Our Summary

This research paper investigates whether there are differences in complications during surgery and within 30 days after surgery for patients who undergo spinal fusion (a surgery that joins, or fuses, two or more vertebrae into a single structure) with and without a procedure called laminectomy (surgery that removes part of a vertebra to relieve pressure on the spinal cord or nerves).

The study examined the medical records of 874 adults with spinal deformity who had spinal fusion surgery between 2005 and 2015 at a major academic institution. Of these, 374 also had a laminectomy.

The study found that patients who had both procedures had higher rates of complications such as blood loss, need for blood transfusions, and damage to the protective covering of the spinal cord during surgery. They were also more likely to need intensive care after surgery. Within 30 days of leaving the hospital, they were more likely to experience confusion, urinary tract infections, wound drainage, and failure of the surgical hardware.

However, there was no significant difference in the rate of patients needing to be readmitted to the hospital within 30 days between the two groups.

The conclusion is that patients who undergo spinal fusion with laminectomy may have higher rates of complications than those who have spinal fusion alone.

FAQs

  1. Are there increased risks associated with undergoing a spinal fusion surgery with a laminectomy compared to spinal fusion surgery alone?
  2. What types of complications were more common for patients who underwent both spinal fusion and laminectomy?
  3. Was there a difference in the rate of hospital readmissions within 30 days between patients who had spinal fusion with laminectomy and those who had spinal fusion alone?

Doctor’s Tip

A helpful tip a doctor might tell a patient about spinal laminectomy is to carefully weigh the risks and benefits of the procedure. It is important to discuss all potential complications with your surgeon and make sure you fully understand the potential risks before deciding to undergo the surgery. Additionally, following your surgeon’s post-operative instructions and attending all follow-up appointments is crucial for a successful recovery.

Suitable For

Patients who are typically recommended for spinal laminectomy are those who have spinal deformity and are experiencing symptoms such as pain, numbness, weakness, or tingling in the legs or arms due to pressure on the spinal cord or nerves. These symptoms may be caused by conditions such as spinal stenosis, herniated discs, or spinal tumors.

Patients who have not responded to conservative treatments such as physical therapy, medications, or injections may be recommended for spinal laminectomy to relieve pressure on the spinal cord or nerves and improve symptoms. Additionally, patients who have spinal instability or deformity that requires spinal fusion may also undergo laminectomy as part of the surgical procedure.

It is important for patients to discuss the risks and benefits of spinal laminectomy with their healthcare provider to determine if it is the right treatment option for their specific condition. It is also important for patients to be aware of the potential complications associated with the procedure and to follow post-operative care instructions to reduce the risk of complications and promote healing.

Timeline

Timeline of patient experiences before and after spinal laminectomy:

Before surgery:

  • Patient experiences symptoms of spinal cord or nerve compression, such as back pain, weakness, numbness, or tingling in the arms or legs.
  • Patient undergoes diagnostic tests, such as X-rays, MRI, or CT scans, to determine the cause of their symptoms.
  • Patient consults with a spine surgeon to discuss treatment options, including spinal laminectomy.
  • Patient undergoes pre-operative testing, such as blood tests and EKG, to ensure they are healthy enough for surgery.

During surgery:

  • Patient is placed under general anesthesia.
  • Surgeon makes an incision in the back and removes part of the lamina (the bony arch of the vertebra) to relieve pressure on the spinal cord or nerves.
  • If necessary, the surgeon may also perform a spinal fusion to stabilize the spine.

After surgery:

  • Patient is monitored in the recovery room before being transferred to a hospital room.
  • Patient may experience pain, swelling, and stiffness at the surgical site.
  • Patient is encouraged to walk and perform gentle exercises to aid in recovery.
  • Patient may need physical therapy to regain strength and mobility.
  • Patient may need to wear a brace or collar to support the spine during healing.
  • Patient is discharged from the hospital and given instructions for at-home care, including wound care, pain management, and activity restrictions.
  • Patient follows up with the surgeon for post-operative appointments to monitor healing and address any concerns.

What to Ask Your Doctor

Some questions a patient should ask their doctor about spinal laminectomy include:

  1. What is the purpose of a laminectomy in conjunction with spinal fusion surgery?
  2. What are the potential risks and complications associated with a laminectomy during spinal fusion surgery?
  3. How will having a laminectomy affect my recovery time and overall outcome?
  4. Are there alternative treatment options to consider instead of having a laminectomy?
  5. How experienced are you in performing spinal fusion surgeries with laminectomies?
  6. What is your success rate with this type of surgery?
  7. How long will I need to stay in the hospital after having spinal fusion with laminectomy?
  8. What is the expected timeline for my recovery and return to normal activities?
  9. What steps can I take to minimize the risk of complications during and after surgery?
  10. Are there any specific warning signs or symptoms I should watch out for after the surgery?

Reference

Authors: Elsamadicy AA, Adogwa O, Warwick H, Sergesketter A, Lydon E, Shammas RL, Mehta AI, Vasquez RA, Cheng J, Bagley CA, Karikari IO. Journal: World Neurosurg. 2017 Jun;102:370-375. doi: 10.1016/j.wneu.2017.03.096. Epub 2017 Mar 28. PMID: 28359921