Pinched Nerve

Put a straw in your fist. Now squeeze. You’ll notice not much is able to pass through the straw. This is, essentially, what is happening in your spine when you have a pinched nerve. Your spinal cord or nerves (the straw) are being squeezed because of the impinging by bone/and or disc material.

Decompression is a surgical procedure to relieve pressure and alleviate pain caused by this impingement. A small portion of the bone over the nerve root, called lamina, and/or disc material from under the nerve root is removed to give the nerve more space.

There are 3 common types of spinal decompression procedures, all of which can be done using minimally invasive techniques:

  • Laminotomy/foraminotomy – Shaving off part of the lamina to create a larger opening to relieve the pinched nerve
  • Laminectomy – Complete removal of the lamina
  • Discectomy – Removal of part of a disc that is compressing a nerve

Each of these procedures can be performed as an independent surgery or can be combined together. For example, a laminotomy may be done together with a discectomy. Your doctor will determine which procedure or procedures will give you the most relief.

What Are a Laminotomy and Laminectomy?

Laminotomy and laminectomy are spinal decompression surgeries on the lower spine that involve removing bone, called the lamina, to relieve pressure on the spinal nerve(s).

  • Laminotomy is the partial removal of the lamina to create an larger opening
  • Laminectomy is the complete removal of the lamina

Why Are These Procedures Done?

Laminotomy and laminectomy are commonly done to relieve symptoms of spinal stenosis, including pain, and weakness or numbness that can radiate down the arms or legs.

Your doctor may recommend one of these procedures if non-surgical treatments do not improve symptoms, or if muscle weakness or numbness makes standing or walking difficult.

There are many other spinal conditions that may be treated with a laminotomy and/or laminectomy:

  • Spinal stenosis
  • Herniated disc
  • Sciatica

In some cases, these procedures may be necessary as part of surgery to treat a herniated spinal disk. Your surgeon may need to remove part of, or the complete lamina to gain access to the damaged disk.

What to Expect During a Laminotomy or Laminectomy

Laminotomy/laminectomy can be performed as open surgery, where your doctor uses a single, larger incision to access your spine, or using a minimally invasive method, where a smaller incision is made and muscles are gently separated instead of cutting them.

The operation is performed with the patient on his or her stomach.

Accessing the Spine
First, the surgeon makes a small incision. Through this incision, the muscle will be gently and gradually dilated, or separated, and a tubular retractor will be inserted to create a “tunnel” through which the surgeon may perform minimally invasive surgery.

Laminotomy/Laminectomy
Part of the lamina is cut away to uncover the ligamentum flavum—a ligament that supports the spinal column. Next, an opening is cut in the ligamentum flavum, through which the spinal canal is accessed. The compressed nerve is now visible, as is the cauda equina (the bundle of nerve fibers at the end of the spinal cord) 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.

At this point the surgeon will assess and perform a discectomy (removal of a disc or bone spur) or a spinal fusion, if necessary.

Your surgeon will then close the incision, which typically leaves behind only a small scar, if a minimally invasive procedure is performed.

What to Expect After Surgery

The minimally invasive procedure allows many patients to be discharged the same day of surgery; however, some patients may require a longer hospital stay. Many patients will notice immediate improvement of some or all of their symptoms; other symptoms may improve more gradually.

What is a Discectomy?

A discectomy is a surgical procedure to remove a herniated disc that is causing back pain and/or leg pain, numbness or muscle weakness.

Why is This Procedure Done?

Discectomy procedure

When an intervertebral disc ruptures in the spine, it puts pressure on one or more nerve roots (often called nerve root compression). This causes pain and other symptoms in the neck, arms, and even legs.

Your doctor may recommend one these procedures if non-surgical treatments do not improve symptoms, and if you are experiencing leg pain that limits your normal daily activities or weakness or numbness in your leg(s) or feet.

What to Expect During a Discectomy

Like the laminotomy/laminectomy, this procedure may also be performed using an open or minimally invasive approach. Your doctor will determine what is the best method for your spinal condition.

The operation is performed with the patient positioned on his or her stomach.

Exposure of the Nerve Root
In a minimally invasive discectomy, after a small incision is made, the muscles of the spine are dilated, or gently separated, and a tubular retractor is inserted to create a “tunnel” through which the surgeon may perform surgery. A microscope or an endoscope is used to look down the tube and visualize the spine. Through the tubular retractor, a portion of the lamina is removed to expose the compressed area of the spinal cord or nerve root(s).

Decompression
The disc is visualized underneath the nerve root and pressure is relieved by removing the source of compression—herniated disc, a bone spur, or in some instances a tumor. Implants may or may not be needed to stabilize the spine.

The small incision is closed, which typically only leaves behind a minimal scar.

This surgery may also be performed as a microdiscectomy, using a surgical microscope and microsurgical techniques. A microdiscectomy requires only a very small incision and will remove only that portion of your ruptured disc, which is "pinching" one or more spinal nerve roots.

What to Expect After Surgery

This minimally invasive procedure allows many patients to be discharged the same day of surgery; however, some patients will require a longer hospital stay. Many patients notice immediate improvement in some or all of their symptoms; other symptoms may improve more gradually.

At home you will have medication to help with any discomfort. Any severe increase in pain not controlled with the medication should also be reported to your physician or the physician's nurse. You should report any elevation in your temperature, drainage from your incision, or increase in numbness or weakness.

What Are the Risks of These Procedures?

Potential risks to any surgical procedure include unforeseeable complications caused by anesthesia, blood clots, undiagnosed medical problems such as silent heart disease, and rare allergic reactions. Complications of spinal surgery can include neurological damage, paralysis, damage to the surrounding soft tissue and, where used, instrument malfunction. Most of these complications can be treated once they are detected, but sometimes they require a longer period of hospitalization or recovery, additional medications, and sometimes even additional surgery. Depending upon the type of surgery you are having, these risks will be explained by the primary surgeon. As a patient, it is important to understand and follow your doctor’s advice so that the best possible outcome can be achieved. This surgery is not for everyone. Please consult your physician.