Spine consists of several vertebra stacked on top of each other along with cushion discs in between each vertebra to allow the spine to move easily. A small bone at the back of each vertebra is called lamina that form the back wall of the spinal canal (in which spine cord runs). Some spine problems cause the lamina to compress one of the nerves in the spine cord resulting in severe pain in the leg or arm.
Laminotomy refers to partial removal of the lamina and is minimally invasive procedure performed to relieve nerve pressure on the spinal cord or its surrounding nerve roots caused by spinal diseases that may restricts daily activities like walking, sitting and working. Some of these spinal problems that cause nerve pressure are:
• Degenerative discs
• Herniated discs
• Spinal stenosis
• Bulging disc or bone spurs
• Ankylosing spondylitis
• Spondylosis (spinal osteoarthritis)
• Other obstructive spine problems
When disc degenerates, it affects its height and facet in the back collapse on each other (imbricate) causing further arthritis degeneration over time.
Some of the symptoms caused by a compressed nerve in the spinal canal include:
• Weakness in arm or leg
• Pain and stiffness in the lower
• Might also experience imbalance problem
• Numbness in back neck, legs or arms
• Difficulty in walking and standing
There are different types of laminotomies performed depending on the type of the disease or vertebra to be operated on.
Some of the common types of laminotomies include:
• Microscopic/microdecompression laminotomy – In microscopic/microdecompression laminotomy, surgery is performed with the help of microscope in order to magnify the part to be operated. This microscope is mounted to the operating table.
• Endoscopic/Microendoscopic decompression laminotomy – The surgery is performed by using an endoscope to visualize the surgical procedure. A tiny tube-shaped camera that is inserted into the patient’s body to see the surgical procedure internally is called an endoscope.
• Cervical laminotomy – surgery is done on cervical vertebrae. These cervical vertebrae are closest to the head.
• Thoracic laminotomy – surgery performed on midlevel vertebrae also known as thoracic vertebrae.
• Lumbar laminotomy – surgery performed on the vertebrae that is closest to the sacrum also called lumbar vertebrae.
• Bilateral laminotomy- in this surgery, the part of a bone from both of the lamina of the single vertebrae is removed.
• Unilateral laminotomy – a part of bone from one lamina of vertebrae is removed in this procedure.
Laminotomy has many benefits as compared to spinal surgery that include:
• Less invasive or minimally invasive procedure
• Cost efficient
• Less stay at the hospital
• Faster recovery depending on the procedure done
• Improved mobility
• Improvement in pain
• Less scarring due to small incision
• Best outcome
• Relief from back stiffness
• Relief from weakness
Doctor may perform several tests before planning a surgery procedure. These tests may include medical history of the patient, X-rays, MRI, CT scans, blood tests, electrocardiogram and may asked patient to stop taking all non-steroidal anti-inflammatory medicines and blood thinners a week before surgery.
During the procedure, patient will be given anesthesia through intravenous (IV) line and will be lying on their stomach with back facing up. Surgeon will make an incision down the middle of the back to expose the vertebrae on which the laminotomy will be done by moving aside the muscles in the back. The length of the incision depends on the number of laminotomies to be performed. After exposing the vertebrae, a small portion of the lamina will be removed to relieve the pressure and create space in the spinal canal. Once the procedure is done, the incision will be closed with stitches or surgical tapes. A laminotomy can take 2-3 hours depending on the type of procedure used. Less time may require in unilateral laminotomies as bone is removed from one lamina whereas in case of bilateral laminotomies can take more time because bone is removed from both laminae.
Patient will be moved to recovery room post surgery to be monitored for few hours and may need to stay at the hospital for 1-3 days depending on the condition and type of the procedure performed. Patient may feel some discomfort for first few weeks after a laminotomy. Doctor will recommend some pain medicines and physical therapy to help patient in recovering soon.
All surgeries have some risk and complications associated with them. Some of the risk involved in laminotomy may include:
• Chances of infection at the wound site
• Unexpected bleeding
• Clotting of blood
• Increase in chronic back pain
• Fluid leakage from the spine
• Reaction to anesthesia