Laminectomy/Diskectomy with or without Fusion
A laminectomy is the surgical removal of the lamina of a vertebra. It may be performed to allow for removal of a neoplasm or bone fragments that are putting pressure on nerve roots or the spinal cord or to enable a rhizotomy or cordotomy to be performed to treat intractable pain. Most commonly, a laminectomy is performed to gain access to a herniated nucleus pulposus (HNP, “ruptured disk”) so that a diskectomy (removal of the herniated portion of the disk) can be accomplished.
Disk herniation is usually the result of trauma (e.g., falls, vehicular accidents) or strain caused by factors such as improper or repeated lifting of heavy objects, twisting, sneezing, or coughing. Age-related degenerative changes in the disks, supporting ligaments, and vertebrae make the disks more prone to rupture. The most common sites of disk herniation are C5-6, C6-7, L4-5, and L5-S1. These areas of the spine are the most flexible and therefore are subjected to a greater amount of movement and strain. Signs and symptoms of lumbar disk herniation can include low back pain which radiates down the buttock, thigh, calf, and ankle on affected side; muscle spasms in lower back; muscle weakness, diminished knee and ankle reflexes, numbness, or tingling in affected lower extremity; constipation; and/or urinary retention. Clinical manifestations of cervical disk herniation can include neck pain which radiates to the shoulder, arm, and fingers on affected side; stiff neck; muscle spasms in neck; and/or muscle weakness, diminished biceps and triceps reflexes, numbness, or tingling in affected upper extremity.
A diskectomy is usually indicated if conservative measures such as rest, heat or cold applications, anti-inflammatory medications, analgesics, muscle relaxants, and local steroid injections fail to control pain or if neurological deficits persist or worsen. Disk removal is usually accomplished by a microdiskectomy or laminectomy and can be performed using an anterior and/or posterior approach. The surgical procedure performed depends on the location and size of the herniated disk and physician preference. If the vertebral column in the surgical area is unstable, a spinal fusion may be performed along with a laminectomy. The surgical immobilization of the unstable area is accomplished using a bone graft (autograft [usually from the iliac crest], allograft, or bone substitute) or implanted fixation devices such as cages, plates, screws, and
Risk for peripheral neurovascular dysfunction
Actual/Risk for impaired tissue integrity
cerebrospinal fluid leak
laryngeal nerve damage
Deficient knowledge, Ineffective therapeutic regimen management, or Ineffective health maintenance