Lumbar Hemilaminectomy Surgery

If lumbar spine pain becomes so severe that it disrupts daily life or is accompanied by swelling, tenderness, or redness, it’s important to seek medical attention.

At Complete Orthopedics, our expert lumbar spine specialists are adept at treating lumbar spine pain through both surgical and non-surgical means. We examine symptoms, diagnose the condition, and recommend suitable treatments, including surgery if necessary.

Serving New York City and Long Island, we partner with six hospitals to offer cutting-edge lumbar spine surgery and comprehensive orthopedic care. You can schedule a consultation with our orthopedic surgeons online or by phone.

Learn about the common causes of lumbar spine pain and the treatment options available, including when surgery might be the best choice.

Overview

Hemilaminectomy/laminotomy is a minimally surgical procedure used to decompress the neural tissues. Decompression involves the removal of structures/tissues compressing/irritating the spinal nerves. The hemilaminectomy differs from laminectomy surgery in the removal of a very small part of the lamina. The surgery is commonly used to relieve symptoms caused by spinal canal stenosis in the lumbar spine.

The lamina forms the roof of the spinal canal that forms the conduit for the spinal cord/thecal sac. The lamina is present at the back of the spinal cord/thecal sac whereas the vertebral body and the intervertebral discs are present at the front. The spinal nerve roots exit the spinal column at each segment through the intervertebral foramen.

Axial section of the lumbar MRI showing a herniated intervertebral disc compressing the thecal sac and narrowing the intervertebral foramen.

Axial section of the lumbar MRI showing a herniated intervertebral disc compressing the thecal sac and narrowing the intervertebral foramen.

As the spinal nerves exit the foramen they may be compressed or irritated due to narrowing or stenosis of the canal. Bone spurs may form that may compress the neural structures. The bone spurs may form as a part of age-related wear and tear of the spine or secondary to trauma. There may be thickening of the lamina which may cause compression of the neural structures.

The patients requiring lumbar hemilaminectomy surgery may present with complaints of back pain, radiating pain in the buttocks, radiating pain in the back of the thigh or front of the thighs. Patients may also complain of numbness and tingling in the lower extremities. Some patients may have difficulty walking due to pain and may have an exacerbation of symptoms while walking downhill or when bending backward.

The Basics of Spinal Anatomy

The spine is composed of individual bones called vertebrae, stacked on top of each other. Between these bones are intervertebral discs, which act as cushions to absorb shock and allow movement. The spinal cord runs through a central canal in the vertebrae, with spinal nerves branching out to different parts of the body through openings called foramina.

Symptoms and Diagnosis

The symptoms may initially be managed conservatively in the form of pain medications and physical therapy. In patients with continuous symptoms, an epidural corticosteroid or a nerve block injection may be tried. Only in patients with continued symptoms despite conservative management, surgical management is indicated. Patients with the instability of the spine segment and deformity are usually candidates for lumbar fusion surgery

 

Hemilaminectomy/Laminotomy: A Minimally Invasive Option

Hemilaminectomy/laminotomy is a surgical procedure used to relieve pressure on the spinal cord and nerves. Unlike a full laminectomy, which involves removing a larger portion of the lamina (the roof of the spinal canal), a hemilaminectomy removes only a small part, making it less invasive.

However, not all patients are candidates for hemilaminectomy. Patients with extensive involvement and compression may benefit from laminectomy surgery or lumbar fusion surgery.

Procedure Overview

Preparation: The surgery is performed under general anesthesia. The patient lies face down on the operating table.

Incision: A small incision is made in the back to access the affected area.

Muscle Retraction: The paraspinal muscles are gently moved aside to expose the spine.

Removal of Lamina: Using specialized instruments, the surgeon removes a portion of the lamina and may also remove parts of the thickened ligamentum flavum or herniated disc material.

Closure: The incision is closed in layers, and a sterile dressing is applied.

Recovery and Rehabilitation

Patients typically stay in the hospital overnight and are discharged the next day. Post-operative care includes pain management, wound care, and gradual return to activities. Physical therapy is often recommended to strengthen the back muscles and improve flexibility. Most patients experience significant relief from their symptoms and can resume normal activities within a few weeks.

Potential Complications

As with any surgery, hemilaminectomy/laminotomy carries some risks. Complications may include:

  • Incomplete Decompression: Sometimes, the surgery may not fully relieve the pressure on the nerves.
  • Accidental Durotomy: This refers to an unintentional tear in the dura mater, the outer membrane of the spinal cord.
  • Nerve Damage: There is a risk of damaging the nerves or spinal cord during the procedure.
  • Bleeding and Infection: As with any surgery, there is a risk of bleeding and infection.

Advanced Surgical Options

For patients with more extensive spinal issues, additional procedures may be necessary:

Laminectomy: This involves removing a larger portion of the lamina to provide more significant decompression.

Lumbar Fusion Surgery: In cases of spinal instability or deformity, fusion surgery may be required. This procedure involves joining two or more vertebrae together to stabilize the spine.

