1. What is a laminectomy?
   A laminectomy is, strictly speaking, an operation to remove the lamina (part of the vertebra). By removing the lamina, the spinal canal is opened and enlarged, giving the spinal nerves more room. The major cause of sciatica in compression of these nerves, so a Laminectomy relieves the pressure on the nerves and relieves leg pain, weakness and numbness.
   
   
2. What conditions does laminectomy treat?
   Laminectomy is usually used to treat a condition called spinal stenosis. Spinal stenosis is a condition in which there is nerve impingement due to bone spurs, calcium deposits or thickened ligaments. In the process of the laminectomy, these offending structures are removed, therefore freeing up the nerves.
   
   Laminectomy is also sometimes used to decompress the nerves when they are compressed by other conditions, such as tumor and bone fragments from fracture.
   
   
3. What is believed to be the cause of spinal stenosis?
   The exact cause is unclear but appears to be related to repeated stresses over the years. If the spine is subjected to repeated stress, the bones respond by enlarging. There are some soft tissues which also increase in size. As these structures increase in size, there is less room for the nerves to pass through the openings to the rest of the body. This is spinal stenosis.
   
   Spinal stenosis is a common problem in people over 50 years old. It is most common between the third and fourth, and the fourth and fifth, lumbar vertebrae. It is more common in women.
   
   The pressure on these nerves often will increase when you are standing or walking, causing an increase in your back pain and your leg pain. The leg symptoms are quite varied, ranging from mild aching to severe fatigue. Leg pain, buttock pain, pins-and-needles sensations, numbness and multiple combinations of these symptoms are also common. Often your ability to walk is limited to a few blocks or less.
   
   The goal of a laminectomy is to enlarge the openings for your nerves by removing the excess bone and soft tissue. Enough of these offending structures are removed to free the nerves. Sometimes this requires removal of enough bone to make the spine unstable and your doctor may recommend a fusion to stabilize your spine and improve your surgical outcome.
   
   
4. Can you give more details about the operation?
   The operation takes approximately 1-3 hours to perform, and you will be in the recovery room for about 2 hours. We will have you get out of bed and walk on the first day after surgery, as that can help to avoid many complications. We try to keep you as comfortable as possible with pain medications. You usually are in the hospital from two to four days. Our main focus will be to get you moving and independent as soon as possible.
   
   
5. What are some of the problems that I can expect after surgery while in the hospital?
   A common problem is that your stomach and bladder may be temporarily not functioning due to the anesthesia and immobility. This may require a catheter in your bladder to keep the bladder empty so that you do not have to use a bedpan or attempt to get to the bathroom. If your stomach does not work, you may not be able to eat or drink for a few days. You are allowed to go home when you are off pain shots, when you are able to get out of bed, and when your stomach and bladder are working.
   
   
6. What are some of the risks I may face with surgery?
   The most common problem is that of inadequate pain relief. If not enough space is created or if the nerve is permanently damaged by having had too much pressure on it for a long period of time, you may have some residual symptoms, especially in the legs. If too much bone is removed, your spine may be rendered unstable, requiring a fusion in the future. Generally speaking, however, the risk of this is no higher than 5%. Other complications included a 1-2% chance of infection, which may require several additional surgeries to control. There is a small chance of damaging the nerves to your legs. This may result in weakness in one or several parts of your leg. It does not generally result in paraplegia, but occasionally the weakness may be quite significant. Bowel and bladder damage can occur, but this is extremely rare.
   
   It is not uncommon in spinal stenosis surgery to cause a leakage of cerebrospinal fluid by puncturing the fluid filled sac that contains the nerve. This is repaired at the time of surgery, but it may require that you spend an extra day or two flat on your back for the area to seal over completely.
   
   Other complications that might occur are pneumonia, bladder infection, kidney infection and blood clots in the legs causing a pulmonary embolus to the lungs. This can occasionally be fatal. If you have a history of blood clots, make sure you inform your surgeon so that preventative measures can be taken.
   
   The side-effects of anesthesia are rare and usually are no more than just stomach upset and some dizziness. Medical complications can occur, as with any surgery. These include heart attacks, stroke, or even death. These severe complications occur much less often in this operation than in bigger operations.
   
   
7. What is your overall philosophy regarding spine surgery of this kind?
   A laminectomy is a reasonably reliable operation with a relatively low complication rate. However, it is not an operation that “has to be done.” If you can live with your symptoms, then we would not recommend doing a surgery. If you find your pain significantly altering the quality of your life, then we think it is a reasonable alternative for you to consider.
   
   A patient often asks if the purpose of this letter is to provide the surgeon with legal and medical protection. This is true. However, the main goal of this letter is to provide you with as much information as possible, to assist you in your decision-making. We believe that patients who are more informed about the procedure are less anxious and apprehensive about the surgery. These patients usually experience less pain and will have better overall outcome.
   
   

Final Comments
This letter is intended to answer questions, but do not hesitate to ask as many questions as needed to get a clear picture of the procedure and options available.