Getting a Laminectomy: Before, During, and After

Laminectomy is one of the most common back surgeries. During a laminectomy, a surgeon removes the rear portion of one or more spinal bones (vertebrae). Bone spurs and ligaments that are pressing on nerves may be removed at the same time. Here's what to expect before, during, and after your laminectomy.

Before Your Laminectomy

Before your laminectomy, you should receive detailed instructions on how to prepare from your surgeon's staff during one of your office visits. Here's what you should do and plan for before the surgery:

• Don't eat or drink anything after midnight the night before your laminectomy.
• Wear loose, comfortable clothing. Don't wear jewelry, especially necklaces or bracelets.
• Bring your insurance information and your pocketbook for any co-payments or required paperwork.
• If your doctor thinks you might be able to go home the same day, bring someone to drive you home and help take care of you.
• Plan for being slow for a while. Stock up on groceries and take care of all the errands and housekeeping you can.
• Let friends and family know you'll be having surgery; you'll be able to use extra help during your recovery.

On the day of your laminectomy:

• You'll be provided a private area to change into a loose-fitting medical gown.
• You'll wait in a "pre-op" area on a stretcher or bed. Your surgeon, your anesthesiologist, or the anesthesiologist's assistant will visit you and examine you.
• When everyone is ready, you'll be transported to the operating room.

During Your Laminectomy

Most laminectomies are performed with general anesthesia and mechanical ventilation. Here's what will happen:

• The anesthesiologist or an assistant will place a mask over your face, delivering a mix of oxygen and anesthetic gas. You may also be given medicines through your veins to help you relax. Within a few breaths, you'll be unconscious. This is general anesthesia.
• The anesthesiology professional will then insert a plastic tube through your mouth and vocal cords, into your windpipe, or trachea. This is called intubation.
• During the surgery, a ventilator, or breathing machine, will pump air in and out of your lungs. Your vital signs will be continuously monitored throughout the operation.
• You'll be rolled over into the face-down position to provide access to your back.

Next, the surgeon will perform the laminectomy:

• The surgeon will make an incision in the skin of your back over the affected area. The muscles and soft tissues around the spine will be pulled to the side, exposing the spine.
• The surgeon will then cut away bone, bone spurs, and ligaments that are compressing nerves. This is referred to as decompression. The surgeon may remove a small part or a large portion of several spinal bones, depending on your reason for the operation.
• Some people may also undergo spinal fusion to stabilize the spine, receive a special implant that will help stabilize the bones in the lower back but not restrict motion in the same way a fusion does, have a disc removed, or have additional removal of bone to widen the passageway where nerves leave the spinal canal.

At the end of the surgery, the wound will be stitched, you'll be turned back over, the anesthesia will be turned off, and the breathing tube will be removed.

After Your Laminectomy

Here's what will happen in the hospital or surgical center after the laminectomy:

• You'll be transported to a "post-op" area for observation and continued monitoring of your vital signs. Most people are awake but groggy for several hours after a laminectomy.
• Although some people go home the same day, most are admitted to the hospital for at least one day.
• You will feel pain in your lower back. You'll be provided pain medication.
• Depending on the extent of your surgery, you may need help getting out of bed and walking for up to a few days after the laminectomy.

Here's what you can expect at home after your laminectomy:

• Expect some significant pain that may require strong pain medication. You shouldn't drive while taking these drugs. Most people can return to driving in one to two weeks; your surgeon will let you know when it is safe to get back on the road.
• You'll need to limit your activities that include bending, stooping, or lifting for several weeks after your laminectomy.
• You'll also need to keep the incision site clean and dry. Ask your doctor for instructions on showering and bathing.
• Your doctor will remove your stitches or staples after about two weeks.
• You should avoid long plane flights or car rides -- they can lead to blood clots in your legs. If you do travel, stand and walk around once an hour or so.

Your recovery time will depend on the extent of your surgery and your own personal situation. In general, here's what to expect:

• After a minor (decompressive) laminectomy, you are usually able to return to light activity (desk work and light housekeeping) within a few days to a few weeks.
• If you also had spinal fusion with your laminectomy, your recovery time will likely be longer -- from two to four months.
• Your doctor may not advise a return to full activities involving lifting and bending for two to three months.
• You should start light walking for exercise and physical therapy exercises as soon as your doctor says you're ready. This will help speed your recovery.

How will you know the results of your laminectomy? The majority of people who undergo laminectomy do experience a reduction in their back pain symptoms. You may not know if the surgery reduced your back pain until about six weeks or more after the laminectomy.

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