Spinal laminectomy: the essence of the procedure, its stages, possible risks and complications. Decompressive laminectomy.

Decompressive laminectomy is a common operation performed along the entire length of the spine from the neck to the lower back (lower back). It is carried out in order to reduce pressure on the roots of the spinal nerves caused by age-related dystrophic changes in the spine (its narrowing), and also to treat other conditions (for example, the consequences of spinal injuries, intervertebral hernias, tumors). Depending on the severity of the disease, one or more vertebrae may be involved. In most cases, the result of the procedure can be removed pain syndromeback to everyday activities.

Laminectomy is usually used only when more conservative methods of treatment, such as drug therapy, physiotherapy or injections, do not work. The procedure can also be recommended if severe symptoms are observed or the patient's condition worsens sharply.

Why is this operation done?

Bony growths in the spinal canal can narrow the space reserved for the spinal cord and nerves. This pressure causes pain, weakness, or numbness in the arms and legs. In most cases, a laminectomy helps relieve these symptoms.

She is appointed by a neurosurgeon in the following cases:

• severe, gradually worsening symptoms limit the possibilities for normal daily activities;
• conservative treatment methods do not relieve pain and do not reduce symptoms caused by compression of the nerve (numbness, weakness);
• the patient has difficulty controlling the bladder and intestines;

• sudden changes in the ability to take a stable position when walking are noticed, movements become awkward.

In some cases, a laminectomy can become part of a complex of surgical procedures aimed at treating an intervertebral hernia. The surgeon will need to remove part of the bone plate to gain access to the damaged disc.

As a rule, direct lesions that do not have a structural effect on the brain cause small pericapal bleeding, which confuses gray matter. About 4 hours after the injury, infection with gray matter and swelling of the white matter occurs. A heart attack with a lesion occurs within 8 hours after an injury. It is important to know that necrosis and hematoma expand and occupy a segment or two above and below the main affected area. Bone tissue is trying to recover through the process of gliosis, which develops in areas of necrosis several months after the injury and can cause singioomyelia syndrome.

When deciding on the feasibility of the procedure, the neurosurgeon is based not only on the results of imaging (X-ray diagnostics and computed tomography). Even if the tomography shows that the spinal cord and spinal nerve roots are compressed, the recommendation for surgical intervention occurs only if there are severe symptoms that interfere with the ability to conduct normal life activities.

From a functional point of view, spinal cord injury causes medullary shock and supraminal functional inhibition of a sublevel segment. In the situation of the medullary region, there is flaccid paralysis and the abolition of osteotonic reflexes, sensitivity disorders, sphincteric and trophic disorders in the sublingual segments. The brain loses control over the sublevels of the medullary segments. This symptomatology lasts 1-3 weeks, after which the recovery period of cerebral automatism is established.

Osteotonic reflexes become exaggerated, a Babinsky sign appears, and some limb movements can be resumed if the brain has not been completely torn. If the bone marrow had an incomplete or complete incision or a medullary infarction, in the first moments of the injury a patient with lower limbs did not throw out an arbitrary or involuntary movement. The only engine reaction that is sometimes visible in the early days of an injury is the slow movement of the halo flexion after scratching the plant.

What happens before the operation?

1. a few days before the operation most likely you will need to undergo an examination (take a blood test, cardiogram, perform an x-ray of the chest).
2. the neurosurgeon will offer to sign a consent form and fill out the necessary documents with personal information regarding your medical history (indicate the presence of allergic reactions, including anesthesia, the number and limitation period of the last blood transfusion, describe the medications / vitamins taken, previous operations).
3. you may want to donate your own blood a few weeks before the operation in order to be able to use it for transfusion during the operation.
4. a week before the operation, stopping the use of non-steroidal anti-inflammatory drugs and blood thinners will be required;
5. cessation of smoking, chewing tobacco, drinking alcohol two weeks before and as much after surgery, because they can lead to problems with blood coagulation and cause blood loss.

You should come to the hospital in the morning of the day on which the procedure is scheduled. Water intake stops after midnight before. An intravenous catheter is connected to the patient’s arm for subsequent administration of anesthesia.

What happens during surgery?

Laminectomy cervical   The spine, like the spinal, is carried out in 6 stages. The duration of the procedure is 1-3 hours.

The risks of laminectomy

Potential risks and complications for the described procedure.

The likelihood of common anesthetic complications, such as myocardial infarction (heart attack), blood clots, stroke, pneumonia, pulmonary embolism is about the same as with any other type of surgical intervention.

Clinical manifestations depending on the topography of the lesion. In case of vertebral injury, there are dislocations and fractures of the atlas, body axis, and odontoid apophysis. These elements lead to slipping of the head limb to the front of the head, which leads to depression of the bulb by the odontoid apophysis. In the case of damage to the bulbar, the damage is fatal, which leads to exit through cardiorespiratory arrest. If the flask is not damaged, tetraepilation occurs with anesthesia from C2 and respiratory distress. When the fractures are not structurally interested in the bone marrow or bulb or are of little interest, the patient returns completely neurologically. Some people experience a decrease in muscle strength in their upper limbs. However, after a few months, tetraparet syndrome can sometimes occur due to a local arachnoid process. fracture rate also causes respiratory disorders, affecting the physical nerve. Paralysis occurs at the level of the deltoid and superficial and subpinal muscles. Fractures and lead to paralysis of the biceps. Lesions are caused by triceps, extensors of the forearm and muscles of the forearm. lesions at and below levels lead to paraplegia. There are also sphincter disorders. The most common fractures occur in the area between the vertebrae. Impairment of the lower thoracic spine can lead to congenital or caudal condyle syndrome. fractures occur in the event of an impact in the upper or middle back. Clinically related are signs of horse cone and tail dysfunction. In case of spinal cord injury, a simple radiograph of all segments of the spine is performed.

What are the results?

Decompressive laminectomy successfully relieves leg pain in 70% of patients, allowing a significant improvement in their function (ability to perform normal daily activities), the level of pain and discomfort is markedly reduced.

However, back pain does not completely disappear, and 17% of patients require another surgery, symptoms may return in a few years.

The results of the operation are largely up to you. It is important to maintain a positive attitude and diligently perform physical exercises, maintain an optimal level of weight suitable for your height. This phoned to reduce the load on the spine and reduce pain. Do not console yourself with vain hopes of hoping that you will be "like new" immediately after the procedure. It is important to understand that back pain will always accompany you, you must learn to take the right postures and techniques to prevent re-injury.

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