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The Purpose of this Information This information is being provided to you in order to prepare you to make decisions about your own health care. If you should ultimately decide that surgery is the best treatment option for you, this section will help you understand what happens during a lumbar laminectomy and will help you prepare for your role in the healing and recovery process. Read it thoroughly and answer the questions before making your final decision about your treatment options. The Health Care Team's Role The duty of your health care team is to:
The Patient's Responsibilities You are the only one who can decide to have surgery. It is important that you take ownership of this decision, recognizing the limitations your particular physical condition places on the potential success of each of the treatment options. If you choose to have surgery, your physical condition and your mental attitude will determine your body's ability to heal. You must approach your surgery with confidence, a positive attitude, and a thorough understanding of the anticipated outcome. You should have realistic goals - and work steadily to achieve those goals. The decision to have or not to have surgery includes weighing the risks and benefits involved. You will make the final decision, so ask questions about anything you do not understand. Since medical care is tailored to each person's needs and differences, not all information presented here will apply to the patient's treatment or its outcome. Seek the advice of your physician and other members of the health care team for specific information about the patient's medical condition.
Anatomy of the Back The spinal column, or backbone, consists of 33 bones (vertebrae) and can be divided into five segments (Fig. 1A). The uppermost 24 vertebrae are separated from one another by fibrous cartilage pads, called intervertebral discs (Fig. 1B), which provide flexibility to the spine and act as shock absorbers during activity. In the lowest part of the spine, the vertebrae are naturally fused to form the sacrum and the coccyx (tail bone).  Protruding from the back of each vertebral body is an arch of bone that forms the large, vertical opening (the spinal canal) through which runs the spinal cord and nerve bundles. A fluid-filled protective membrane, the dura, covers the contents of the spinal canal from where the cord begins at the base of the skull to where it ends (in a bundle of nerve fibers known as the cauda equina). A pair of spinal nerves branches at each vertebral level (one to the left and one to the right), providing sensation and movement to all parts of the body. Three large, bony projections, or processes, arise from the vertebra's arch - one to each side (transverse) and one straight toward the back of the body (spinous). Strong ligaments and muscles attached to the vertebra's body and processes support the spine and further protect the delicate spinal cord and nerves encased within. Back and leg pain, among other symptoms, may occur when an intervertebral disc herniates (Fig. 1B, above). This happens when some of the disc's jellylike center (the nucleus pulposus) bulges or ruptures through its tough, fibrous outer ring (the annulus fibrosis) to press upon a nerve.(Fig. 1C, above).
What is It? Lumbar laminectomy is an operation performed on the lower spine to relieve pressure on one or more nerve roots. The term is derived from lumbar (lower spine), lamina (part of the spinal canal's bony roof), and -ectomy (removal).
What Happens Afterwards? Successful recovery from lumbar laminectomy requires that you approach the operation and recovery period with confidence based on a thorough understanding of the process. Your surgeon has the training and expertise to correct physical defects by performing the operation; he and the rest of the health care team will support your recovery. Your body is able to heal the involved muscle, nerve, and bone tissues. Full recovery, however, will also depend on your having a strong, positive attitude, setting small goals for improvement, and working steadily to accomplish each goal.
Laminectomy After a retractor is used to pull aside fat and muscle, the lamina is exposed. Part of it is cut away to uncover the ligamentum flavum - a ligament that supports the spinal column (Fig. 4). 
Entering the Spinal Canal Next an opening is cut in the ligamentum flavum through which the spinal canal is reached. The compressed nerve is now seen, as is the cauda equina (bundle of nerve fibers) to which it is attached. The cause of compression may now also be identified - a bulging, ruptured or herniated disc, or perhaps a bone spur (Fig.5).  Sometimes a fragment of disc has moved away from the disc space to press on the nerve root as it leaves the spinal canal (Fig. 6). This will often cause more severe symptoms. Because of its distance from the disc space, the fragment may not be seen on a myelogram, and a CT scan (computerized x-ray) may be required to locate it. 
Removal of the Herniated Disk The compressed nerve is gently retracted to one side, and the herniated disc is removed. As much of the disc is taken out as is necessary to take pressure off the nerve (Fig. 7). Some surgeons will remove all "safely available" disc material. After the cause of compression is removed, the nerve can begin to heal. The space left after removal of the disc should gradually fill with connective tissue. 
Fusion and Instrumentation 
Risk Certain risks must be considered with any surgery. Although every precaution will be taken to avoid complications, among the most common risks possible with surgery are: infection, excessive bleeding (hemorrhage), and an adverse reaction to anesthesia. Since lumbar laminectomy involves the nervous system, nerve damage is another possible risk. Clinical experience and scientific calculation indicate that these risks are low; but surgery is a human effort. Unforeseen circumstances can complicate a normally no-risk procedure and lead to serious or even life-threatening situations. Although such complications are rare, you should feel free to discuss the question of risk with your doctor.
