A lumbar laminotomy is a surgical procedure aimed at relieving pain, particularly leg pain and other symptoms caused by a pressure on a nerve in the spine by conditions such as spinal stenosis, bone spurs or cysts. Here’s a step-by-step overview of what is involved in the procedure:

What happens during a Lumbar Laminotomy?

Preparation

• You will be admitted to hospital on the day of surgery and will be required to fast prior to the procedure. The specific fasting time will be provided by your anaesthetist.
• Anaesthesia:  You’ll be given general anesthesia, meaning you’ll be asleep and pain-free during the procedure.
• A urinary catheter may be inserted during the procedure if longer procedural time is anticipated. Antibiotics are also administered to reduce the risk of infection.

Positioning

• You’ll be positioned face down on the operating table, with your abdomen supported to maintain the natural curve of your spine. This position helps A/Prof Buckland access the spine.

Incision

• Small Incision: A/Prof Buckland makes a small incision, usually 1 to 1.5 inches long, in the lower back directly over the affected disc level. This is much smaller than the incisions used in traditional open surgery.

Accessing the Spine

• Muscle Retraction: A/Prof Buckland uses specialised instruments to gently move the muscles of the back aside without cutting them. This technique helps minimize muscle damage and aids in a quicker recovery.

Removal of Bone (Laminotomy)

A small part of the bone over the nerve (called the lamina), as well as the underlying ligament is removed to make space for the nerve and relieve it of any pressure. This step is called a laminotomy.

• A/Prof Buckland carefully removes this part of the bone using specialized instruments, and under high magnification microscope to optimize visibility and accuracy.

• In some cases, A/Prof Buckland may also remove or trim other structures such as bone spurs, or cysts that are contributing to the nerve compression.

Closing the Incision

• Once the nerve is freed up from compression, the instruments are withdrawn, and the muscles are allowed to return to their normal position.
• The incision is then closed with dissolvable sutures, and a sterile bandage is applied.

Recovery Room

• After the surgery, you’ll be taken to a recovery room where you’ll be monitored as you wake up from anaesthesia.
• Pain relief will be managed, and you may be asked to walk a short distance soon after the surgery to start your recovery.

Postoperative Care and Recovery

Most people experience significant relief from leg pain (sciatica) almost immediately after the surgery. However, full recovery might take several weeks, during which you’ll gradually return to your normal activities.

• Hospital Stay: Laminotomy is often done as an outpatient procedure, meaning you might go home the same day, or alternatively you might stay overnight.
• Pain Management: You may be prescribed pain medication to treat the incisional pain, and advised to avoid heavy lifting, twisting, or bending for 8 weeks. The leg pain will usually have substantially improved when you awake from the procedure.
• Physiotherapy: A tailored physiotherapy program may be recommended to strengthen the back muscles, improve flexibility, and reduce the risk of future injuries.
• Follow-up: You’ll have follow-up appointments to monitor your recovery and ensure that the symptoms have improved.

Risks and Complications

As with any surgery, there are potential risks, including infection, bleeding, spinal fluid leak, nerve injury, or recurrence of symptoms. However, laminotomy is generally considered safe and effective, with a high success rate. Learn more about A/Prof Buckland’s patient-reported outcomes of lumbar laminotomy surgery.