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Laminectomy is one of the most common procedures to decompress the spinal canal in cases of narrowing secondary to various conditions such as degenerative stenosis, fracture, primary and secondary spinal tumors, abscess, and deformity. The spinous process and the lamina are removed limited laterally to the medial part of facet joints. The central canal, the lateral recesses, and the neural foramina must be decompressed for good clinical recovery and the prevention of failed back surgery syndrome. This activity describes the laminectomy technique, highlighting the role of the interprofessional team in evaluating and improving care for patients who undergo this posterior spinal decompression surgery. Objectives: Identify the indications for performing a laminectomy. Describe the equipment, personnel, preparation, and technique used to perform a laminectomy. Outline appropriate evaluation of the potential complications and clinical significance of laminectomy. Review the contraindications to performing a laminectomy. Access free multiple choice questions on this topic.

Posterior spinal decompression is one of the most common surgical procedures to release neural structures when nonoperative treatment has failed and is usually the procedure performed for degenerative conditions such as spinal stenosis, especially in middle-aged and elderly patients.[1] It is one of the most common spinal surgeries among cohorts more than 65 years of age. The classical laminectomy constitutes a central, facet joint sparing laminectomy. The spinous process and the lamina are removed limited laterally to the medial part of facet joints. There was no benefit in preserving the midline structures.[2] The central canal, the lateral recesses, and the neural foramina need to be decompressed for good clinical recovery and prevention of failed back surgery syndrome. Currently, there are several techniques to accomplish posterior spinal decompression, such as open or minimally invasive laminectomy, hemilaminectomy, laminotomies, and laminoplasty. Decompression techniques classify as direct and indirect; direct procedures involve those techniques with visualization of the dural sac during the surgery, such as laminectomy. On the other hand, indirect decompression takes place without dural sac visualization. Laminectomy alone or associated with fusion is one of the most common procedures performed by a spinal surgeon.[3] The goals of the surgery include: Reduce neurological claudication Halt clinical deficits and Promote functional ambulation.

Instability: Damage to the pars interarticularis is a risk. Damage to more than fifty percent of facets on both sides or complete facets on one side intraoperatively mandates fusion surgery. Since L1-3 has a narrow surgical corridor for decompression, preservation of pars is of paramount importance at these levels.[15] Bony Re-growth [16] Kyphosis: due to disruption of posterior tension banding function of posterior Osseo-ligamentous complex.[17][18] Spinal epidural hematoma: maximum risk at the L2/3 level.[19] Dural tear: The incidence is 3.1% to 13% and 8.1% to 17.4% for primary and revision surgery, respectively. It increases the risk of surgical site infections, postoperative deficits, and delirium. The most location is the lower surgical field near the nerve root, followed by the dorsal sac.PMC4206814 Previous surgery and older age were found to be risk variables.[20] The dural closure technique does not impact revision surgery rates or its complications. Primary repair followed by bed rest is advocated.[21] Minimal access surgeries produce minimal dead space, reducing the risk of pseudomeningocele and CSF fistula. Mortality: incidence of 0.5 to 2.3%.

Laminectomy is among the most common procedures spinal surgeons perform to decompress the spinal canal in various conditions. Preoperative and postoperative patient care is crucial to improving outcomes of laminectomy. General practitioners, nurses, and pharmacists should advise the patient to change lifestyle, such as weight control and stop smoking. Making referrals to other professionals is essential when concomitant and associated pathologies could be present. All involved members of the interprofessional team need to communicate across interprofessional lines to achieve optimal outcomes. [Level 5] Complete comprehensive preoperative planning requires assessment. It is essential to carefully document neurological status before surgery and develop correct and complete operative consent describing the magnitude, scope, and detailed complications of the surgery, as well as detailed alternatives considering nonoperative management. The nurse plays a role during the preoperative preparation of patients undergoing spine surgery. The nurse assists the clinician during the procedure and helps with the proper positioning of the patient. The nurse monitors the patient's vital signs before, during, and after the procedure. If there are any untoward changes in the patient's observations, the nurse should immediately alert the clinician and document the findings in the patient's medical records. The nurse should counsel patients appropriately about their care plans and ensure that the patient understands all components of valid consent. The best possible outcome for patients undergoing laminectomy could only be fostered through clear and efficient communication and collaboration among the interprofessional team members. [Level 5] Relief of symptoms by bending forward is a reliable clinical variable in canal stenosis.[53] Physical variables alone were not found to be predictors of a favorable postoperative outcome.[54] A combination of clinical and radiological variables is of utmost importance.[55][56] The relief of pain after epidural steroid injections may be a good prognostic indicator of surgical outcome. The neurological deficit and low comorbidity were good prognostic indicators for favorable outcomes.[57] Increased signal intensity within the cord is a prognostic variable.[58]

Relief of symptoms by bending forward is a reliable clinical variable in canal stenosis.[53] Physical variables alone were not found to be predictors of a favorable postoperative outcome.[54] A combination of clinical and radiological variables is of utmost importance.[55][56] The relief of pain after epidural steroid injections may be a good prognostic indicator of surgical outcome. The neurological deficit and low comorbidity were good prognostic indicators for favorable outcomes.[57] Increased signal intensity within the cord is a prognostic variable.[58] Multivariate analysis showed medical comorbidities, previous laminectomy, and accidental durotomy increased the risk of surgical complications.[59] Independent risk factors for readmission were long operative time, previous spinal surgery, and extended hospital stays.[60] Multi-national Scandinavia study showed similar indications for decompression surgery but significant differences in advocating arthrodesis. Fusion did not improve effectiveness.[61] There was no significant difference in the clinical outcome while comparing unilateral laminotomy with crossover, bilateral laminotomy, and spinous process osteotomy.[62] Outpatient Versus Inpatient Surgery Outpatient surgery is comparable to inpatient surgery. Risk variables such as BMI >30 kg/m^2, age ≥55 years, functional dependency, medical comorbidities, and operative time >90 minutes have been linked to increased risk of complications in cohorts undergoing outpatient surgery.

The nurse's role in the postoperative period should include finite management of intravenous fluids, foley catheter care until ambulating, administering antibiotics, pain control, wound/dressing care, encouraging patient ambulation, and advanced diet when appropriate.

Postoperative patient monitoring is essential for recognizing some early complications, especially CSF leakage from dural sac tears; it is crucial to evaluate the wound by looking for some suggestive signs, such as wound bulging or CSF sinus. Clinical signs of CSF leakage, such as headache and dizziness, should raise alert from possible complications. The presence of erythema, increased pain, or swelling may raise the suspicion of wound infection.