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usually safer than other surgeries that are open or invasive. This surgery usually is shorter than other spinal decompression procedures by having an average duration of 70–85 minutes, whereas other decompression surgeries can have a duration anywhere from 90 to 109 minutes. Laminotomies are usually more cost efficient than other surgical decompression surgeries. In 2007, it was seen that laminotomies were around $ 10,000, whereas other surgical procedures were around $ 24,000. Smaller skin incisions and scarring as well as less surgical trauma are also a benefit of laminotomy. With this procedure there is usually a faster recovery time, and a shorter hospital stay if one is necessary at all. During the surgery there is also a benefit of minimizing the injury to muscles, ligaments, and bones in the spine since more invasive surgeries have a greater risk of damaging them. General anesthesia is usually required, but postoperative spinal instability is typically limited.
264:
560:
around this region to function properly. Laminectomies also often produce a longer recovery time as well as a greater risk for post-operative complications. There is typically more damage to the surrounding muscle tissue accompanied by a laminectomy. Since a laminectomy involves the excision of the entire lamina, a laminectomy will usually cause more spinal instability than a laminotomy. When going with the option of laminotomy, the procedure reduces the total amount of muscle severed. Because a laminotomy does not damage the spinous process and critical ligaments, there is not as much muscle weakness, pain, and lumbar instability seen with laminectomies. Laminotomies are fairly new compared to laminectomies, and it involves using less invasive methods with precise instruments to minimize the risk of tissue damage.
651:, commonly causing pain in the lower back and lower extremities. Cauda equina compression can also be due to stenosis of L4-5 region as well. Even though the CT scan allows for intensive image studying, the fixed nature of the image collection process alone is not enough to reach a definitive diagnosis of lumbar spinal stenosis. The outcome of the CT scan can help compile physiological evidence that the patient has lumbar spinal stenosis, and that the patient may potentially benefit from a laminotomy to improve his or her quality of life.
251:
162:
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typically require less time because bone is removed from only one lamina, whereas bilateral laminotomies usually take more time because bone is removed from both laminae. The level of the vertebrae that the laminotomy is performed on and what instrument is used produce no significant differences in the length of the procedure. Both unilateral and bilateral laminotomies are performed in a shorter time period compared to a conventional
154:
363:
46:
489:. Stenosis is classified as a decaying disease because it causes the canal to gradually become more and more narrow which can cause pain or loss of function. Common symptoms of lumbar stenosis are pain, fatigue, weakness of the muscle and numbness. Stenosis can be caused by old age or an injury to the vertebral column and usually requires a
694:
Spinal microsurgery is a minimally invasive unilateral laminotomy used to correct bilateral lumbar spinal compression. Spinal microsurgery is the most common and effective microsurgical decompression treatment for patients who present with moderate to severe spinal stenosis. Spinal microsurgeries are
448:
to perform a second laminotomy. The incision for this procedure is smaller because doctors need only access one lamina yet can perform a bilateral laminotomy—remove bone from both lamina of a single vertebra. The unilateral laminotomy with bilateral spinal decompression procedure was developed almost
659:
was removed, the ligamentum flavum did not appear to be a factor in the change in the dimensions of the spinal canal. By understanding the magnitude of the role that ligamentum flavum hypertrophy plays in lumbar sacral stenosis, the necessity of an invasive lumbar spinal procedure can be accurately
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Other than static imaging processes, a CT scan can also be used for observing changes in spinal canal features before and after a laminotomy. One of the main signs of lumbar spinal stenosis is the thickening of the ligamentum flavum, causing it to expand towards the spinal canal. When observing the
559:
Historically, laminectomies have been the primary way to treat lumbar spinal stenosis. A laminectomy is a more invasive method with the aim to decrease the total amount of pain and numbness associated with lumbar spinal stenosis. It is a surgery that eliminates the entire lamina to allow the nerves
671:
are a more common alternative due to the decreased risk of damaging significant muscle tissue. The difference between invasive and minimally invasive spinal surgeries is that minimally invasive procedures involves a series of small incisions. Minimally invasive procedures can be performed anywhere
613:
MRI machines are being utilized due to the increased vascular imaging capabilities. Better resolution capacity allows for more detailed observations by the healthcare provider. The sharp contrast of the high power MRI outlines details in the vertebra that are critical when examining a patient with
526:
The laminotomy procedure has many benefits as to why it is a preferred spinal surgery since it is less invasive than other spinal procedures such as a laminectomy or a spinal fusion. Once a laminotomy procedure is done, patients have a great improvement in their pain and mobility. Laminotomies are
378:
