Laminotomy and Laminoplasty
Laminotomy is a procedure performed from the posterior of the spine in order to remove part of the lamina and the ligamentum flavum covering the spinal canal. In a laminectomy a large amount of the backbone is removed and fusion is often required to keep the spine stable and prevent slippage or abnormal curvature. Laminotomy and laminoplasty are back surgeries that achieve decompression without significantly compromising spinal stability. In essence a laminotomy opens a ‘window’ in the backbone, and a laminoplasty creates a hinge in the back bone to create more space for spinal nerves and the spinal cord itself.
Patients who may undergo a laminotomy or a laminoplasty in order to decompress the spine include those suffering from:
An open procedure may be used to allow full visual access to the spine, but it is not necessary in many cases as minimally invasive spine surgery can often be performed. In a microsurgical laminotomy the surgeon will use a series of tubular retractors to create a tunnel through a small incision down to the lamina. Small, specialized surgical instruments will then be passed through the tube and used to excise a portion of the backbone in order to create more space for the inner structures of the spinal canal. Laminoplasty involves the cutting of one side of the lamina and creating a hinge, using plates, or connecting material, to increase space in the spinal column. These two procedures can be very effective at relieving pressure on the spinal cord and pinched spinal nerves and are preferable to a full laminectomy as they can preserve the rigidity of the spine. A full laminectomy may be necessary in some cases however in order to operate at several vertebral levels, to remove significant degenerated disc material and/or osteophytes, and is commonly followed by spinal fusion.
If a patient has existing spinal curvature then a laminotomy or laminoplasty is more likely than a laminectomy in order to reduce the risk of further degeneration. Laminotomy and laminoplasty can provide significant relief from neck pain and alleviate back pain. Symptoms of radiculopathy, paraesthesia, weakness, numbness, and discomfort may be relieved fairly swiftly as the pressure on the nerves and cord is removed. Minimally invasive procedures have a shorter recovery period as they inflict less trauma on surrounding tissues, and most patients leave the hospital on the same day as their surgery or within a day or two. Patients undergoing and open procedure may take a little longer to recover and should expect to be away from work for a couple of weeks or more (particularly if working in a physically demanding profession).
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