In September of 2011 I underwent a Laminectomy for a herniated disc at L5/S1. The operation was performed by a Neurosurgeon who advised decompression to alleviate a large herniated disc applying pressure to a nerve root. He also performed another procedure unrelated to the L5/S1 disc issue which I won’t discuss at the moment. The entire procedure lasted approximately 5 hours and I stayed one night at the hospital.
My recovery took several months and involved a few weeks rest then a long period of Physiotherapy. There was inflammation in the area(s) of incision and I was constantly looking for pain relief from the burning sensation. It was later determined by MRI that scar tissue had formed around a nerve root which may be the cause of the burning.
It’s taken several years for the pain to settle down from the Laminectomy and follow up imaging shows that there is far less pressure on the nerve root from the protruding disc at L5/S1.
Here is a detailed account of how this surgery is performed: Please visit Health24 for additional information.
Step 1: A laminectomy is performed with the patient lying on his stomach or side and under general anaesthesia. The surgeon (an orthopaedic or neurosurgeon) reaches the spinal column through a small incision in the back.
Step 2: He will use a retractor to spread the muscles of the back apart in order to expose the bony lamina.
Step 3: He cuts away part of the lamina to uncover the ligamentum flavum – a ligament supporting the spinal column.
Step 4: In the next step he will cut an opening in the ligamentum flavum to reach the delicate spinal canal containing the compressed nerve.
Step 5: The compressed nerve can now be seen as well as the bundle of nerve fibres (known as the cauda equina) to which it is attached. It is now possible to identify the cause of compression: a bulging, ruptured or herniated disc, or perhaps a bone spur.
Step 6: The source of the pressure can now be removed. This may involve removing the bulging portion of the disc or the bony spurs and scar tissue. The herniated disc is removed after the compressed nerve has been gently retracted to one side. The surgeon will remove as much of the disc as is necessary to take pressure off the nerve. Sometimes a fragment of disc has moved and presses on the nerve root as it leaves the spinal canal. This will often cause more severe symptoms.
Step 7: With the cause of compression removed, the nerve can now begin to heal. The space created by removal of the disc will gradually fill with connective tissue. The incision is closed in several layers, from the inside outwards.
Step 8: The skin layer will be closed with steri-strips, sutures or skin clips. A dressing will be placed over the incision to protect the wound.
This operation is normally performed within one or two hours, depending on the number of levels that are decompressed.
After surgery
A plastic drain will run from inside the wound to remove any accumulating blood. In most cases, the drain can be removed on the second day after surgery.
An intravenous line to administer medication may remain connected through a vein in your hand or arm for two to three days.
Pain can and should be well controlled. Usually the acute pain subsides after a day or two. Pain may be most severe in the lower back. Leg pain may be caused by swelling of the previously compressed nerve and the trauma of the surgery. Muscle spasms across the back and down the legs are not uncommon and this can be relieved by muscle relaxants.
A physiotherapist will help you to begin standing and walking again, and show you how to get in and out of bed and how to sit, stand, and sleep.
