General Overview

A lumbar laminectomy is a surgical procedure most often performed to alleviate leg pain caused by nerve impingement. The goal of a laminectomy is to relieve pressure on the spinal cord or spinal nerves by widening the spinal canal. A laminectomy is typically performed to treat spinal stenosis. Spinal stenosis is simply the narrowing of the spinal canal. Narrowing occurs as people age and is due to thickening of the ligaments of the spine, disc bulging, joint enlargement and bone spur formation.

Procedure

Pinched Nerve Laminectomy An incision is made on the back near or at the midline. The incision is vertical and will vary in length from approximately two to five inches and is dependent on how many vertebrae are involved. Once the spine is exposed, the lamina (roof of bone covering the nerves) is removed (laminectomy) to provide more space for the nerve roots. If only a small portion of the lamina is removed it is called a laminotomy. Bone spurs are then trimmed if necessary. The incision is then closed with sutures or staples.

Risks of spinal fusion surgery include but are not limited to nerve damage, leg pain, blood vessel damage, blood clots, blood loss, dural tear, spinal fluid leak and infection. Rare risks of surgery include weakness of an extremity, bowel or bladder dysfunction or incontinence, paralysis, worsening of neurologic symptoms, worsening of low back pain and possibly death.

Preparing for Surgery

Please contact the office immediately if should develop any of the following conditions before your surgery date:

• Dental Infections
• Urinary tract infections
• Cuts that will not heal or that appear red
• Open wounds or sores
• Fever
• Any infection requiring antibiotics
• Cold or Flu
• Blood Clot
• Heart condition
• Any significant change to your overall health status
• Skin Rash
• New Allergies

7 Days Prior to Surgery

You MUST discontinue all anti-inflammatory medications and anticoagulation medications seven days prior to the surgical procedure unless told otherwise by your surgeon. This includes, but is not limited to, Aspirin, Naprosyn (Aleve), Ibuprofen (Advil, Motrin), Lovenox, Coumadin, Plavix, etc. If you are taking Plavix, Lovenox, Coumadin or other anticoagulation medication please contact the surgical coordinator immediately.

Prescreening

Pre-operative testing and any other necessary arrangements for your surgery are managed by the Surgical Coordinator. Please contact the Surgical Coordinator with any surgical questions you may have.

All patients that undergo surgery at the New England Baptist Hospital are required to go to the New England Baptist for a prescreening appointment prior to the date of surgery. At that visit you will undergo a complete physical examination by the anesthesia department. Blood work, special x-rays and an EKG will be taken. If you are required to see a specialist for surgical clearance (i.e. cardiologist), arrangements will be made to see that physician during your prescreening appointment. Please plan on spending a full day at the hospital.

Please report to the hospital 30 minutes prior to your appointment to register. Bring your insurance card(s) or workers compensation information with you to your prescreening appointment. Please bring a small snack and any medications (including pain medications) that you will need to take during the day to your prescreening appointment, as this may be a long day. There is a cafeteria and vending machines on site for your use.

You are required to bring all medications that you take on a regular basis to your pre-screening appointment at the New England Baptist Hospital in their original containers. This helps eliminate any confusion regarding your medications and will ensure that you will receive the appropriate medications during your stay at the hospital.

On occasion, the pre-screening staff will detect a medical issue that needs to be either treated or further tested prior to the surgery date. If you are informed that additional testing and/or treatment is needed before surgery, please contact the surgical coordinator immediately. If the pre-screening staff has told you that you have not been cleared for surgery please alert the surgical coordinator immediately.

You cannot have surgery without this pre-screening evaluation. If you cannot make your pre-screening appointment, you must call 617-754-5498 to reschedule as soon as possible.

If you miss your prescreening appointment your surgery will be canceled. Contact the office immediately if you have any difficulty rescheduling this appointment.

To minimize time spent at prescreening, you may pre-register at www.onemedicalpassport.com. Your surgical coordinator will provide you will you surgeon’s ID number.

