Thoracic Laminectomy

Thoracic = having to do with the spine in the upper and mid-back
Laminectomy = removal of the lamina (a section of bone that forms the “roof” over the spinal canal)

A laminectomy the removal of the lamina, a part of the spine that forms a bony “roof” over the spinal canal. This common procedure gives a neurosurgeon access to the spinal canal and relieves pressure on the spinal cord or nerve roots.

When performed in the thoracic spine (upper and mid-back), the procedure is known as a thoracic laminectomy.  For information about laminectomy in the neck, see our page on cervical laminectomy. For information about laminectomy in the low back, see our page on lumbar laminectomy.

The most common reasons this procedure is performed are to remove a tumor or to relieve the pressure of spinal stenosis.

Certain tumors can occur inside the spinal canal–for example, nerve sheath tumors, meningiomas, astrocytomas, ependymomas and hemangioblastomas. A surgeon performs a laminectomy as part of a microsurgical tumor removal to access and remove these tumors.

Spinal stenosis is a narrowing of the spinal canal that has many possible causes. A thoracic laminectomy can help treat stenosis caused by a narrowing at the back of the spinal canal (as opposed to the front or the sides).

A thoracic laminectomy is performed under general anesthesia.

An incision is made over the spine at the level of the surgery. The skin and muscles are opened and the bones at the back of the spine are revealed. The surgeon then removes the lamina.

Compression of the spinal cord is relieved when the lamina is removed. The surgeon may also relieve pressure on the spinal nerves with a procedure called a foraminotomy. In this procedure, the surgeon enlarges the foramina, or the small holes through which nerves exit the spinal canal. The surgeon may also remove some bone from a spinal joint called a facet joint. The facet joint is sometimes involved in nerve compression.

If the laminectomy is being performed a part of a tumor removal, the surgeon proceeds with the rest of the operation to remove the tumor.

After a laminectomy, the “roof” of the spinal canal can be left open; the lamina does not need to be replaced by a plate or bone graft. However, in cases where the spine is already weakened and/or bone removal is extensive, the surgeon may perform a spinal fusion to ensure the spinal column is strong and stable. During a spinal fusion, the surgeon inserts a bone graft that joins two or more vertebrae together into a single unit. The surgeon may also use instruments such as a metal plate and screws to hold the bones in place until they heal.

Finally, working layer by layer, the surgeon closes the incision using absorbable sutures that can be dissolved by the body.

Make sure to tell your doctor about any medications that you’re taking, including over the counter medication and supplements, especially medications that can thin your blood such as aspirin. Your doctor may recommend you stop taking these medications before your procedure. To make it easier, write all of your medications down before the day of surgery.

Be sure to tell your doctor if you have an allergy to any medications, food, or latex (some surgical gloves are made of latex).

On the day of surgery, remove any nail polish or acrylic nails, do not wear makeup and remove all jewelry. If staying overnight, bring items that may be needed, such as a toothbrush, toothpaste, and dentures.

Post-surgical pain is usually controlled with intravenous pain medication for the first day, followed by oral pain medication. On average, patients are discharged from the hospital two to three days following surgery. Most patients are encouraged to walk as soon as possible, often on the day of surgery.

The surgeon will schedule a follow up visit, typically 4-6 weeks after surgery.

Will I need to wear a brace?
No brace is usually required.

When can I resume exercise?
Patients are usually encouraged to increase their activities as they are able to tolerate. However, patients should usually stick to low-level activities, like walking or riding a stationary bike, for the first 4-6 weeks.

Will I need rehabilitation or physical therapy?
Physical therapy that focuses on the thoracic region will often be started at the time of the follow up visit. Physical therapy initially involves stretching and range of motion exercises, and then endurance and strength training. Physical therapy may be delayed for an additional 4-6 weeks for patients who have had a spinal fusion.

Will I have any long-term limitations due to thoracic laminectomy?
There are no long-term disabilities or limitations due to thoracic laminectomy.

Drs. Paul C. McCormick, Michael G. Kaiser, Peter D. Angevine, Alfred T. Ogden, Christopher E. Mandigo, Patrick C. Reid and Richard C. E. Anderson (Pediatric) are experts in thoracic laminectomy.