A laminectomy is a surgery that decompresses the spine by removing a small portion of bone over the nerve root to relieve spinal stenosis pain. Following a laminectomy, approximately 70 to 80 percent of patients will have a significant improvement in their function and a decreased level of pain, according to Spine-health.com. Postoperative surgical complications from can result from a variety of factors.
Infection
Infection occurs in about 1 percent of elective laminectomy cases, according to Spine-health.com. If an infection occurs, further surgery may be required, along with intravenous antibiotics. An infection after a laminectomy can be in the incision skin site only, or it can spread deeper to involve areas around the spine and spinal cord. A 1986 report in Clinical Orthopedics and Related Research states the bulk of evidence supports a bacterologic agent as a cause, but the route of infection is still not clear. Symptoms of an infection include increased pain, muscle spasm and fever.
Nerve Root Damage
The Journal of Neurology, Neurosurgery and Psychiatry cites that about 5 percent of laminectomy patients complain of pain associated with damage to nerve roots. This pain is called tabes dorsalis and is described as stabbing spasms. The study found that the pain typically began within one month of surgery and appeared to improve over the next three to five years. This pain probably arises from damage to the ganglion or posterior root of the nerve.
Cerebrospinal Fluid Leak
A cerebrospinal fluid, or CSF, leak may occur after a laminectomy. If the dural sac is inadvertently entered, a CSF leak can happen, but it will generally seal itself if the patient lies flat for 24 hours. Neurosurgical Focus states that CSF leaks are relatively common following spinal surgery, occurring in 17.6 percent of cases. Leakage may occur at the suture line or may be caused by accidental dural tears during surgery. CSF leakage causes a potential risk of meningitis. Treatment may include a spinal fluid drain, antibiotics and possible surgical re-exploration.
Transitional Syndrome
Transitional syndrome is the transition of pain from the abnormal area of the spine that has been fused to a normal area. If a segment of the spine is not working properly, the neighboring segments have to take on more of the load. The segment closest to the non-working section begins to take on more stress, transitioning the pain to that area. Spine journal reports that lumbar transpedicular fixation, another term for transitional syndrome, has been reported as high as 35 percent after a laminectomy.
Other Complications
Other complications after a laminectomy can include bleeding, persistent pain, hardware fracture, implant migration, sexual dysfunction and psudoarthrosis. In addition, any time the spine is operated on, there is a risk of injuring the spinal cord.
References
- Spine-Health.com: Laminectomy
- University of Maryland Medical Center: Laminectomy
- Clinical Orthopedic and Related Research:" Postlaminectomy Disc Space Infection
- "Neurosurgery": Paraplegia After a Routine Lumbar Laminectomy
- "Journal of Neurology, Neurosurgery and Psychiatry": Recurrent Pain after Laminectomy
