending on the method of penetration to the vertebrae, it has various types:
- In some cases, penetration is via the skin and soft tissue on the back.
- And the cervical vertebrae can open through the left or right side of the neck.
- For a number of indications, the surgeon can penetrate the lumbar spine through the abdominal cavity.
The choice of penetration method depends on which side of the spine is damaged or which side of the nerve root is pinched.
Alternative Laminectomy Techniques
Modern medicine has developed several alternative types of laminectomy, that is, using modern electronic equipment. So, for example, znzdoscopic microdisectomy is widely used, in which the operation is performed using metal tubes equipped with tools and microchambers and inserted through a puncture on the patient’s skin.
This procedure does not affect soft tissues; instruments immediately reach the vertebrae and vertebral discs and remove growths from them. After such an intervention, the time for rehabilitation and subsequent treatment is significantly reduced, since there are no incisions, and therefore no risk of infection.
Another modern treatment - laser vaporization - is performed as a treatment procedure for hernias of the intervertebral discs, scoliosis and other curvatures of the spine. During the operation, a strong laser beam evaporates unnecessary bone from the vertebra. Since soft tissue is minimally affected and cut during surgery, it is anemic and fast. The patient after such an operation gets better after a few weeks.
The laser is used both for the prevention of spinal curvature and for the treatment of intervertebral discs. To do this, his beam simply heats the bone of the vertebra and the disc itself, causing cartilage cells to grow more intensively. They quickly fill with themselves the old cracks and cracks in the vertebra, restoring its mobility, increasing the ability to load.
Indications for laminectomy
The reasons that led to the need for a laminectomy of the spine are very different:
- Herniated disc with significant prolapse of the spinal column.
- The appearance of a growth on the arch of the vertebra, which reduces mobility, and pain during movement. A striking example of such a pathology is cervical osteochondrosis.
- Damage to nerve tissue in the lumbar, which often leads to disruption of the normal functioning of the lower extremities.
- The operation is performed in cases of the formation of adhesions or tumors on the spinal column.
- Fixation laminectomy is performed during manipulations with the yellow ligaments of the spine, for example, with their significant thickening.
- The procedure is indicated for people with severe infringement of the nerve, leading to paralysis of the limbs or impaired function of internal organs. An example of such an infringement is dysfunction of the human reproductive or urinary system. Simply put, impotence and incontinence.
- Scoliosis and other spinal deformities.
- Compression injury resulting, for example, from falling from a great height.
- The operation is performed as an alternative treatment for a conservative method of therapy. But only after the doctor is convinced of the inefficiency of the conservative method, it takes up to 6 months.
- Intervertebral hernia with prolapse between the vertebrae.
This list does not cover all indications for surgery, since there are a lot of them. An operation is performed only by decision of the attending physician.
Complications after Laminectomy
As after any surgery, the consequences of a laminectomy are possible. But they are minimized by a series of procedures and patient warnings prescribed by doctors.
The patient is discharged from the hospital 3-4 days after the operation, from that moment it is very important to comply with all medical prescriptions, otherwise complications arise.
The doctor regularly examines the patient and assesses his condition, because without proper care, his soft tissues may become inflamed from infection. Inspection is carried out on the 14-15th day after surgery.
Statistics of the operations performed show that the percentage of complications after the procedure is extremely low, and in general the patient has a positive prognosis of complete recovery.
Postoperative period
It may take up to 4-5 months for the patient to recover completely. All this time, the patient is under the supervision of the attending physician. On the 2nd month after discharge from the hospital, the patient can return to work, unless his activity is associated with physical labor. In this case, he can take up his duties only after 4 months.
In general, the periods for which the postoperative period is stretched depend on the age of the patient, his physical condition and the complexity of the operation.
In some cases, the postoperative period takes 6-7 months, because a laminectomy is an operation on the spine - one of the main complex organs of a person.
In the postoperative period, the patient is recommended to undergo a course of therapeutic massage, do gymnastics and, if necessary, wear special back-supporting bandages. Physiotherapy and reflexology courses are also shown.
Conclusion
Laminectomy can be a salvation for a person. The price of an operation in the Russian Federation ranges from 14,000 to 60,000 rubles., Depending on the status of the clinic, the professionalism of the doctor and additional services. It is possible to carry out free surgical intervention according to the compulsory medical insurance policy, however in state neurosurgical departments you will not be able to choose the appropriate method, they perform the intervention in the classical way.