Laminotomy

Laminotomy is a surgical procedure where the lamina (portion of the spinal bone) is partially removed. The lamina of the vertebra serves as the roof of the spinal canal. The laminotomy is used to decompress the spinal cord and nerves, which serves as an “unroofing” of the spinal canal.

 

What is the purpose of the laminotomy procedure?

 

With the laminotomy, the surgeon makes a hole in the lamina and removes only a tiny portion of the vertebra.

Spinal Stenosis pinching nerves

Spinal Stenosis pinching nerves

The doctor then can see the damage to the bones, spinal cord, and nerves. With this procedure, the surgeon removes herniated disc material, bone spurs, damaged lamina, tumors, and thickened ligaments that press on spinal nerves in the spinal canal.

 

Why is the laminotomy preferred over the laminectomy?

 

Neurosurgeons perform laminotomies whenever possible because they require making a smaller incision, removing only a portion of the bone as compared to the entire vertebra, and are less damaging to the surrounding muscles and soft tissues.

In addition, the surgeon can use a magnifying glass device or microscope during the procedure, which makes viewing the nerves easier. The small hole in the lamina frees the nerves with the laminotomy, so pain subsides.

 

Are other procedures performed along with the laminotomy?

 

Along with the laminotomy, the surgeon may also perform a discectomy. This procedure is used to remove a herniated disc that is applying pressure to the spinal cord and/or nerves. During the laminotomy, the surgeon may remove the ligamentum flavum, which is a fibrous structure that connects the lamina to the vertebra. This structure is removed when it is damaged or thickened.

 

How do I prepare for the laminotomy?

 

Before surgery, you will meet with the neurosurgeon to review the procedure. The doctor will discuss the pros and cons of the surgery and ask you to sign a consent form. If you take an agent that thins the blood, you need

See how the laminotomy procedure takes away much less bone?

See how the laminotomy procedure takes away much less bone?

to hold this for several days before the surgery. Be sure to discuss all your medications with the surgeon. Because you will be given general anesthesia for the surgery, you cannot eat or drink after midnight, and should arrange to have transportation to and from the hospital. Because the surgeon must assure you are fit for surgery, certain blood tests, imaging scans, and EKGs are done in advance.

 

How is the laminotomy performed?

 

When you arrive at the hospital, you will check in, and a nurse has you change into a gown. After an IV catheter is placed in your arm, you are positioned face down on the procedure table. The anesthesiology provider will give you anesthesia, and the doctor cleans the skin of the back using an antiseptic. A small incision is made over the identified spinal level, and the muscles are moved to expose the lamina. The doctor uses surgical tools to remove the lamina and open the spinal canal. After decompressing the spinal cord and nerves, the muscles and soft tissues are re-positioned, and the incision is closed. A dry, sterile bandage is applied over the incision, and you are moved to the recovery area.

 

How will I feel right after surgery?

 

After the laminotomy, you will be monitored in the procedure room by a nurse. After 1-2 hours, when you are awake, alert, and stable, you are moved to a regular hospital room. Expect some soreness and mild discomfort of the surgical area. Physical therapy begins soon after surgery, with the therapist helping you get in and out of bed, and teaching you how to use a walker or cane. Nurses will administer medications to keep you comfortable and you are released home after 1-3 days, depending on your recovery.

 

Does the laminotomy work?

 

In a prospective study, researchers followed 227 patients with lumbar stenosis who received surgery (either laminotomy, laminectomy, or trumpet laminectomy). According to the study, the laminotomy patients had the lowest complication rate, and patient satisfaction was higher for the laminotomy patients.

 

Resources

Haddadi K & Qazvini HR (2016). Outcome after Surgery of Lumbar Spinal Stenosis: A Randomized Comparison of Bilateral Laminotomy, Trumpet Laminectomy, and Conventional Laminectomy. Front Surg, 3, 19.

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