Laminectomy: What It Is, Why It’s Done, and How to Prepare

A laminectomy is a surgery on your spine to remove the lamina, the “bony arch” that supports the back of your spinal cord. If you’re facing severe back and neck pain or a herniated disk, it may be a good treatment option to decrease your symptoms if other medical treatments haven’t worked.

What Is a Laminectomy?

“In basic terms, it’s creating space in the spinal canal for nerves that are being pinched. When there’s tightness, the nerves get irritated, and that can cause symptoms like pain, numbness, tingling, and weakness from being compressed,” says Payam Farjoodi, MD, a board-certified orthopedic spine surgeon who treats patients with both common and complex spinal disorders and deformities in Orange County, California.

“The laminectomy alleviates those symptoms by cutting away some of the bone,” Dr. Farjoodi says.

If you’re grappling with lower back or neck pain that can be severe and disabling, or restrict your ability to move and function, your doctor may recommend a laminectomy when more conservative treatments — like medication, physical therapy, or injections — have failed to ease pain.

• Arthritis
• Bone fractures
• Bone spurs
• Degenerative back conditions
• Herniated disk
• Spinal stenosis, which is a narrowing of the spinal column
• Spinal tumors or abscesses

Laminectomy can also be an option to treat chronic symptoms, such as:

• Severe neck, shoulder or back pain causing persistent pain
• Pain and weakness or numbness in your arms and legs from spinal cord or nerve damage
• Weakness or heaviness in your buttocks or legs
• Bowel or bladder problems from pressure in the cervical or lumbar spine

You and your doctor can decide whether you need to have surgery for these symptoms, especially if they’re interfering with your daily life or your job.

Farjoodi says the need for a laminectomy usually comes back to four key factors: genetics, wear and tear through repetitive movements, back and neck injuries, and age.

• Adjustment to your physical activity
• Medication, including muscle relaxants, anti-inflammatory medicines, and pain relievers
• Spinal injections
• Physical rehabilitation, physical therapy, or both
• Occupational therapy
• Weight loss (if you’re overweight)
• Smoking cessation
• Assistive devices, such as mechanical back supports

• Make an incision in your back or neck, depending on where you’re feeling pain or pressure
• Separate or move your skin, ligaments, and muscles to the side to access your spine
• Use a surgical microscope to get a close look at the bone or area of your affected spine
• Remove all or part of your lamina with small instruments, as well as any disk fragments, bone spurs, or affected soft tissue (they’ll remove the smallest amounts of your lamina as possible)
• If necessary, perform a foraminotomy (which involves widening a spinal opening for nerve roots) or a spinal fusion procedure (which is to stabilize the bones in your spine). If a laminectomy is performed as part of a surgery for a herniated disk, your surgeon will remove the herniated portion of the disk and any pieces that have broken loose. This is called a diskectomy.
• Move your muscles, ligaments, and skin back in place
• Sew or stitch your skin closed around the incision site

In some cases, the surgery is minimally invasive, meaning your surgeon will make a tiny incision and use a special surgical microscope to gain access to your spine rather than a “traditional open approach,” Farjoodi says.

Laminectomy is not an emergency procedure. Typically it is scheduled from as short as two weeks to several months ahead of time.

Farjoodi prefers to schedule the procedure several months out, so that patients can spend at least two to six weeks preparing to set themselves up for better recovery. Farjoodi often gives patients the following recommendations:

• Do physical therapy and exercise. You will have a better chance of bouncing back post-op if you maintain strong core muscles.

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  Farjoodi suggests exercise that’s safe for your abilities but keeps your body strong and in movement. He connects patients with physical therapists for about four to six weeks of exercise when a patient is preparing for a laminectomy, and then assesses their progress.
• Quit smoking. If you are a smoker, you should stop before laminectomy, as smoking slows down wound healing, which can lead to complications after surgery.

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  Farjoodi encourages his patients to stop smoking as far in advance as possible.
• Monitor (and manage) blood sugar levels if you’re diabetic. Farjoodi will take extra time with diabetic patients to optimize their glucose levels, through medication and eating a diabetes-friendly diet limiting sugar and processed foods. “If we have elevated blood sugars going into surgery, we run the risk of poor healing and increased rate of infection,” he says.
• Try to lose weight if your body mass index falls in the overweight or obese categories. Overweight patients put a lot of stress on their discs and accelerate the degeneration of their lamina, causing wear and tear. Farjoodi also encourages patients to try to lose weight — at a healthy one to two pounds per week — to ease symptoms pre- and post-op. “Practically speaking, I like to see any weight loss. If we lose some weight, even a little bit, that tends to have a pretty profound effect on back pain,” Farjoodi says.
• If you have other chronic diseases, connect with providers managing those conditions for specific recommendations. If you have diabetes, heart disease, or other medical problems, your surgeon will ask you to see your regular provider to ensure these problems are under control. Often, they’ll have to receive clearance from your care team before booking the surgery.

