Lumbar Laminectomy¶

Overview¶

Lumbar laminectomy is the surgical removal of the lamina (and often the ligamentum flavum) to decompress the spinal canal and neural elements. It is performed for spinal stenosis, disc herniation, or tumor resection. Variants include hemilaminectomy, laminotomy, and multilevel laminectomy.

Normal Post-Operative Appearance¶

Absent lamina at the operative level(s)
Epidural scar tissue filling the laminectomy defect — develops over weeks to months and is expected
The thecal sac may appear expanded into the laminectomy defect (no longer compressed by the removed bone/ligament)
Paraspinal muscle edema and enhancement along the approach (resolves over weeks)

Complications¶

Recurrent disc herniation — New or recurrent disc material at the operative level
Epidural scar — Can cause recurrent symptoms by compressing nerve roots (less common than recurrent herniation)
Instability — Excessive bone removal (especially bilateral facetectomy) can lead to post-surgical instability/spondylolisthesis
Dural tear/pseudomeningocele — CSF collection through a dural defect
Epidural hematoma — Acute post-operative complication

Clinical Pearl

After lumbar laminectomy, evaluate for post-surgical instability — particularly if bilateral facetectomy was performed. Compare standing/upright radiographs with supine MRI, as instability may only be apparent on weight-bearing images. New or progressive spondylolisthesis at the laminectomy level suggests post-surgical instability.

Key Points¶

Absent lamina with epidural scar at the operative level is expected
Distinguish recurrent disc from scar with post-contrast MRI
Evaluate for post-surgical instability, especially after bilateral facetectomy
Pseudomeningocele suggests dural tear
Paraspinal muscle changes are normal in the early post-operative period

References¶

Estefan M, Munakomi S, Camino Willhuber GO. Laminectomy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542274/
Malhotra A, Kalra VB, Wu X, Grant R, Bronen RA, Abbed KM. Imaging of lumbar spinal surgery complications. Insights Imaging. 2015;6(6):579-90. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4656239/
Corona-Cedillo R, Saavedra-Navarrete MT, Espinoza-Garcia JJ, Mendoza-Aguilar AN, Ternovoy SK, Roldan-Valadez E. Imaging Assessment of the Postoperative Spine: An Updated Pictorial Review of Selected Complications. Biomed Res Int. 2021;2021:9940001. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8154286/
Babar S, Saifuddin A. MRI of the post-discectomy lumbar spine. Clin Radiol. 2002;57(11):969-81. Available from: https://pubmed.ncbi.nlm.nih.gov/12409106/
Guha D, Heary RF, Shamji MF. Iatrogenic spondylolisthesis following laminectomy for degenerative lumbar stenosis: systematic review and current concepts. Neurosurg Focus. 2015;39(4):E9. Available from: https://pubmed.ncbi.nlm.nih.gov/26424349/
Post-laminectomy syndrome. Radiopaedia.org. Available from: https://radiopaedia.org/cases/post-laminectomy-syndrome
Pseudomeningocele. Radiopaedia.org. Available from: https://radiopaedia.org/articles/pseudomeningocele-1