Pain It is normal to have pain after the operation, especially in the lower back. This does not mean that the procedure was unsuccessful or that your recovery will be slow. Leg aching is also not unusual, caused by inflammation of the previously compressed nerve. It will go away slowly as the nerve heals. You may experience muscle spasms across your back and even down your legs. Medication will be given to control pain and relieve spasm. Moist heat and frequent repositioning may also help. Physical Activity You may move about in bed and rest in any comfortable position when you have recovered from anesthesia. Walking may begin within several hours. The easiest way for you to get out of bed is to raise the head of the bed as far as it will go, and then swing your legs to the floor. Use the trapeze to change positions in bed. During the first few trips from bed, you will require help from a nurse to avoid falls or injury. Hygiene Usually, you may take a shower the day after surgery. This will make you feel better and should be done with the dressing left in place to protect the incision. Your nurse will change the dressing afterwards. Lotion may then be massaged into the lower back, including the area around the incision to eliminate dryness and help relieve muscle spasm. Nutrition Intravenous (I.V.) fluids will be discontinued when you can tolerate regular liquids without nausea or vomiting. Your diet will then be adjusted back to normal as your appetite returns. Constipation will be treated with laxatives and a diet of whole grain cereals, fruits, and fruit juices. Emotional Changes It is normal to feel discouraged and tired for several days after surgery. These feelings may be your body's natural reaction to the cutback of extra hormones it put out to handle the stress of surgery. Although emotional let-down is not uncommon, it must not be allowed to get in the way of the positive attitude essential to your recovery and return to normal activity. Discharge from the Hospital The hospital stay for lumbar laminectomy patients usually lasts from 3 to 5 days. This will be determined by your progress and by the amount of comfort and help available to you at home.
Physical Activity Daily walking is the best exercise. Try to increase your distance a little each day, setting a pace that avoids fatigue or severe pain. You may climb stairs when you feel able. Avoid sitting or standing for long periods of time. Change positions frequently to help eliminate lower back muscle spasms and leg aching. Sexual relations may be resumed during the recovery period, but positions that strain the back or cause pain should be avoided. "Listen" to your body. Discomfort is normal while you gradually return to normal activity, but pain is a signal to stop what you are doing and proceed more slowly. Sleep During the recovery period, it will help to take several short rests throughout the day. If lying flat, place a small pillow or rolled towel under the small of your back. The best positions for resting are on one side with the top leg bent up, or on your stomach. Waking up with a stiff back is not uncommon and may be relieved by taking a short walk or a warm shower. A firm mattress is important for proper back support. Working Your doctor will help determine when you can return to work and with what limitations. If your job requires lifting, twisting, or bending, a work release may be given to you during the first postoperative visit. Driving Drive a car only when you have recovered full coordination and are experiencing minimal pain. Do not drive after taking pain medication. Medication You should gradually use less pain medication while recovering at home. This can be accomplished by increasing the amount of time between taking pills, then by reducing the number taken each time. A certain amount of discomfort and pain in the lower back can be expected until the inflammation and nerve sensitivity have subsided. Heat, exercise, massage, and short rest periods will also help relieve pain. Physical Fitness It is important that you develop a general physical fitness program. Being overweight or out of shape strains the lower back and will delay recovery. Controlling weight will help you develop a stronger and more flexible back. Exercises must also be done every day to build up strength and keep muscle tone. Hygiene If the skin sutures were removed before your discharge from the hospital, it is not necessary to keep the incision covered. Unless instructed otherwise, you may take a daily shower or tub bath, which will help you feel better. Let the water run over the incision, but do not scrub or rub over it. Pat it dry. After bathing, massage lotion over the tightened muscles of the lower back and buttocks. Inflammation If you notice increased redness, swelling, or any drainage around the incision after leaving the hospital, notify your doctor. Nutrition A well balanced diet is necessary for proper healing. Include foods from each basic food group: dairy products, meats, vegetables, and fruits. Since you will be less active during recuperation, avoid rich, heavy foods and those high in calories but low in nutrients.
Healing is the body's natural process of restoring its damaged tissues to a normal or nearly normal state. Although healing may be improved by general good health, proper nutrition, rest, and physical fitness, it will occur without your having to work at it. Recovery is the process during which you work to become well. It requires a gradual but persistent effort to increase physical strengths and minimize weaknesses. You must concentrate on what is improving, rather than on what symptoms remain. This focus on progress that has been made, combined with the constant effort to improve, make up the positive attitude that will speed your return to normal daily activity.
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