Laminotomy versus Laminectomy

Two types of spinal decompression surgeries may relieve your nerve pain related to a spinal disorder.

Laminectomy and laminotomy are two types of spinal decompression surgeries involving your spine’s lamina. The lamina is a bony protective covering at the back of your spinal canal. The difference between laminectomy and laminotomy is straightforward: A laminectomy is the total removal of the lamina; a laminotomy is the partial removal of the lamina. Your spine surgeon may choose one of these procedures to gain access to a compressed nerve that is causing neck or back pain and/or other nerve-related symptoms.
Spinal column structures labeledThe location of the spine’s lamina in the cervical, thoracic and lumbar regions of the spine is illustrated in this drawing. Photo Source: Shutterstock.

Different Methods, Same Intent: The Goal of Decompression Surgery

Though your surgeon has reasons for performing a laminectomy over a laminotomy (and vice versa), the overarching goal is the same regardless which procedure is performed: to create space around the spinal cord and surrounding spinal nerves by removing the compressing structure(s).

  • In some cases, a laminectomy or laminotomy is performed because the lamina itself is compressing your nerves and/or spinal cord.
  • In other cases, your surgeon may need to remove parts of your lamina so that he or she can access other parts of your spine. For example, removing the lamina may allow your surgeon a clearer view at a herniated disc.

When the spinal cord and/or nerve are compressed, you may experience neurological symptoms (eg, numbness, weakness, tingling, electric shock-like sensations). By freeing up the impinged neural structures, your symptoms may subside.
Gloved hand holding a scalpel and computer imagery of the thoracic spine.Surgeon preparing to begin spine surgery by making the first incision. Photo Source:

Laminectomy and Laminotomy: What to Expect During Surgery

Laminectomies and laminotomies are performed using a posterior approach—that is, you will be lying face down during the procedure.

The surgeon will begin by making an incision near the affected spinal level. Once the incision has been made, a retractor will move your skin, fat, and muscles to the side so your surgeon can access your spine.

Your surgeon will then perform a laminectomy or laminotomy, using a great deal of caution to avoid damaging the nerves or the spinal cord. In addition to carefully removing all or part of your lamina, your surgeon may remove all or part of a herniated disc, or bone spurs causing nerve compression.

Your surgeon may then perform other procedures, such as a foraminotomy or spinal fusion, before closing the incision area.

Other Spine Procedures Performed with Laminectomy and Laminotomy

In most cases, laminectomies and laminotomies are not performed together. However, your surgeon may perform both if your surgery affects multiple levels of your spine.

A laminectomy or laminotomy may be combined with other spine surgeries, including:

  • Foraminotomy: Like laminectomy and laminotomy, a foraminotomy is a decompression procedure. But instead of the removing part or all the lamina, the surgeon accesses the nerves through the spine’s foramen (the passageway that nerves pass through on both sides of each intervertebral disc).
  • Discectomy: This common herniated disc decompression surgery involves the removal of all or part of the damaged intervertebral disc.
  • Spinal fusion: Fusion with supporting spinal implants is often performed after decompression procedures, as the space created by removing a spinal structure(s) may introduce instability to the spine.

Laminectomy and Laminotomy: Minimally Invasive and Outpatient Options

Laminectomies and laminotomies have long been performed in a traditional, open way, but advances in spine surgery have made minimally invasive approaches for these procedures a reality.

Minimally invasive laminectomy and laminotomy are known as microlaminectomy and microlaminotomy. Like all types of minimally invasive spine surgery, microlaminectomy and microlaminotomy boast smaller incisions, less cutting/trauma to your muscles and tissues, and quicker recovery times.

Additionally, both procedures may be performed in an outpatient surgical setting, such as an ambulatory surgery center. Outpatient spine surgery offers comfort and convenience. From start to finish, a minimally invasive lumbar laminectomy in an outpatient spine center takes about 45 minutes.

Minimally invasive spine surgery isn’t an option for everyone, and your specific spinal disorder and health status will help your doctor determine if it’s the right choice for you. If your doctor has recommended laminectomy or laminotomy for your back pain, ask if you are a candidate for a minimally invasive approach performed in an outpatient setting.

Will Laminectomy or Laminotomy Treat My Spinal Disorder

Several spinal conditions may be surgically treated by laminectomy or laminotomy, including spinal stenosis, herniated disc, sciatica, degenerative disc disease, and spondylosis (also called spinal osteoarthritis).

While these and other spinal problems may be alleviated by laminectomy and laminotomy, most back and neck disorders can be well managed with non-surgical treatments (such as medications or physical therapy). Because of this, your doctor may recommend you try a variety of those therapies first before considering spine surgery.

If you are a candidate for laminectomy or laminotomy, talk to your doctor about the risks and benefits of the procedure for you. Among the best things you can do prior to undergoing spine surgery is to ask your surgeon questions about the procedure. Clear expectations lead to better recoveries—the conversations you have before surgery will pay off after.

Updated on: 04/27/20
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