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• Tell your healthcare provider if you have any allergies. This includes any sensitivities to or allergies to any medicines, latex, tape, and anesthesia medicines (local and general).

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And in the days before surgery, remember to:

• Prepare for when you leave the hospital and return home, so you have the liquids, nourishing meals, comfortable bedding, and everything you’ll need to rest and recover comfortably on hand.

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• Stop taking blood thinners in the week before surgery. Some of these drugs include aspirin and Plavix. Also stop ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), which are anti-inflammatory medicines that can affect bleeding. If you are taking warfarin (Coumadin), dabigatran (Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto), or clopidogrel (Plavix), talk with your surgeon and your prescribing doctor before stopping or changing how you take these drugs.

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• Keep your surgeon updated on any health changes by letting them know right away if you get a cold, flu, COVID-19, fever, herpes breakout, or other illnesses you may develop.

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  In some cases, your surgery may be postponed altogether to make sure you’re in better health before undergoing surgery. This is to ensure you have the best shot at a smooth recovery, so your body can focus solely on healing instead of fighting an infection.

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• Arrange for someone to pick you up post-op, take you home safely, and help you for a few days with household activities and driving.

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And on the day of the surgery, you will likely:

• Be asked not to drink or eat anything for 6 to 12 hours before the procedure.

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A laminectomy is typically an outpatient procedure, meaning most patients go home the same day of the surgery, according to Farjoodi. It usually takes about an hour but can be up to three hours, depending on the complexity of the surgery.

Note that you’ll likely spend another three hours at the hospital after the procedure before being allowed to go home, so that your doctor can monitor your vital signs post-op and make sure you’re stable.

“This is a straightforward procedure that tends to have minimal risk, and requires minimal recovery time,” Farjoodi says.

On the day of your surgery, an anesthesiologist will give you general anesthesia so you’ll be asleep for the entire procedure and won’t feel any pain.

You’ll lie facedown on special pads to protect the front of your body while your surgeon works on your spine.

Farjoodi says that while the risks linked to laminectomy tend to be low, with any surgical procedure complications can occur.

• Bleeding
• Infection
• Blood clots in the legs or lungs
• Spinal cord or nerve root injury
• Risks linked to the use of general anesthesia
• The need for more surgery, if anything unexpected, such as leakage of spinal fluid, occurs
• Injury to nerve or blood vessels in the area of surgery, which is rare, but may cause numbness or weakness

Immediately After the Procedure

After the procedure, which should be between one and three hours, you’ll be taken to a recovery room for observation after the surgery. Doctors will monitor your blood pressure, pulse and breathing. Once you’re given clearance with all signs stable, you may be discharged.

Your doctor will encourage you to get up and walk around, if you’re able to, when the anesthesia wears off.

In the First Month After the Procedure

At home, Farjoodi instructs patients to limit bending, lifting, and twisting movements for the first six weeks after the surgery. “That’s to help the muscles and wound heal,” he says.

He also recommends a course of gentle physical therapy two weeks after surgery to build up a strong core to prevent further issues down the road.

Your doctor will also prescribe you medication for pain relief. Take a pain reliever for soreness as recommended by your healthcare provider.

A meta-analysis published in 2022 pored over the 5-year and 10-year post-op outcomes of more than 83,400 patients and found potential side effects, such as:

• Lower back pain and leg pain, although in some of the studies reviewed, patients saw a “significant improvement in pain from baseline”
• Disability, including difficulty walking, with one study finding that that 62.2 percent of patients were not able to walk more than 100 meters without pain pre-op, and that decreased to 8.1 percent post-op
• Potential re-operation

After a laminectomy, patients often report improvement in their symptoms, especially a decrease in pain in their back, neck, and down the leg or arm.

The key is to maintain good health to avoid a second procedure, which may be needed because of stress on the spine from weight gain, more wear and tear, or age-related spinal degeneration, Farjoodi says.

“Anytime you have a spine issue requiring surgery, you want to stay ahead of the problem and minimize the chances of this returning,” Farjoodi says.

Keep a healthy BMI, include physical activity in your daily routine, and report any symptoms of arthritis to your doctor, he says.

A laminectomy is performed to relieve pressure on the spinal cord and surrounding area, which typically shows up as pain in the back, neck, or down the legs or arms. If less-invasive treatment options (like medications, physical therapy, and others) don’t help symptoms, your doctor may recommend laminectomy. It’s considered a low-risk procedure, and often patients go home the same day.