Disclaimer: The following neither contains medical or legal advice but is for Informational Purposes Only. Consult a medical professional or attorney for your unique situation.
A laminectomy is a surgery used for treatment of spinal stenosis. In order to understand how this stenosis occurs, it is important to know the basics of spine anatomy.
Anatomy of Spine
Basically, most vertebrae have three main parts: vertebral body, vertebral arch, and processes.
The shape and size of the vertebral body depends on the spine region. So in the neck region, vertebral bodies are smaller than in the lumbar (low back) spine.
Each arch creates a space for the spinal cord to pass. It is made up of two pedicles and two laminae. The size of this canal will also depend on the spinal region. In the neck region, the spinal canal is narrowest and in the lumbar spine it is the widest. Between each vertebra there is a disc-like structure which separates them and prevents their contact. It is made of harder fibrous tissue on the outer side and on the inner side it is made of gel-like tissue. Another important structure is the facet joints which are small joints that allow the movement of the spine.1
What Is Spinal Stenosis
Basically, spinal stenosis is a narrowing of a spinal canal which causes compression of the spinal cord and nerves which leave the spine. In most cases it occurs in the neck or lower back, while in the thoracic and sacral spine it rarely occurs.
In a normal spine, the spinal cord has enough space to pass through it without any compression. If anything causes narrowing of that space, it will cause spinal compression. The most common causes of spinal stenosis are degenerative changes which occur with age, and thickening of the spinal ligaments which can cause compression. Disc herniations are common causes of compression on the spinal cord or nerve roots. Tumors can also cause compression if they grow towards the spinal cord.
Spine trauma is another common cause of spinal stenosis. It can occur in car accidents, falls, or a direct blow to the spine. Any trauma that can cause fracture of a vertebra or dislocation can also cause spinal stenosis. Even if there is no fracture or dislocation, people can suffer from symptoms of spinal stenosis if the swelling of surrounding structures is so severe that it causes compression.2
In severe cases of spinal stenosis, it is important to reduce the compression on the spinal cord and nerve roots. The easiest way to do this is to increase the space through which the spinal cord and nerves pass. It is done surgically with a surgery called laminectomy.
What Is Laminectomy
Laminectomy is sometimes known as decompression surgery which basically describes the main mechanism of the laminectomy: to create wider space for the spinal cord and spinal nerves to pass through it without having contact with parts of vertebra or other structures.
The main principle of laminectomy is to remove the posterior (back) bony part of vertebra in order to widen that space. The surgeon will need to make a cut on the back or neck (depending where the stenosis is located) in order to approach the spinal segment. Once he/she can see it clearly, he/she will remove all the bone spurs or enlarged ligaments which might cause compression. Also, part of the vertebral arch called the lamina is removed in order to increase the space for the spinal cord and nerve to pass.3
Indications for Laminectomy
Laminectomy is indicated in cases where there is verified cause of spinal compression. That compression is primarily caused by bone spurs of vertebra. Not all bone spurs will cause symptoms. If there is enough space for the nerve or spinal cord, then it can slightly move and this condition will not cause any severe symptoms. However, if bone spurs encroach upon the passage of the spinal nerve, it will compress it causing radiculopathy symptoms.3
Spinal trauma which is common in car accidents is another common cause of spinal compression.
Complications of Laminectomy
Just like any other surgery, laminectomy is not completely without possible complications. Some of them can occur during the surgery, like spinal nerve injury, excessive bleeding and need for blood transfusions, leakage of spinal fluid in the case of rupture of dura (spinal cord envelope), etc. In later stages an infection can occur, and in less mobile patients there is increased risk of blood clots and pulmonary embolism which can result in severe complications and in some cases even lead to death.
But generally speaking, the rate of complications after laminectomy is low and it is considered a safe procedure. Also, the surgeon will have protocols created especially to reduce the rates of complications.3
Do People Sometimes Require Laminectomy After A Car Accident?
Car accidents can cause injuries of the spine. The most common are injuries of the cervical and lumbar spine. Car accidents can cause flexion or extension injuries or direct blows to the spine. In most cases, spine injuries after car accidents are minor and resolve after a short period of conservative treatment.
However, there are some cases when conservative treatment won’t restore normal functioning, so a surgery might be required. Disc bulge or disc herniation can be caused by a car accident. Symptoms of these conditions include severe neck, thoracic or low back pain, pain radiation down the arms, pain radiation to the buttocks or down the legs, numbness in arms, hands, buttocks, thighs, legs, feet, etc., or tingling in those areas. Loss of strength in arms/hands or legs/feet are signs of severe spinal compression. Another red flag is inability to control bowel movement and urination. An MRI is required to diagnose these conditions. MRI will clearly show the severity of spinal compression, level of compression and which structures are affected. At the beginning, non-operative treatment such as bed rest during periods of strong pain, pain medications, corticosteroid injections, and later physical therapy, acupuncture, chiropractic care might be tried in order to resolve the issues. If conservative measures don’t succeed, then surgery may be the best solution.4
- “Spine Anatomy, Anatomy Of The Human Spine.” Mayfieldclinic.com. N. p., 2019. Web. 1 Dec. 2019.
- “Spinal Stenosis – Symptoms And Causes.” Mayo Clinic. N. p., 2019. Web. 1 Dec. 2019.
- ” Laminectomy – Mayo Clinic.” Mayoclinic.org. N. p., 2019. Web. 1 Dec. 2019.
- “Laminectomy: Purpose, Procedure, And Risks.” Healthline. N. p., 2019. Web. 1 Dec. 2019.