Hemilaminectomy vs. Other Surgical Techniques

While hemilaminectomy is less invasive and has a shorter recovery time, it may not be suitable for all patients. Those with severe spinal stenosis or multiple levels of compression might benefit more from a full laminectomy or fusion surgery. The choice of procedure depends on the specific condition, the severity of symptoms, and the overall health of the patient.

Conclusion

Understanding the different surgical options for treating spinal conditions is crucial for making informed decisions about your health. Hemilaminectomy/laminotomy offers a minimally invasive solution for relieving pressure on the spinal nerves, with a quicker recovery time compared to more extensive surgeries. However, it’s essential to discuss all available options with your healthcare provider to determine the best approach for your individual needs.

Do you have more questions? 

How do I know if I’m a candidate for hemilaminectomy?

Candidates for hemilaminectomy typically have symptoms of nerve compression such as back pain, leg pain, numbness, and difficulty walking that haven’t improved with conservative treatments like physical therapy or medications.

What are the potential benefits of a hemilaminectomy over a full laminectomy?

Hemilaminectomy is less invasive, involves a smaller incision, and generally results in a quicker recovery time with less postoperative pain.

How long does the surgery usually take?

A hemilaminectomy typically takes about 1 to 2 hours, depending on the complexity of the case and the specific area being treated.

What kind of anesthesia is used during hemilaminectomy?

The surgery is performed under general anesthesia, meaning you will be asleep and pain-free during the procedure.

What is the recovery process like after hemilaminectomy?

Recovery includes an overnight hospital stay, pain management, wound care, and physical therapy. Most patients can return to normal activities within a few weeks.

Are there any dietary restrictions before or after the surgery?

Generally, you may be advised to avoid eating or drinking after midnight before the surgery. Postoperatively, a balanced diet helps in recovery, but specific restrictions are usually not necessary unless advised by your surgeon.

What are the risks of hemilaminectomy?

Risks include infection, bleeding, nerve damage, incomplete decompression, and dural tears. These complications are relatively rare but possible.

How soon can I return to work after hemilaminectomy?

This depends on your job and how quickly you recover. Patients with sedentary jobs may return in 2-4 weeks, while those with physically demanding jobs might need 6-8 weeks.

How effective is hemilaminectomy in relieving symptoms?

Hemilaminectomy is generally very effective in relieving symptoms of nerve compression, with most patients experiencing significant pain relief and improved function.

Can the symptoms return after surgery?

While hemilaminectomy provides long-term relief for many, there is a chance that symptoms can return if new areas of compression develop or if there is recurrent disc herniation.

What should I do if I experience new or worsening symptoms after surgery?

Contact your surgeon immediately if you experience new or worsening symptoms, as this could indicate a complication that needs prompt attention.

Is there anything I can do to prevent spinal problems in the future?

Maintaining a healthy weight, regular exercise, good posture, and avoiding activities that strain your back can help prevent future spinal issues.

Can I drive after the surgery?

You should avoid driving until you have stopped taking narcotic pain medications and feel comfortable sitting and turning your body, which is usually after a couple of weeks.

Will I have a scar after the surgery?

Yes, there will be a small scar where the incision was made, but it typically fades over time.

How soon can I start exercising after hemilaminectomy?

    • Light activities and walking can start soon after surgery, but strenuous exercises and heavy lifting should be avoided for at least 6-8 weeks. Follow your surgeon’s recommendations.
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Will I need to wear a brace after the surgery?

This depends on the individual case. Some patients may be advised to wear a brace for additional support, but it is not always necessary.

What happens if I need another surgery in the future?

If further surgery is needed, your surgeon will discuss the best options based on your current condition and previous surgeries.

Can hemilaminectomy be performed on multiple levels of the spine?

Yes, hemilaminectomy can be performed on multiple levels if necessary, although the complexity and recovery time may increase.

How do bone spurs contribute to spinal stenosis?

Bone spurs, or osteophytes, can form due to arthritis and other degenerative changes. They can narrow the spinal canal and compress the nerves, contributing to spinal stenosis.

Is hemilaminectomy effective for treating herniated discs?

Yes, hemilaminectomy can be effective in relieving symptoms caused by herniated discs by removing the part of the disc that is compressing the nerve.

What is the role of the ligamentum flavum in spinal stenosis?

The ligamentum flavum can thicken and lose elasticity with age, which can narrow the spinal canal and contribute to nerve compression.

What are the signs of a successful hemilaminectomy?

A successful hemilaminectomy is indicated by significant pain relief, improved mobility, and the absence of neurological symptoms like numbness or weakness.

What follow-up care is necessary after a hemilaminectomy?

Follow-up care includes regular check-ups with your surgeon, adherence to physical therapy, and monitoring for any signs of complications. You will be given specific instructions tailored to your recovery needs.

Suhirad-Khokhar-MD

My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.

My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.