and frequently require a hospital stay following the procedure—although the duration of the stay depends on the physical condition of the individual and their reason for having a laminotomy. A laminotomy takes about 70–85 minutes depending on the type of procedure used. Unilateral laminotomies
263:
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is not the most effective imaging technique when observing lumbar abnormalities, however it can supplement an MRI by detecting certain degenerative processes. When determining whether or not a laminotomy will be beneficial for the patient, a healthcare provider must assess the severity of the
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that must be relieved. In this procedure, the same spinal ligaments are kept intact and the paraspinous muscles must still be detached. A unilateral laminotomy is performed on one lamina of a vertebra. This removal of bone from one lamina provides an opening into the spinal canal. Using a
406:. In a unilateral laminotomy, these muscles are detached only from the side on which the laminotomy is being performed. During a bilateral laminotomy, these muscles must be removed on both sides of the vertebrae. The ligaments connecting the lamina of upper and lower vertebrae, known as
639:, which are some of the main pathophysiological changes indicative of lumbar spinal stenosis. Even though a CT scan can reveal these pertinent signs of lumbar spinal stenosis, it can sometimes give a cloudy image due to the shadowing of the tissue contrast. When this occurs, an
655:
cross sectional area of the spinal canal of a human cadaver, it was found that the area had decreased due to ligamentum flavum thickening. The ligamentum flavum did not appear to alter the dynamic alterations in the dimensions of the spinal cord. Even after the intervertebral
609:, it is recognized as the best type of imaging to observe signs associated with lumbar compression. The precise measurement of the diameter of the spinal canal is a particularly important component when determining the severity of the stenosis itself. High strength
353:
These classifications of laminotomies can be combined to form the most descriptive name for the procedure possible. For example, an endoscopic unilateral lumbar laminotomy is the removal of bone from only one lamina of a lumbar vertebrae using an endoscope.
707:. However, an endoscopic spine surgery can be performed to treat other spinal conditions, such as a herniated lumbar disc. Recovery time from this type of surgical treatment is often very quick, with patients ambulating within a few hours of the procedure.
517:
or problems with the blood vessels supplying the spinal cord. In any scenario where the inside of the spinal canal must be accessed or there is an increase in pressure in the spinal canal, laminotomy may be used to treat the disorder or alleviate symptoms.
418:
to have a visual of the procedure, a small surgical drill is used to remove a part of bone from one or both laminae of the vertebrae. Laminotomies can be performed on multiple vertebrae during the same surgery; this is known as a multi-level laminotomy.
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have always been the gold standard when treating lumbar spinal stenosis, but recently, less invasive surgeries have emerged as a safer alternative treatment that helps maintain the postoperative structural integrity of the spine.
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lumbar spinal stenosis who may need a laminotomy. MRI scanning post invasive surgery is used to see the quality of the surgery itself, yet the appropriate postoperative time elapsed before conducting an MRI is a debated topic.
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A slightly different, but commonly used procedure of laminotomy is the unilateral laminotomy for bilateral spinal decompression. This minimally invasive procedure is often used to treat patients with excessive pressure in the
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through these portals allows for surgeons to perform more efficient procedures. Minimally invasive procedures often yield a much faster recovery time than fully invasive surgeries, making them more appealing to patients.
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are typically inserted to assure that the spacer is held in place. The most common lumbar spinal fusion occurs between L4 and L5. A lumbar spinal fusion may be recommended when non-surgical treatment options for severe
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and cause intense pain and impaired sensation. Removing a portion of the lamina allows physicians to be able to access and repair the herniated disc. Laminotomies may also be used to treat intraspinal lesions such as
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and serve as attachment points for muscles and ligaments that stabilize the vertebral column. The lamina is the segment of bone that connects the spinous process to the transverse process. Each vertebra has two
1137:
809:
Overdevest GM, Jacobs W, Vleggeert-Lankamp C, Thomé C, Gunzburg R, Peul W (March 2015). "Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis".
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is composed of several anatomical features in addition to laminae that must be taken into account when performing a laminotomy. In the center of the vertebral arch is a bony projection called the
117:. As a result, laminotomies typically have a faster recovery time and result in fewer postoperative complications. Nevertheless, possible risks can occur during or after the procedure like
727:
are ineffective. A laminotomy would not be effective in this case, since this procedure is concerning a degenerated disc that needs to be removed in order to relieve certain symptoms.