Other Suggestions for Pre-Operative Planning

* Place items in your home that you use on a daily basis between waist and shoulder height. That way you can safely avoid reaching or bending.

* Make small meals or grocery shop before your surgical date so you will have little need to do so post-operatively.

• Find someone to help with chores or errands.
• If you live alone it may be helpful to stop mail for a period of time while you are in the hospital.
• Buy a pair of slip on shoes so that you will not have to bend to put them on post-operatively.
• Make arrangements for your pets to be fed or cared for.

Hospital Guest Hotel Services

New England Baptist Hospital offers hotel services on the hospital grounds exclusively to patients and their family or friends. This program was put in place to help eliminate the stress of traveling to and from the hospital for appointments or surgery.

Guests have the option of a twin, double or queen bed. Some rooms include a sleep chair for an additional person.

All guest rooms have:

• A private bath with shower
• Cable TV
• Telephone
• Clock radio
• Daily housekeeping

Other amenities include:

• Complimentary parking
• Use of the common room, with complimentary coffee service, microwave, refrigerator and sitting area
• Discounts at the hospital cafeteria

Room rates range from $75 to $105 per night

For reservations, please call Guest Services at 617-754-5173 between 8 am and 4 pm Monday through Friday. It is recommended that you call for reservations as soon as possible to ensure availability.

7 Days Prior to Surgery

**You MUST discontinue all anti-inflammatory medications and anticoagulation medications seven days prior to the surgical procedure unless told otherwise by your surgeon. This includes, but is not limited to, Aspirin, Naprosyn (Aleve), Ibuprofen (Advil, Motrin), Lovenox, Coumadin, Plavix, etc. If you are taking Plavix, Lovenox, Coumadin or other anticoagulation medication please contact the surgical coordinator immediately.

Your Operative Day

Please do NOT eat any food or drink after midnight the night before your surgery. Do NOT eat candy or gum. You may have your morning medications with a sip of water. If you use insulin, do not administer your morning injection. Bring your insulin with you to the hospital.

Hospital Arrival

You will arrive at the hospital at the time provided to you by the surgical coordinator. This will be approximately 1 ½ to 2 hours prior to your surgical time. Please report to the admitting office immediately to check in. Please bring your insurance card with you. Once you are admitted, you will be escorted to the Bond Center.

Bond Center

Once you arrive at the Bond Center, your will meet the nurse who will be taking care of you that morning. You will be asked to change into a hospital gown. The anesthesiologist will put in an IV in your arm for medications. Your surgeon will see you before surgery.

Length of Surgery

The length of your surgery is dependent on how many vertebrae are involved. The average length of surgery is 1-2 hours. You will be transferred to the recovery room after the surgery is completed. Once you are awake and alert, you will then be transferred to your hospital room.

In Patient Post-Operative Care

Pain: Your low back will be sore following this procedure. This is managed with pain medications.

Bowel Discomfort: Your bowels may not work normally for a few days following the procedure. You will be slowly introduced to food as tolerated. We recommend small meals for the first few days, gradually increasing to your normal portions.

Breathing: Breathing exercises are incorporated into your post-operative program to help prevent pneumonia from developing. You will be given a device called an incentive spirometer, to assist you with these exercises.

Bladder Care: Following surgery, it may be difficult to urinate due to the affects of anesthesia. You may have a catheter placed temporarily to help you to urinate, though this is uncommon.

Clot Prevention: When you are inactive, precautions are taken to avoid the development of blood clots. You may be required to wear elastic stockings post-operatively.

Physical Therapy: Physical therapy begins the day after your surgery. The therapists will assist you in getting out of bed and walking. They will help you to regain your strength and motion so that you may be discharged to home safely.

Discharge Planning

Your hospital case manager will review your post-operative plan with you before you are discharged. The hospital case manager is responsible for arranging the following services for you if needed:

• Home Physical Therapy
• Inpatient Rehabilitation Transfers
• Home Nursing
• Transportation to Home or a Rehab Center
• Home Health Aides

Rehabilitation Hospital Transfer: This is not generally necessary following a laminectomy, however, if it is necessary, this will be arranged by the hospital case manager.

