A laminotomy is an orthopaedic neurosurgical procedure that removes part of the lamina of a vertebral arch in order to relieve pressure in the vertebral canal. A laminotomy is less invasive than conventional vertebral column surgery techniques, such as laminectomy because it leaves more ligaments and muscles attached to the spinous process intact and it requires removing less bone from the vertebra. 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 infection, hematomas, and dural tears. Laminotomies are commonly performed as treatment for lumbar spinal stenosis and herniated disks. MRI and CT scans are often used pre- and post surgery to determine if the procedure was successful.
Anatomy overview
The spinal cord is housed in a bony hollow tube called the vertebral column. The vertebral column is composed of many ring-like bones called vertebra (plural: vertebrae) and it spans from the skull to the sacrum. Each vertebra has a hole in the center called the vertebral foramen through which the spinal cord traverses. Laminae (singular: lamina) are the anatomical structures of primary importance in a laminotomy. Laminae are part of the vertebral arch 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. The vertebral arch 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 spinous process. The spinous process is located on the posterior or back side of the vertebra and serves as the attachment point for ligaments and muscles which support and stabilize the vertebral column. Each vertebra has two lateral bony projections called the transverse processes which are located on either side of the vertebral arch. Transverse processes come into contact with the ribs 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 lamina, one on each side of the spinous process.
Types
Different types of laminotomy are defined by the type of instrument used to visualize the procedure, what vertebra the procedure is performed on, and whether or not both lamina of a vertebra are operated on or just one.G Common types of laminotomy:
Microscopic/Microdecompression laminotomy uses an operating microscope 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 Endoscopic/Microendoscopic decompression laminotomy uses an endoscope, a small tube-shaped camera inserted into the patient in order to visualize the procedure internally. Cervical laminotomy is performed on cervical vertebrae, the ones closest to the head. Thoracic laminotomy is performed on thoracic (middle) vertebrae. Lumbar laminotomy is performed on lumbar vertebrae, the ones closest to the sacrum. Bilateral laminotomy is removal of a part of the bone from both lamina of a single vertebra. Unilateral laminotomy is removal of a part of the bone from only one lamina. 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.
Procedure
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