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along the spine, and have been used to treat various abnormalities. The percutaneous pedicle screw fixation technique allows for a procedure that presents minimal risk to the patient.
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During a laminotomy, the individual lies on his or her stomach with the back facing up towards the physician. An initial incision is made down the middle of the back exposing the
1000:
Spetzger U, Von
Schilling A, Winkler G, Wahrburg J, König A (August 2013). "The past, present and future of minimally invasive spine surgery: a review and speculative outlook".
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Levy RM, Deer TR (December 2012). "Systematic safety review and meta-analysis of procedural experience using percutaneous access to treat symptomatic lumbar spinal stenosis".
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Since this procedure is a surgical technique there are many complications that can occur either during or after the surgery. Some major complications that can occur are
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vertebrae, which ultimately decreases the cross sectional area of the spinal canal. As an increase in the size of the L3 vertebrae occurs, pressure builds up on the
547:. Death is also a risk; however, it occurs only once per thousand surgeries. Other potential complications are nerve root damage, which can lead to nerve injury or
1123:
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to be compressed which can be very painful and can impair motor control and/or sensation. A common disorder that causes increased pressure in the spinal canal is
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performed with high magnification 3-D imaging of the fixated area of the spine, reducing the potential risk of harming the architecture of the spine itself.
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in order to magnify the area being operated on. The operating microscope is typically mounted to the surgery table and held over the area of operation
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US Navy Cmdr. Kenneth Kubis, director of surgical services aboard the
Military Sealift Command hospital ship USNS Mercy uses an operating microscope
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contrast is conducted with the CT scan to fix the abnormal contrast. A CT scan can also reveal an increase in the cross sectional area of the
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For radiographic imaging, an x-ray is the least effective way to collect information when observing a patient with lumbar spinal stenosis. A
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to diagnose. Performing a laminotomy can relieve pressure in the spinal canal caused by lumbar stenosis and therefore alleviate symptoms.
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This article is about the procedure to increase the size of an opening in a lamina. For the procedure to completely remove a lamina, see
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which is the region of bone on the back side of each vertebra that forms a protective covering for the back side of the spinal cord.
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Maus TP (July 2012). "Imaging of spinal stenosis: neurogenic intermittent claudication and cervical spondylotic myelopathy".
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Costandi S, Chopko B, Mekhail M, Dews T, Mekhail N (January 2015). "Lumbar spinal stenosis: therapeutic options review".
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involves fusing two vertebrae together using a spacer, and is intended to prohibit movement at that particular segment.
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Endoscopic spine surgeries can be used to treat thoracic lesions, and have been proven to be a much safer option than a
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90:
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203:(singular: lamina) are the anatomical structures of primary importance in a laminotomy. Laminae are part of the
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are often removed or remodeled in this procedure to adjust for the small amount of bone lost. Using either a
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are kept intact, but the muscles adjacent to the vertebral column known as the paraspinous muscles (example:
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The procedure of a laminotomy remains largely the same regardless of the instrument used, or the level of
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Different types of laminotomy are defined by the type of instrument used to visualize the procedure, what
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which are located on either side of the vertebral arch. Transverse processes come into contact with the
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303:, a small tube-shaped camera inserted into the patient in order to visualize the procedure internally.
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at any level of the vertebral column (cervical, thoracic, lumbar). A herniated disc can compress
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possible abnormalities. Out of all the potential reasons to have a laminotomy performed, lumbar
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McKinley, Michael; O'Loughlin, Valerie; Pennefather-O'Brian, Elizabeth; Harris, Ronald (2015).
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477:. Lumbar spinal stenosis is formally defined as a decline in diameter length of either the
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to visualize the procedure, surgical tools are inserted through this opening into the
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are often used pre- and post surgery to determine if the procedure was successful.
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attached to the spinous process intact and it requires removing less bone from the
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provides a 360-degree compiled view of the vertebrae that is more precise than an
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and across the spinal canal to reach the other lamina on the opposite side of the
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is the chief reason. CT scans are used specifically to pinpoint a buckled lumbar
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is removal of a part of the bone from both lamina of a single vertebra.
218:. The spinous process is located on the posterior or back side of the
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110:
504:. Laminotomies are frequently used as a way to surgically repair a
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on which the laminotomy will be performed. In this procedure, the
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177:. The vertebral column is composed of many ring-like bones called
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20 years ago and is a common successful surgical treatment for
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Laminotomies are also performed to create a window into the
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A laminotomy is typically used to relieve pressure from the
234:. Each vertebra has two lateral bony projections called the
440:. The surgical tools are then navigated underneath the
275:
the procedure is performed on, and whether or not both
129:. Laminotomies are commonly performed as treatment for
349:
is removal of a part of the bone from only one lamina.