Home Services: If you have been told that you are having home care and you are not contacted within two days of your discharge from the hospital by the home care agency, call the agency’s number that is listed on your discharge papers. If they do not respond, contact the office immediately at 617-730-9814.

Length of Stay: You will be expected to spend 1-3 days in the hospital.

Medications: You will receive prescriptions for pain medications upon discharge. The prescriptions are provided to you by the hospital. You will need to contact the office for refills. Please keep in mind that many medications cannot be called in and must be mailed. It is important to call the office several days in advance so that you can receive your medications on time.

Pain medications are designed to make your pain more tolerable. Do not expect to be pain free.

Medical Equipment: Medical equipment such as a cane, commode, walker, shower chair, etc. is arranged for by the hospital if needed.

Please contact the office immediately if you develop any of the FOLLOWING SYMPTOMS after discharge from the hospital:

• A significant increase in pain
• New numbness, tingling or weakness of legs
• Fever over 100°F
• New back or leg pain
• Severe headaches
• Redness or discharge from the incision site

Office Phone Number: (617) 738-8642

Recovering from Laminectomy

Please contact the office immediately if you develop any of the FOLLOWING SYMPTOMS after discharge from the hospital:

• a significant increase in pain
• new numbness, tingling or weakness of legs
• fever over 100°F
• new back or leg pain
• severe headaches
• redness or discharge from the incision site

Office Phone Number: (617) 738-8642

Post Op Visits

1st Post-Op visit: Your first post-operative visit will be scheduled by the surgical coordinator. You must be seen in the office between the 10th and 14th post-operative day for suture/staple removal and a wound check. If you are unable to come to the office for this visit, please contact our office as soon as possible.

2nd Post-Op visit: Your second post-op visit will be scheduled by the surgical coordinator. This will be approximately 6 weeks from the date of surgery. You will see your surgeon on this date and x-rays will be taken.

Immediately After Surgery

Incision Care

Dressing: A dressing will be applied to your incision following surgery. This dressing should be left on until your first office visit unless otherwise specified by your physician or physician assistant. Your visiting nurse may receive instructions to remove or change this bandage before your first post-operative visit. Do not be alarmed if the dressing becomes moist or bloodstained. However, if the area continues to bleed, you should call the office immediately.

Wound Care: Your wound should be kept clean and dry. You should not allow your incisions to get wet in a shower unless otherwise specified by your physician.

Incision: Initially the incision appears pink. Over time, with proper care, it will heal into a fine white line. This may take up to one year. For best results, put vitamin E directly onto the incision once it has healed. Keep the incisionout of the sun or cover with sunscreen.

Exercise and Precautions

You are expected to walk daily for exercise. Begin with short distances and try to walk two times per day. Avoid prolonged sitting. Avoid bending or twisting at the waist. Do not lift anything greater than 5 pounds. 3-6 Weeks after Surgery

Intercourse: You should avoid sexual activity for 3-4 four weeks following surgery. Before you resume sexual activity, make your partner aware of your pain and any concerns that you may have. Limit activity and positions that cause pain. The dependent (supine) position is recommended. Avoid twisting and excessive bending of the hips and sudden movements.

Work: You are expected to be out of work for a minimum of 4 to 6 weeks. This of course varies from person to person and is dependent upon the rate of healing, symptoms, work demands, etc. If you need disability paperwork completed, please contact the office at the earliest possible date.

Physical Activity Limitations: Avoid any lifting with the surgical limb for six weeks following surgery unless advised otherwise by your physician. You are restricted from household chores such as laundry, vacuuming, cleaning, raking, shoveling, etc. If you have a question regarding a certain activity, contact the office.

Driving: You should not drive for 6 weeks unless told otherwise by the physician