Laminotomy - The Detailed Information You Need to Know

The term laminotomy is derived from the Latin words lamina - Bony plate that covers the vertebras posterior arch and otomy - Cutting or incision.

When a laminotomy is performed it is done to gain access to the spinal canal. A laminotomy uses an endoscopic approach to this for the surgeon to free any compressed or “tethered" nerves in the area. Because of the minimally invasive nature to this procedure, it can be performed in a surgical outpatient setting without the need for general anesthesia or lengthy hospital stays.

A laminotomy is performed when there is evidence of nerve compression due to bone spurs, disc problems such as a herniated or bulging disc, scar tissue formation from failed back surgery and other natural phenomena and arthritis in the spine.

A laminotomy works by increasing the amount of room available for surrounding nerves and the spinal cord.

Differences between a traditional laminectomy and minimally invasive laminotomy:

Laminotomy - Procedure performed to remove the ligamentum flavum which spinal stenosis is attributed to. The ligamentum flavum can naturally thicken over times, constricting the spinal canal and causing nerve root compression. When a laminotomy is performed to remove the ligament, the surrounding nerves and spinal cord will no longer suffer from constriction due to a lack of space.

Laminectomy - This is conventional open back surgery that requires general anesthesia and (often) a lengthy hospital stay combined with long recovery time. A laminectomy is performed to remove the lamina to increase the amount of space for surrounding neural tissues.

The Laminotomy procedure in detail:

The patient is first given a local anesthetic and a small incision is made. A round Depuy tube is then inserted into the incision with the tube being gradually increased in size by sliding new tubes over the previous one. The final working tube is about 18 millimeters in diameter which the surgeon will use to gain access to the patients back for the medical instruments. These instruments include the laser, camera, suction, irrigation and a few others. When a working tube is used in minimally invasive procedures, it helps to maintain minimal damage by pushing the surrounding muscles out of the way instead of cutting or tearing them.
Once the working tube has been secured the surgeon can then begin the process of removing the material causing the pain. During the procedure and once the surgeon has released trapped nerves many patients will comment on immediate relief of pain. The symptoms of back and leg pain are caused by entrapped nerves and corrected by decompressing the spinal canal.

It is important to realize a laminotomy is not an arthroscopic procedure performed inside the joint. A laminotomy is an endoscopic procedure performed with the same tube as other arthroscopic surgeries, without breaching the joint.

Recovery for a laminotomy:

Once the procedure is complete the patient will receive one or two stitches (sometimes none!) and be moved to a recovery room where they are monitored for the next few hours. After this time the patient is then allowed to leave as long as they are accompanied by a companion. It is recommended that the patient takes a long walk that afternoon or night. The following day the patient returns to get full clearance from the doctor to head home.

Author : Brenda Miller
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