LAMINECTOMY

By : RN Nurul Syazwani
Rosli
 OBJECTIVES

Understand about Laminectomy

Management of Laminectomy
Post op care (nursing care) of
Laminectomy
 DEFINITION
 Lumbar Laminectomy :
Removal of lamina.
Surgical procedure to
relieve pressure on the
spinal nerves.
Degeneration, or wear and
tear, in the parts of the
spine may narrow the
spinal canal.
Spinal stenosis,
spondylolisthesis, Cauda
Equina Syndrome.
 DEFINITION
Spinal Stenosis :
narrowing of the spinal canal, which
places pressure on the spinal cord.
progressive narrowing of the
opening in the spinal canal.
 DEFINITION

Spondylolisthesis:
The slipping of one vertebra onto another.
also occurs and leads to compression.

*When these conditions occur in the spinal area,

they can cause the spinal canal to narrow, creating
pressure on the spinal nerve.
 INDICATION
Some of them was born with narrowing
of spinal.
Patients over the age of 50.
Ligaments of the spine can thicken and
harden (called calcification).
Bones and joints may also enlarge, and bone
spurs (called osteophytes) may form.
Bulging or herniated discs are also common.
Most likely is a genetic predisposition.
Cauda Equina Syndrome.
 SYMPTOMS
 Neurogenic claudication while walking or
standing.
Weakness
Numbness
 Permanent Symptoms :
Leg pain
Motor deficit, sensory deficit
Rarely, urinary dysfunction or impotence can be found
in this order of frequency.  
 Intermittent Symptoms :
Low back pain
Referred pain or back weakness.

(symptoms are triggered or worsened in postures that

aggravate lumbar lordosis, including standing, walking,
especially downhill or downstairs, as well as while
wearing shoes with high heels. )
ANATOMY
 The bones of the spinal column
protect the spinal cord.
 The vertebral body at each level
of the spine protects the front
of the spinal cord.
 The pedicle and lamina bones
form a protective ring of bone
that surrounds the sides and
back of the spinal cord.
 The pedicles connect to the
vertebral body.
 The lamina bones attach to the
pedicles.
 The lamina bones cover the
back surface of the spinal canal,
forming a protective roof over
the spinal cord.
 OBJECTIVES OF SURGERY
 To open up the spaces that nerve roots travel through
on their way from inside to outside the vertebral canal.

 The site along the nerve root's course where it is most

liable to compression is as it passes through the opening
from the canal to the surrounding paraspinous back
muscles, this opening is known as the "neural foramen".

 In cauda equina syndrome surgery must be done as

soon as possible to avoid permanent neurologic deficit.
 HOW LAMINECTOMY DONE?
 Surgeons perform lumbar
laminectomy surgery through
an incision in the low back.
 The surgery involves the pedicle
and lamina bones.
 These bones attach to the back
of the spinal column, forming a
bony ring that encloses the
spinal canal.
 Surgeons may remove bone
spurs from the facet joints along
the back of the spine during the
laminectomy procedure, taking
pressure off the spinal nerves.
COMPLICATION
 Problems with anesthesia
 Bleeding
 Thrombophlebitis
 Infection
 Nerve damage
 Segmental instability
 Ongoing pain
PRE OP PREPARATION

 MRI Lumbar Spine

 CXR
 Pre Op II
 GXM
 ECG
 NBM at 12mn
POST OP (RECOVERY ROOM)
 Immediately post operatively the patient is checked to
make sure that he or she is moving their legs and can
feel in their legs as well as pre-operatively.

 The back may also be inspected to make sure there is

no seepage of blood through the dressings.

 Check for airway due to anaesthesia.

 Observation till stable.

POST OP (IN WARD)
 Hourly observation
 Position – supine
 Care of radivac
 Care of IVD
 Care of CBD
 Diet
 Ambulation
 Dressing
 HOURLY
OBSERVATION

BP – to detect any hypovolumic shock if

sudden hypotension.
Pulse – tachycardia…check for any
hypovolumic shock
 POSITION

Supine position
Allowed to turn using Log Roll Method.
Can prop up patient as Dr. permission.
 CARE OF RADIVAC
Patent
Intact
Life span – 48 hours
Observe the characteristic of drainage
Amount
Color
 CARE OF IVD
Correct regime or rate
Correct fluids
Observe for sign &
symptom
of phlebitis
Redness
Pain
Swelling
Warm
 CARE OF CBD
 Anchor properly
 Above the floor – not touch the
floor
 Urine color
 Amount – observe & record
output
 Perineal care – to prevent odor
& maintain hygiene
 Empty when necessary
 If Dr. order to off…to observe
for PU within 6 hours – to
observe any bladder retention
 DIET
According to Dr. order
Start with fuids, if no vomiting, can
allowed milo, followed by soft diet,
then normal diet.
 AMBULATION
As Dr. ordered.
Will refer to physiotherapist for
ambulation.
Lumbar Corset
Walking frame
 OTHERS NURSING CARE
Activity Daily Living (ADL)
Sponging

Observe for abdomen distention