continuous laminectomy

laminectomy /lam·i·nec·to·my/ (lam″ĭ-nek´tah-me) excision of the posterior arch of a vertebra.

lam·i·nec·to·my (l

-n

-m

)

Excision of a vertebral lamina. Also called rachiotomy.

Laminectomy

An operation in which the surgeon cuts through the covering of a vertebra to reach a herniated disk in order to remove it.

Mentioned in: Disk Removal

laminectomy

[lam′inek′təmē]

Etymology: L, lamina + Gk, ektomē, excision

surgical removal of the bony arches of one or more vertebrae. It is performed to treat compression fractures, dislocations, herniated nucleus pulposus, and cord tumors and to stimulate the spinal cord. With the patient under general anesthesia and prone to eliminate lordosis, reduce venous congestion, and keep the abdomen free, the laminae are removed, and the underlying problem is corrected. Spinal fusion with cages, rods, screws, and/or bone graft is used to stabilize the spine if several laminae are removed. If the procedure is a cervical laminectomy, the patient is observed for signs of respiratory distress caused by cord edema. Motor function and sensation in the extremities are evaluated every 2 to 4 hours for 48 hours. The dressing is examined frequently for hemorrhage or leakage of cerebrospinal fluid. The patient is taught to logroll without twisting the spine or hips. laminectomize, v.

laminectomy [lam″ĭ-nek´to-me]

surgical excision of the lamina of a vertebral arch, usually done to relieve the symptoms of a herniated disk by disk excision. The spinal canal is exposed and the portion of the nucleus pulposus that has herniated through the ruptured disk is removed. This is indicated when conservative treatment is not effective and nerve damage is becoming progressively worse or when the patient is suffering from repeated attacks of leg pain. Laminectomy is sometimes followed by spinal fusion in the area to stabilize that part of the spinal column. Bone grafts, usually taken from the iliac crest, are applied to fuse the affected vertebrae permanently, resulting in limitation of movement of this portion of the spine. Laminectomy is also performed for adequate visualization for the removal of an intervertebral or spinal cord tumor.

Patient Care. Prior to surgery the procedure and its expected outcome are explained to the patient and family. Patients will also need to know about intravenous fluids, a urinary catheter, and any other devices that may be used postoperatively. In most cases postlaminectomy patients are allowed out of bed one to three days after surgery. A back brace may be prescribed for spinal fusion patients when they are standing and walking. Fluids by mouth are usually allowed after bowel sounds reappear, which should be one to three days postoperatively.

Patients with this type of surgery have experienced significant long-term pain before surgery and may be apprehensive about perioperative pain, or they may expect to be completely free of discomfort after surgery. They should know that there probably will be some discomfort and that analgesic medications will be given promptly when requested.

Immediately after surgery the vital signs are noted and recorded and level of consciousness assessed. Peripheral pulses are palpated, and color, range of motion, temperature, and sensation in the feet and toes are checked. Dressings are checked for unusual drainage. Evidence of spinal fluid leakage on the dressing is immediately reported. Patients who have had a spinal fusion will have two dressings, one at the spinal column where the affected disk is located and one at the iliac crest where bone was removed for the graft.

The patient is assessed frequently and regularly for pain. In general, patients with laminectomies have less pain after than before surgery because pressure on the nerve root has been relieved. In contrast, those who have had spinal fusion often experience more postoperative pain at both operative sites. In keeping with the preoperative promise of prompt response to a request for relief, analgesics are given as needed. Transcutaneous electrical nerve stimulation (TENS) may be prescribed to provide relief and facilitate ambulation and recovery.

Positioning after surgery will depend on the preference of the surgeon. In general, the patient's head is not raised beyond a 45-degree angle. This avoids placing a strain on the lumbar region. Log-rolling spinal fusion patients while they are in bed prevents twisting of the spine and nonsetting or failure of the fusion. When these patients are allowed up they are instructed to avoid sudden movements and twisting of the spine. They also must wear lumbar orthoses to stabilize the spine when walking. They should be watched for orthostatic hypotension, which can occur if sympathetic nerves were traumatized during surgery.

Physical therapy and exercises to strengthen abdominal, back, and leg muscles are begun as soon as permitted by the surgeon. These usually are carried out under the direction of a physical therapist. Several months of rehabilitation and recuperation are usually needed to completely rehabilitate the spinal fusion patient. Patients who have had a diskectomy or laminectomy typically return to sedentary work in one month. If lifting or manual labor are necessary on the job, the patient should be able to resume work in three to six months.

Laminectomy for the interlaminal removal of a herniated disk. From Polaski and Tatro, 1996.

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