465:. Excessive pressure in the spinal canal causes the
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operated on. Laminotomies require general or spinal
189:. Each vertebra has a hole in the center called the
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Endoscopic/Microendoscopic decompression laminotomy
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97:. A laminotomy is less invasive than conventional
402:) must be separated from the spinous process and
950:(4th ed.). McGraw Hill. pp. 204–213.
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593:MRI of the lumbar spine showing spinal stenosis
16:Surgical procedure to widen the vertebral canal
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173:is housed in a bony hollow tube called the
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181:(plural: vertebrae) and it spans from the
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1531:Anterior cruciate ligament reconstruction
664:Alternative minimally invasive procedures
383:which takes over 100 minutes on average.
287:Microscopic/Microdecompression laminotomy
1483:Ulnar collateral ligament reconstruction
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1043:
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313:vertebrae, the ones closest to the head.
752:
222:and serves as the attachment point for
35:
7:
93:in order to relieve pressure in the
1389:Autologous chondrocyte implantation
457:Reasons for performing a laminotomy
333:vertebrae, the ones closest to the
89:procedure that removes part of the
64:
1540:Unicompartmental knee arthroplasty
1384:Knee cartilage replacement therapy
1002:Minim Invasive Ther Allied Technol
14:
531:Risks and potential complications
1064:10.1111/j.1526-4637.2012.01504.x
230:which support and stabilize the
1648:Orthopedic surgical procedures
820:10.1002/14651858.CD010036.pub2
601:provides excellent imaging of
1:
669:Minimally invasive procedures
555:Laminotomy versus laminectomy
1014:10.3109/13645706.2013.821414
282:Common types of laminotomy:
101:surgery techniques, such as
1653:Surgical removal procedures
366:Featured: Ligamentum Flavum
50:Surgery on Vertebral Column
1669:
1372:Articular cartilage repair
812:Cochrane Database Syst Rev
91:lamina of a vertebral arch
25:
18:
1155:
1099:10.1016/j.rcl.2012.04.007
725:degenerative disc disease
537:cerebrospinal fluid leaks
394:and the ligaments of the
65:
43:
1498:Finger joint replacement
1289:Distraction osteogenesis
699:Endoscopic spine surgery
254:Vertebral Column: Lamina
641:intrathecal myelography
105:because it leaves more
1279:Femoral head ostectomy
1247:Vertebral augmentation
594:
506:spinal disc herniation
475:lumbar spinal stenosis
451:lumbar spinal stenosis
367:
268:
255:
166:
165:Vertebra Superior View
158:
157:Human Vertebral Column
131:lumbar spinal stenosis
1476:Weaver–Dunn procedure
1377:Microfracture surgery
1146:Procedures involving
592:
365:
347:Unilateral laminotomy
266:
253:
164:
156:
1466:Shoulder replacement
1428:Intervertebral discs
1186:Orthognathic surgery
1087:Radiol Clin North Am
564:Radiographic imaging
341:Bilateral laminotomy
236:transverse processes
28:Spinal decompression
1618:Arthroscopic lavage
1350:Tension band wiring
690:Spinal microsurgery
323:(middle) vertebrae.
317:Thoracic laminotomy
307:Cervical laminotomy
1560:Triple arthrodesis
1555:Broström procedure
1493:Brunelli procedure
1294:Ilizarov apparatus
1242:Vertebral fixation
1158:Orthopedic surgery
906:10.1111/papr.12188
595:
545:epidural hematomas
368:
289:uses an operating
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193:through which the
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1629:
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1596:Joint replacement
1550:Ankle replacement
1358:
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1345:External fixation
1340:Internal fixation
1191:Chin augmentation
957:978-0-07-352573-0
678:guided navigation
635:as well as facet
633:ligamentum flavum
327:Lumbar laminotomy
191:vertebral foramen
76:
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1536:Knee replacement
1461:Shoulder surgery
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543:, infection, or
425:vertebral column
396:vertebral column
329:is performed on
319:is performed on
309:is performed on
232:vertebral column
175:vertebral column
149:Anatomy overview
99:vertebral column
69:edit on Wikidata
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1058:(12): 1554–61.
