If lumbar spine pain becomes so severe that it disrupts daily life or is accompanied by swelling, tenderness, or redness, it’s important to seek medical attention.
At Complete Orthopedics, our expert lumbar spine specialists are adept at treating lumbar spine pain through both surgical and non-surgical means. We examine symptoms, diagnose the condition, and recommend suitable treatments, including surgery if necessary.
You are viewing: What Is A Hemilaminectomy
Serving New York City and Long Island, we partner with six hospitals to offer cutting-edge lumbar spine surgery and comprehensive orthopedic care. You can schedule a consultation with our orthopedic surgeons online or by phone.
Learn about the common causes of lumbar spine pain and the treatment options available, including when surgery might be the best choice.
Overview
Hemilaminectomy/laminotomy is a minimally surgical procedure used to decompress the neural tissues. Decompression involves the removal of structures/tissues compressing/irritating the spinal nerves. The hemilaminectomy differs from laminectomy surgery in the removal of a very small part of the lamina. The surgery is commonly used to relieve symptoms caused by spinal canal stenosis in the lumbar spine.
The lamina forms the roof of the spinal canal that forms the conduit for the spinal cord/thecal sac. The lamina is present at the back of the spinal cord/thecal sac whereas the vertebral body and the intervertebral discs are present at the front. The spinal nerve roots exit the spinal column at each segment through the intervertebral foramen.
As the spinal nerves exit the foramen they may be compressed or irritated due to narrowing or stenosis of the canal. Bone spurs may form that may compress the neural structures. The bone spurs may form as a part of age-related wear and tear of the spine or secondary to trauma. There may be thickening of the lamina which may cause compression of the neural structures.
The patients requiring lumbar hemilaminectomy surgery may present with complaints of back pain, radiating pain in the buttocks, radiating pain in the back of the thigh or front of the thighs. Patients may also complain of numbness and tingling in the lower extremities. Some patients may have difficulty walking due to pain and may have an exacerbation of symptoms while walking downhill or when bending backward.
The Basics of Spinal Anatomy
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The spine is composed of individual bones called vertebrae, stacked on top of each other. Between these bones are intervertebral discs, which act as cushions to absorb shock and allow movement. The spinal cord runs through a central canal in the vertebrae, with spinal nerves branching out to different parts of the body through openings called foramina.
Symptoms and Diagnosis
The symptoms may initially be managed conservatively in the form of pain medications and physical therapy. In patients with continuous symptoms, an epidural corticosteroid or a nerve block injection may be tried. Only in patients with continued symptoms despite conservative management, surgical management is indicated. Patients with the instability of the spine segment and deformity are usually candidates for lumbar fusion surgery
Hemilaminectomy/Laminotomy: A Minimally Invasive Option
Hemilaminectomy/laminotomy is a surgical procedure used to relieve pressure on the spinal cord and nerves. Unlike a full laminectomy, which involves removing a larger portion of the lamina (the roof of the spinal canal), a hemilaminectomy removes only a small part, making it less invasive.
However, not all patients are candidates for hemilaminectomy. Patients with extensive involvement and compression may benefit from laminectomy surgery or lumbar fusion surgery.
Procedure Overview
Preparation: The surgery is performed under general anesthesia. The patient lies face down on the operating table.
Incision: A small incision is made in the back to access the affected area.
Muscle Retraction: The paraspinal muscles are gently moved aside to expose the spine.
Removal of Lamina: Using specialized instruments, the surgeon removes a portion of the lamina and may also remove parts of the thickened ligamentum flavum or herniated disc material.
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Closure: The incision is closed in layers, and a sterile dressing is applied.
Recovery and Rehabilitation
Patients typically stay in the hospital overnight and are discharged the next day. Post-operative care includes pain management, wound care, and gradual return to activities. Physical therapy is often recommended to strengthen the back muscles and improve flexibility. Most patients experience significant relief from their symptoms and can resume normal activities within a few weeks.
Potential Complications
As with any surgery, hemilaminectomy/laminotomy carries some risks. Complications may include:
- Incomplete Decompression: Sometimes, the surgery may not fully relieve the pressure on the nerves.
- Accidental Durotomy: This refers to an unintentional tear in the dura mater, the outer membrane of the spinal cord.
- Nerve Damage: There is a risk of damaging the nerves or spinal cord during the procedure.
- Bleeding and Infection: As with any surgery, there is a risk of bleeding and infection.
Advanced Surgical Options
For patients with more extensive spinal issues, additional procedures may be necessary:
Laminectomy: This involves removing a larger portion of the lamina to provide more significant decompression.
Lumbar Fusion Surgery: In cases of spinal instability or deformity, fusion surgery may be required. This procedure involves joining two or more vertebrae together to stabilize the spine.
Hemilaminectomy vs. Other Surgical Techniques
While hemilaminectomy is less invasive and has a shorter recovery time, it may not be suitable for all patients. Those with severe spinal stenosis or multiple levels of compression might benefit more from a full laminectomy or fusion surgery. The choice of procedure depends on the specific condition, the severity of symptoms, and the overall health of the patient.
Conclusion
Understanding the different surgical options for treating spinal conditions is crucial for making informed decisions about your health. Hemilaminectomy/laminotomy offers a minimally invasive solution for relieving pressure on the spinal nerves, with a quicker recovery time compared to more extensive surgeries. However, it’s essential to discuss all available options with your healthcare provider to determine the best approach for your individual needs.
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