A laminotomy is a surgical procedure that is done to remove a portion of the vertebra to relieve pressure on the spinal nerves. Patients with degenerating spinal discs or narrowing of the openings between their vertebrae can experience pain caused by pressure on the nerves. Removing a piece of the vertebra can relieve pressure, while still providing support for the spinal cord.
The vertebrae that make up the spine surround and protect the spinal cord. A portion of each vertebra known as the lamina protects the back side of the spinal cord. Nerves leave the spinal cord through openings between the vertebrae and travel to all parts of the body. Between each vertebra is a flat disc that provides cushioning. Any bulging or degeneration of these discs could cause the openings between the vertebrae to narrow and pinch the spinal nerves.
Patients with pinched nerves or narrowing of the openings, also called spinal stenosis, may experience pain or numbness in the arms or legs. There may also be weakness and a loss of muscle function in the limbs. Conservative treatment such as rest, pain medication, and/or physical therapy is usually the first line of treatment.
If conservative measures fail to relieve pain after a few months, the patient may want to consider surgery. Prior to performing surgery on the patient, the physician will most likely order either a computed tomography (CT) scan or a magnetic resonance imaging (MRI). These tests will give the surgeon a complete picture of the size of the openings that contain the spinal nerves.
Surgical options are determined based on the severity of the pain or compression of the nerves. Laminotomy is appropriate for moderate levels of compression and is only a partial removal of the lamina bone on the back of the vertebra. The lamina is in two sections on each side of the large spinous process that extends out from the vertebra. Patients can have one or both laminae removed in what is referred to as a unilateral or bilateral laminotomy. Removing only the lamina and leaving the spinous process in place preserves most of the natural support provided by the spinal column.
There are two ways to perform a laminotomy. For an open laminotomy, the surgeon makes an incision in the skin of the back at the level of the affected vertebra. The muscles are cut and moved aside to reveal the vertebra. A high speed drill is then used to cut away the lamina. This procedure can take one to three hours to perform and the patient is under a general anesthetic.
An endoscopic laminotomy involves the use of a tube that is slowly inserted in the back to push aside the muscles and reveal the surgical area. A camera and surgical instruments are inserted into the tube and used to cut away the lamina. This procedure is done as an outpatient procedure after the patient has been injected with a local anesthetic. Recovery and healing times are shorter than with the open laminotomy.