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890:
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814:(3): CD010036.
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742:Spinal stenosis
733:
713:
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629:spinal stenosis
620:
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479:neural foramina
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408:Ligamenta flava
400:spinalis muscle
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135:herniated disks
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1093:(4): 651–679.
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1008:(4): 227–241.
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1421:Spinal fusion
1419:
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1263:Acromioplasty
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948:Human Anatomy
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716:Spinal fusion
711:Spinal fusion
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689:
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683:Laminectomies
679:
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617:
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591:
584:
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563:
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546:
542:
538:
530:
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519:
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510:spinal nerves
507:
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471:spinal nerves
468:
464:
456:
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87:neurosurgical
85:
81:
70:
60:
58:
54:
47:
42:
37:
33:
29:
22:
1643:Neurosurgery
1600:
1581:Arthroplasty
1545:Ankle fusion
1488:Hand surgery
1443:Arthroplasty
1438:Annuloplasty
1237:Foraminotomy
1222:Laminoplasty
1211:
1207:Coccygectomy
1090:
1086:
1080:
1055:
1051:
1005:
1001:
947:
900:(1): 68–81.
897:
893:
811:
714:
702:
693:
674:Fluoroscopic
667:
653:
649:cauda equina
621:
596:
572:
558:
534:
525:
515:spinal tumor
502:spinal canal
499:
487:spinal canal
467:spinal canal
463:spinal canal
460:
438:spinal canal
421:
385:
369:
352:
346:
340:
326:
316:
306:
296:
286:
281:
270:
209:
199:
168:
79:
77:
61:neurosurgeon
32:Foraminotomy
1591:Arthroscopy
1586:Synovectomy
1416:Arthrodesis
1232:Facetectomy
1217:Laminectomy
737:Laminectomy
705:thoracotomy
637:hypertrophy
541:dural tears
381:laminectomy
197:traverses.
195:spinal cord
171:spinal cord
127:dural tears
103:laminectomy
84:orthopaedic
21:Laminectomy
1637:Categories
1606:Arthrogram
1576:Arthrotomy
1433:Discectomy
1227:Corpectomy
1212:Laminotomy
1150:and joints
894:Pain Pract
748:References
660:measured.
549:paraplegia
430:microscope
412:microscope
376:anesthesia
291:microscope
80:laminotomy
39:Laminotomy
26:See also:
1364:Cartilage
1335:Reduction
1325:Osteotomy
1315:Ostectomy
597:Since an
434:endoscope
416:endoscope
388:vertebrae
372:vertebrae
358:Procedure
301:endoscope
224:ligaments
123:hematomas
119:infection
107:ligaments
57:Specialty
1601:imaging:
1107:22643390
1072:23136978
1052:Pain Med
1022:23964794
914:24725422
828:25760812
731:See also
618:CT scans
522:Benefits
446:vertebra
321:thoracic
311:cervical
299:uses an
273:vertebra
220:vertebra
179:vertebra
143:CT scans
115:vertebra
1569:General
1308:General
624:CT scan
611:3-Tesla
607:tissues
575:CT scan
491:CT scan
228:muscles
201:Laminae
185:to the
111:muscles
1399:Joints
1105:
1070:
1020:
954:
912:
826:
720:Screws
676:image
569:X-Rays
432:or an
414:or an
335:sacrum
331:lumbar
277:lamina
245:lamina
187:sacrum
125:, and
82:is an
1408:Spine
1200:Spine
1166:Bones
1148:bones
579:x-ray
485:, or
259:Types
183:skull
67:[
1174:Face
1103:PMID
1068:PMID
1018:PMID
952:ISBN
910:PMID
824:PMID
657:disc
605:and
469:and
240:ribs
226:and
210:The
169:The
141:and
133:and
109:and
30:and
1509:Leg
1454:Arm
1272:Leg
1256:Arm
1095:doi
1060:doi
1010:doi
902:doi
816:doi
599:MRI
585:MRI
495:MRI
493:or
139:MRI
1639::
1101:.
1091:50
1089:.
1066:.
1056:13
1054:.
1030:^
1016:.
1006:22
1004:.
966:^
922:^
908:.
898:15
896:.
836:^
822:.
755:^
645:L3
622:A
581:.
539:,
481:,
453:.
137:.
121:,
78:A
1538:/
1139:e
1132:t
1125:v
1109:.
1097::
1074:.
1062::
1024:.
1012::
960:.
916:.
904::
830:.
818::
337:.
71:]
23:.
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