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| laminectomy | |
|---|---|
| Name | Laminectomy |
| Icd10 | 0SRB0ZZ |
| Medlineplus | 002971 |
| Specialty | American College of Surgeons, American Academy of Neurology, Royal College of Surgeons |
laminectomy
Laminectomy is a surgical procedure involving removal of the posterior vertebral arch to decompress neural elements. It is performed by neurosurgeons and orthopedic spine surgeons to treat spinal stenosis, herniated discs, tumor resection, and traumatic compression; indications, technique, and outcomes intersect with standards from institutions such as Mayo Clinic, Cleveland Clinic, Johns Hopkins Hospital, and guideline panels including the National Institute for Health and Care Excellence and the Society of British Neurological Surgeons.
The procedure targets posterior elements of the vertebral column—laminae, spinous processes, ligamentum flavum—and adjacent structures in cervical, thoracic, and lumbar regions, with anatomic reference to levels defined by the American Association of Neurological Surgeons, vertebral numbering used in radiology protocols from Radiological Society of North America, and cross-sectional correlates described in atlases by Gray's Anatomy, Netter and surgical texts from A. Benjamin Spence. Indications include symptomatic central or lateral recess stenosis attributable to degenerative spondylosis, facet hypertrophy, ossification of the posterior longitudinal ligament as seen in cohorts from Tokyo Medical University, large sequestrated disc herniations reported in series from Massachusetts General Hospital, epidural abscesses treated per protocols at World Health Organization-endorsed centers, spinal tumor decompression (e.g., meningioma series from Mayo Clinic Arizona), and acute traumatic compression managed in trauma centers like Harborview Medical Center.
Open laminectomy, wide decompression, and variant procedures—hemilaminectomy, laminotomy, and multilevel laminectomy—are described in operative manuals from The Journal of Neurosurgery, training curricula at Johns Hopkins School of Medicine, and technique guides by AO Spine. Minimally invasive techniques use tubular retractors and endoscopic approaches developed at centers including Cleveland Clinic Foundation and Wooridul Spine Hospital. Cervical laminoplasty (expansive open-door or double-door) is contrasted with posterior laminectomy in series from Kyoto University Hospital. Fusion adjuncts—posterior instrumented fusion with pedicle screws as in protocols from Scoliosis Research Society recommendations—are used when laminectomy risks iatrogenic instability, as reported in long-term follow-ups from Harvard Medical School and University of California, San Francisco.
Preoperative workup follows pathways endorsed by American College of Physicians and includes history and targeted neurologic examination, upright and supine radiographs referencing standards from American College of Radiology, magnetic resonance imaging protocols from European Society of Radiology and computed tomography when osseous detail is required, as practiced at Stanford Health Care. Risk stratification incorporates comorbidity indices used by American Society of Anesthesiologists, bone density assessment per International Osteoporosis Foundation for fusion planning, and infection screening per Centers for Disease Control and Prevention perioperative guidelines. Shared decision-making involves discussion of goals, alternatives, and evidence synthesized in systematic reviews by Cochrane Collaboration.
General endotracheal anesthesia with neuromuscular blockade is standard in many centers including Mount Sinai Hospital, while select minimally invasive procedures may use alternative anesthetic plans described in protocols from Royal College of Anaesthetists. Intraoperative neurophysiologic monitoring—motor evoked potentials and somatosensory evoked potentials—follows consensus statements from the American Society of Neurophysiological Monitoring and is utilized in complex deformity or tumor cases as practiced at Barrow Neurological Institute. Blood management strategies reference transfusion thresholds and cell-salvage protocols from American Association of Blood Banks.
Postoperative pathways align with enhanced recovery protocols promulgated by Enhanced Recovery After Surgery societies and institutional programs at Brigham and Women's Hospital. Early mobilization, wound care per National Health Service standards, multimodal analgesia incorporating non-opioid regimens recommended by World Health Organization pain guidelines, and physical therapy programs informed by trials from University of Pennsylvania address gait, core stabilization, and return-to-work planning. Bone health optimization and smoking cessation counseling reference guidance from National Osteoporosis Foundation and Centers for Disease Control and Prevention.
Complications include dural tear and cerebrospinal fluid leak documented in cohort studies from Toronto General Hospital, wound infection rates monitored by National Healthcare Safety Network, iatrogenic instability necessitating fusion as reported by European Spine Journal, recurrent stenosis, neurologic deterioration, and thromboembolic events per data from American College of Surgeons National Surgical Quality Improvement Program. Outcomes vary with diagnosis, comorbidity, and technique; randomized trials and registry data from Cochrane Collaboration, SPORT (Spine Patient Outcomes Research Trial), and national spine registries in Sweden and Norway inform expectations for pain relief, functional recovery, and reoperation rates.
Nonoperative alternatives include structured physiotherapy programs evaluated in trials at Cochrane Collaboration and multimodal pain management protocols from National Institute for Health and Care Excellence. Minimally invasive decompression, endoscopic discectomy pioneered in centers such as Seoul National University Hospital, interspinous process devices with analyses from Food and Drug Administration post-market surveillance, and anterior approaches for disc pathology described at Mayo Clinic are adjuncts or alternatives. When instability or deformity coexists, instrumented fusion techniques endorsed by Scoliosis Research Society and osteobiologic adjuncts from manufacturers regulated by European Medicines Agency are considered.
Category:Spinal surgery