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Laminotomy

Laminotomy

Laminotomy is a surgical procedure where the lamina (back portion of the spinal vertebrae) 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 a laminotomy?

A laminotomy procedure is most often used to treat spinal stenosis, a painful condition caused by narrowing of the spinal canal. With the laminotomy, the surgeon makes a hole in the lamina and removes only a tiny portion of the vertebra. 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 a laminotomy whenever possible because it requires making a smaller incision, removing only a portion of the bone as compared to the entire back of the vertebrae. Therefore, the laminotomy is less damaging to the surrounding muscle and soft tissue. 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 widens the spinal canal to relieve pressure on the spinal cord and the pain it causes.

The laminotomy only removes a small portion of the lamina.

A laminotomy is less damaging than a laminectomy (pictured above) that removes the entire back of the vertebrae.

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 any medications you are taking. As with any surgery, you will be advised to discontinue and blood-thinning drugs several days before the surgery, as they may cause excessive bleeding.

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 area, 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 recovery room by a nurse until you are awake, alert, and stable. Then you will be 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 getting you out of bed and walking (with assistance) within 24 hours. Nurses will administer medications to keep you comfortable and you will be released home after 1-3 days, depending on your recovery.

How effective is laminotomy?

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 the highest rate of patient satisfaction.1

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