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"Laminectomy"


In the United States, the incidence of spinal surgery, to include cervical and lumbar laminectomy, is the highest in the world.

A laminectomy is often referred to as a form of spinal decompression.  The surgical procedure entails the removal of structures in the spine (usually the lamina) that impinge on the spinal canal causing neurolgical dysfunction.  The goal of surgical laminectomies is the alleviation of signs and symptoms associated with neural impingement.

Neurological symptoms caused by neural impingement are pain, weakness, and numbness or tingling sensations in one or both legs. Conditions that contribute to neurolgical impingement are bulging discs, herniated discs, bulged discs, disc protrusions, and spinal stenosis.  Spinal stenosis due to degenerative changes is the most common condition requiring a laminectomy.

A laminectomy is typically perfomed by either an orthopedic spine surgeon or a neurologic spine surgeon in a hospital setting.

A laminectomy surgery should not be contemplated unless there is a direct correlation between those symptoms and diagnostic testing that supports specific neurolgic spinal compression.  Back pain without neurological symptoms (numbness, tingling, or muscle weakness) on clinical examination is not enough to warrant a laminectomy surgery.  Sometimes a laminectomy procedure is performed in conjunction with spinal fusion.

Some Contraindications for laminectomy surgery include:

  1. Vertebral Fractures.
  2. Misalignment due to Kyphosis or Scoliosis.
  3. Spinal instability of involved vertabrae.
  4. Cancer.
  5. Active Infection.

Laminectomy Recovery

Laminectomy recovery should begin one week after surgery.  Post-opertive rehabilitation should begin in an outpatient physical therapy center.  Goals for the post-surgical laminectomy patient should be; a return to activities of daily living, a return to work, improve functional spinal stability, normalize gait deviations, improve flexibility, normalize upper and lower body strength, improve cardiovascular endurance, and improve positional tolerances.

A major component towards achieving these goals is exercise prescription with emphasis on core training.  All post surgical laminectomy exercises are performed with either a “neutral” spine position or in protective positions using an abdominal brace.

Sample exercises used for laminectomy recovery include:

  1. Single leg slides while lying on your back.
  2. Bent and straight leg raises lying on your back.
  3. Curl-ups and diagnonal curl ups (lumbar spine must be in protected position).
  4. Bridging with abdominal brace.
  5. Single arm or leg lifts while lying face down (prone).
  6. Modified push-ups with neutral spine.
  7. Opposite arm and leg lifts while in quadraped.

Laminectomy recovery should also include aerobic conditioning.  Cardiovascular endurance for the post surgical client can be performed using a treadmill, swimming, stationary bike, and upper body ergometer (UBE).  Most physical therapy facilities will be equipped to handle the cardiovascular needs of the post operative laminectomy client.

A return to work, depending on the job description, is usually 12 weeks after laminectomy surgery.  Physical therapy should include a work hardening program to help transition back to a full time, full duty work schedule.

In order to attend physical therapy following your laminectomy procedure, your physician will need to write a prescription indicating the duration and frequency of treatment.  The physician may also order specific treatment modalities (hot or cold packs) and include scar tissue management to help with recovery.

 
Tommy Hoffman, P.T. By Tommy Hoffman, Licensed Physical Therapist

 

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