Laminotomy

Laminotomy is a surgical procedure performed to relieve spinal cord and/or nerve root compression.  To help you understand the term, let’s separate laminotomy into two: lamina and otomy.

• Lamina – Located at the back of the spine, the lamina are thin bony plates between each facet joint in the cervical (neck), thoracic (mid back), and lumbar (low back) spine. The laminar plates are part of the bony wall that covers and protects the spinal canal. Within the spinal canal are the spinal cord and nerve rootlets.
• Otomy means to partially remove

Your spinous processes are bones that project off the back of your spine. You can feel the end of most of your spinous processes by moving your hand up or down your spine.

Purpose

The purpose of a laminotomy is to decompress-take pressure off the spinal cord and nerve roots.  During a laminotomy, part of the lamina is removed to open the spinal canal and access the spinal cord and nerve roots. A laminotomy allows your neurosurgeon to access your spine from behind; your posterior side.

• A laminotomy may be part of another surgical procedure called a discectomy. Sometimes a herniated disc encroaches into the spinal canal and presses on the spinal cord and nerve roots.
• Degenerative spinal disorders may contribute to thickening of spinal ligaments. The ligamentum flavum is a yellow ligament that vertically connects your spinal column. Thickening of this ligament can cause it to buckle and press on the spinal cord and nerve roots.

Causes of spinal cord and/or nerve root compression includes:

• Cervical spinal stenosis
• Cervical herniated disc
• Cervical radiculopathy
• Degenerative disc disease
• Lumbar herniated disc
• Lumbar spinal stenosis
• Spondylosis
• Tumor, infection (uncommon)

Before your procedure

Well in advance of your surgery day, your neurosurgeon explains how he performs your procedure.  During the discussion, you learn if your procedure can be performed as a minimally invasive spine surgery or open approach, and why.

Before surgery, you visit your primary care doctor or general practitioner to obtain a general health clearance. This means your doctor has carefully evaluated your health in terms of undergoing surgery.  Your assessment may include blood tests, x-rays or other imaging studies, as well as special tests for existing medical problems (i.e., diabetes, heart disease).

Of course, the potential benefits of the surgery are important to know, but so are the possible risks and complications. Your risks and complications may be different from those of another patient because you are unique. Your neurosurgeon takes that into serious consideration and thoughtfully explains potential risks to you, which may include infection, bleeding, reaction to anesthesia, and nerve damage.

About the procedure

Laminotomy is performed under general anesthesia. Throughout your procedure, the neurosurgeon and his surgical team are consistently fed information about your vital functions, including your central nervous system. Many different gauges, monitors, and equipment provide visual and audio feedback to the surgical team. Image guidance (real time x-ray; fluoroscopy) allows your neurosurgeon to see other views of the surgical field during (intra-operative) your procedure.

Basic surgical steps

• You are positioned face down on a padded operating table
• Real time x-rays are taken to confirm the spinal level
• Your neurosurgeon makes an incision over the spinal level
• Muscle and other soft tissues are gently pulled aside to expose the lamina*
• Part of the laminar plate is removed to expose the spinal cord and nerve roots
• The spinal cord and nerves roots are decompressed
• The incision is closed

*This is typical of a minimally invasive surgical technique wherein muscles and soft tissues are not cut.  Your surgical procedure may involve a different technique.

After surgery

You are moved from the operating room into the recovery area. Here, the nurses and medical staff closely monitor your vital signs with attention to managing post-operative pain. You should expect some discomfort. You may have pain at the incision site, occasional neck or back muscle spasms, or other symptoms. When you wake up, you may be wearing either a cervical or lumbar brace-depending on whether you had neck or back surgery.

Post-operative care

Your surgery is over, but now your recovery starts! If you do not understand your post-surgical instructions or a problem develops, please call us-we are here to help you.

Conventional post-spine surgery instructions

• Schedule your post-operative appointment call (281) 446-3876
• If prescribed, wear your brace as instructed
• Keep your incision dry and clean
• You may shower, but keep your incision covered and dry
• Rest; you will fatigue easily while your body heals
• Do not take a tub bath, go swimming, or sit in a hot tub or pool
• Begin physical therapy and/or exercise as instructed
• Take medications as prescribed
• Do not lift or carry anything heavier than a shoe
• Short periods of walking are encouraged
• Do not drive until cleared by your neurosurgeon
• Avoid riding in a car; short distances are permitted
• Do not smoke or use tobacco
• Eat well, your body needs nutritious food to heal

Call your neurosurgeon’s office (281) 446-3876

• Fever 101 degrees Fahrenheit or higher
• Redness and/or swelling around the incision site expands
• Change in the amount, odor or appearance of the incision drainage
• Incision pain increases
• Bowel or bladder dysfunction develops
• Genital area numbness develops

Next steps

We hope this information about laminotomy has answered your immediate questions. Remember, your doctor is your most valuable source to answer your questions about symptoms and your healthcare.