The spinal canal is the passageway through which the spinal cord and nerves pass on their way to the destinations. When this canal is narrowed, a surgery may be performed to widen the space for the nerves.
A laminectomy and laminotomy are two similar methods to access the spinal canal. By removing a part of or the entire lamina, the surgeon can visualize and address any pathology that is pinching the nerves. Below, we take a closer look at these two decompression procedures, and we explain how they are performed to help relieve spinal discomfort.
The Basics Of Laminectomy and Laminotomy
A laminotomy removes a small window of the lamina and a laminectomy removes the entire lamina. The decision of which to pursue is based on the location and severity of the pathology affecting the nerves.
- Laminotomy – A 3 to 4 millimeter window in the lamina is removed to allow the surgeon to access the spinal canal. A laminotomy is typically used to address small, isolated causes of nerve compression such as small disc herniations, facet synovial cysts, and discrete bone spurs.
- Laminectomy – When increased visualization is needed to address more extensive and widespread pathology, a laminectomy may be necessary. Careful laminectomy planning and execution is necessary – creating too wide of a window can potentially weaken the structure of the spine and create instability of the target level. A laminectomy is more commonly performed for extensive stenosis due to large bone spurs, overgrown ligamentum flavum, or extremely large disc herniations or synovial cysts.
Performing A Spinal Decompression Procedure
Both a laminectomy and laminotomy begin in a similar manner. The patient lies on their back on the operating table before an anesthesiologist administers general. The patient is then carefully rolled by the surgery team on to their stomach on a well-cushioned surgical bed. A small incision is made on your spine above the location of the compression, and spinal muscles are maneuvered so that the surgeon can view the spinal column.
Once in this location, the two procedures vary a little.
- Laminotomy – A portion of the spinal lamina is removed. This can be done on one side or on both sides of the lamina depending on the location of the nerve compression. The laminotomy provides a window to address the pathology in the spine. A microscope and fine surgical instruments are used as well.
- Laminectomy – When more exposure is necessary to safely address the pathology in the canal, a laminectomy may be performed. The surgeon begins by removing a portion of the vertebrae known as the spinal process. This allow the surgeon to access and completely remove the lamina of the affected vertebrae. The underlying pathology can then be addressed, again with the use of a microscope and specialized surgical instruments.
Each level of the spine typically takes 30-40 minutes to address with either a laminotomy or laminectomy. The surgery is tailored to address the pathology present at each location – a patient may have a left sided laminotomy at one level, a laminectomy at another, etc, etc. Once the nerves are visibly and palpably free of compression, the surgeon will remove the muscle retractor and reposition the spinal muscles that were moved back into their original position. The incision site will be closed with resorbing sutures and sterile dressings applied. Most patients can discharge to home on the same day with family or support friends.
Laminectomy / Laminotomy Surgery Recovery
Once you’re discharged home, you’ll be given specific recovery instructions from your care team. This will cover aspects like wound care, rehabilitation and which activities should be avoided. Generally speaking, patients can “let their body be their guide” after these surgeries. Avoiding bending, lifting, and twisting will allow the back muscles a break while they heal and speed your overall recovery. After about two weeks, you’ll return for a follow up appointment to allow us to monitor your progress, check the incision healing, and make adjustments to your activity restrictions.
For more information about treatment options for low back and leg pain due to spinal pathology, reach out to Dr. Jackman and his team today.