Laminectomy and Spinal Fusion
In laminectomy, the surgeon removes one or more of the bony laminae that cover the vertebrae. Most commonly performed to relieve pressure on the spinal cord or spinal nerve roots resulting from a herniated disk, laminectomy also may be done to treat compression fracture, dislocation of vertebrae, or a spinal cord tumor.
After removal of several laminae, spinal fusion—grafting of bone chips between vertebral spaces—is often performed to stabilize the spine. It also may be done apart from laminectomy in some patients with vertebrae seriously weakened by trauma or disease. Usually, spinal fusion is done when more conservative treatments—including prolonged bed rest, traction, and the use of a back brace—prove ineffective. (See An alternative to laminectomy.) In some patients, endoscopic diskectomy may be an effective alternative to open surgery for decompressing and repairing damaged lumbar disks.
Procedure
The patient is given a general anesthetic and placed in a prone position. To perform a laminectomy, the surgeon makes a midline vertical incision and strips the fascia and muscles off the bony laminae. He then removes one or more sections of laminae to expose the spinal defect. For a herniated disk, the surgeon removes part or all of the disk. For a spinal cord tumor, he incises the dura and explores the cord for metastasis. He then dissects the tumor and removes it, using suction, forceps, or dissecting scissors.
To perform spinal fusion, the surgeon exposes the affected vertebrae, then inserts bone chips obtained from the patient’s iliac crest, from a bone bank, or from both. For optimum strength, he’ll use wire, spinal plates, rods, or screws to secure these bone grafts into several vertebrae surrounding the area of instability. Then he closes the incision and applies a dressing. After completion of the operation, external traction (such as a halo device, if surgery involved the cervical spine) may be applied.
Complications
This complex and delicate surgery carries the risk of several potentially serious complications. The most common include herniation relapse, arachnoiditis, chronic neuritis caused by adhesions and scarring, and problems associated with prolonged immobility, such as urine retention, paralytic ileus, and pulmonary complications. And even though surgery may relieve pressure on the nerves, reducing pain and improving mobility, it can’t reverse existing nerve or muscle damage from chronic disorders.
Key nursing diagnoses and patient outcomes
Risk for injury related to potential for reherniation. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will:
demonstrate proper logrolling technique postoperatively to decrease back pressure and to minimize the risk of disrupting a hematoma
avoid physical strain such as from heavy lifting or harsh coughing; also, when performing permitted activities, he’ll demonstrate proper body mechanics
not develop signs and symptoms of reherniation.
Acute pain related to surgical trauma and nerve inflammation.
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