laminectomy

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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.

lam·i·nec·to·my

(lam'i-nek'tŏ-mē),
Excision of a vertebral lamina; commonly used to denote removal of the posterior arch.
[L. lamina, layer, + G. ektomē, excision]

laminectomy

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

laminectomy

(lăm′ə-nĕk′tə-mē)
n. pl. laminecto·mies
Surgical removal of the posterior arch of a vertebra.

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.
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Laminectomy

laminectomy

Orthopedics A procedure for managing intervertebral disk herniation; the 'classic' laminectomy entails bilateral removal of the lamina of a vertebral body adjacent to a diseased disk as well as varying portions of both articular facets. See Cervical laminectomy, Diskectomy, Hemilaminectomy, Laminotomy.

lam·i·nec·to·my

(lam'i-nek'tŏ-mē)
Excision of a vertebral lamina; commonly used to denote removal of the posterior arch.
[L. lamina, layer, + G. ektomē, excision]

laminectomy

(lăm″ĭ-nĕk′tō-mē) [″ + Gr. ektome, excision]
Enlarge picture
LAMINECTOMY
The excision of a vertebral posterior arch, usually to remove a lesion or herniated disk.

It is recommended only after conservative treatment (physical therapy, anti-inflammatory medication) has been exhausted. Minimally invasive spine surgery can be used to treat conditions such as herniated or ruptured lumbar discs, bone spurs, synovial cysts, and lumbar spinal stenosis. Patients with a history of open spine surgery may be poor candidates for minimal procedures because of scar tissue.; illustration

Patient care

Preoperative: The patient's knowledge of the procedure is determined, misconceptions are corrected, additional information is provided as necessary, and a signed informed consent form is obtained. A baseline assessment of the patient's neurological function and of lower extremity circulation is documented. Health care providers discuss postoperative care concerns, demonstrate maneuvers such as log-rolling, assure the patient of the availability of pain medications on request, and prepare the patient for surgery according to the surgeon's or institutional protocol.

Postoperative: Vital signs and neurovascular status (motor, sensory, and circulatory) are monitored; antiembolism stockings or pneumatic dressings are applied, and anticoagulants are given if prescribed. The dressing is inspected for bleeding or cerebrospinal fluid leakage; either problem is documented and reported immediately, and the incision is redressed as necessary. The patient is maintained in a supine position, with the head flat or no higher than 45° according to the surgeon's preference, for the prescribed time (usually 1 to 2 hr), then repositioned side to side every 2 hr by log-rolling the patient with a pillow between the legs to prevent twisting and hip adduction and to maintain spinal alignment. Deep breathing (with use of an inspirometer in most cases) is encouraged, and assistance is provided with range-of-motion, gluteal muscle setting, and quadriceps setting exercises. Adequate assistance should be available when the patient is permitted to dangle his or her feet, stand, and walk in the early postoperative period. Prescribed anti-inflammatory, muscle-relaxant, and antibiotic agents are administered. Noninvasive measures to prevent and relieve incisional discomfort are provided in addition to prescribed analgesics. Fluid balance is monitored by administering prescribed intravenous fluids and by assessing urine output. The patient is encouraged to void within 8 to 12 hr postsurgery and is assessed for bladder distention, which may indicate urinary retention. Catheterization is used only after other measures to promote voiding have been attempted. The abdomen is auscultated for return of bowel sounds, and adequate oral nutrition is provided as prescribed. Patients who have undergone minimally invasive procedures are out of bed and resuming some normal activities (e.g., showering, engaging in activities around the house) within a day or two of surgery. Responses vary and may depend on the patient's personality, presurgical activity level, and overall health. Specific restrictions on postoperative activity should be outlined with the patient in detail at the time of discharge.

Rehabilitative and home care: Incisional care techniques are taught to the patient and family, and the importance is stressed of checking for signs of infection (increased local pain and tenderness, redness, swelling, and changes in the amount or character of any drainage) and of reporting these to the surgeon. A gradual increase in the patient's activity level is encouraged. Any prescribed exercises (pelvic tilts, leg raising, toe pointing) are reviewed, and prescribed activity restrictions are reinforced. Restrictions usually include sitting for prolonged periods, lifting heavy or moderately heavy objects, or bending over. Proper body mechanics are taught to lessen strain and pressure on the spine: these include maintaining proper body alignment and good posture and sleeping on a firm mattress. Involvement in an exercise program, beginning with gradual strengthening of abdominal muscles, is encouraged after 6 weeks. Walking is encouraged. The patient should schedule and keep a follow-up appointment with the surgeon and communicate any concerns to the surgeon (if necessary) before that visit.

laminectomy

An operation to relieve pressure on spinal nerve roots following PROLAPSED INTERVERTEBRAL DISC. A part of side of the arch of a VERTEBRA is removed to gain access to the site at which some of the pulpy material from the centre of an intervertebral disc is protruding. This material is removed.

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

lam·i·nec·to·my

(lam'i-nek'tŏ-mē)
Excision of a vertebral lamina; commonly used to denote removal of the posterior arch.
[L. lamina, layer, + G. ektomē, excision]

laminectomy,

n the excision of a vertebral lamina, commonly used to denote the removal of the posterior arch.

laminectomy

surgical excision of the dorsal arch of a vertebra. The procedure is most often performed to relieve the signs caused by a ruptured intervertebral disk or a space-occupying lesion that is compressing the spinal cord.

continuous laminectomy
the procedure is carried out on all cervical vertebrae for multiple lesions.
Funquist laminectomy
modifications of the procedure which include in type A, bilateral excision of both cranial and caudal articular processes and partial removal of the peduncles. In type B, these structures are preserved.
selected laminectomy
for single lesions, bone is removed from only the adjacent vertebrae.
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