Spinal Stenosis Laminotomy
For spinal stenosis treatment, the laminotomy, like the laminectomy, is designed to decompress the spinal canal and nerves. In the laminectomy the lamina in removed completely from the vertebra. In the laminotomy, only a portion of the lamina is cut and extracted. This is beneficial because the natural support of the lamina is left in place, increasing post operative stability and recovery. At the same time, the removal of part of the lamina creates more space for the spinal canal and nerves, successfully decompressing.
The most advanced form of this surgery, Microendoscopic decompressive laminotomy (MEDL), uses specialized surgical tools to minimize the damage to adjacent tissues and bone structures while still accomplishing the same decompression as an open laminotomy. The surgeon uses a tool that allows them to see inside the patient on a viewing screen, instead of having to create a large enough opening to see the operative areas with their own eyes. This minimally invasive surgery technique makes for a much smaller incision, and less damage to surrounding muscle groups. Also, in a small study (due to the relative young age of the operation), it was found to signifigantly reduce blood loss, postoperative stay, and pain medication.51
One attractive aspect of the laminotomy is that if the patient is healthy, it’s possible to leave the hospital within twenty four hours, or in other words, it can be an outpatient surgical procedure.
Patients to undergo a laminotomy should meet all the selection criteria as a patient for a laminectomy.
MEDL can also treat patients with:
- Symptoms of radiculopathy from either foraminal stenosis or disc herniation.
Patient should NOT undergo MEDL if they have evidence of:
- Lumbar instability
- Severe Deformity
- Severe Spondylolisthesis
- CSF fistula
- Cauda equina syndrome
The risks for a laminotomy are generally the same as those in a laminectomy.
Laminotomy Success Rates
The success rate of the laminotomy, in one controlled study involving both the open lanimotomy and MEDL, is good. The MEDL reported a symptomatic improvement rate of 84% for back pain, 90% for leg pain, and 96% improvement for stride limitation. The open laminotomy had a symptomatic improvement rate of 72% for back pain, 86% leg pain, and 88% improvement for stride limitation.51 Other studies report similar success rates of 79-85% after a two year follow-up examination of open laminotomies. 52
The advantage of the laminotomy over the laminectomy is that not as much bone is removed, leaving in more natural support then the laminectomy leaves. The MEDL is a greater improvement still with 30% less blood loss, half as long as a stay in the hospital, and three times less narcotics use.51