Mark W. McFarland, DO
Some spine conditions can put pressure on spinal nerves and/or the spinal cord. This pressure or compression can result in pain, numbness, limb weakness and lack of function and/or balance. If left untreated, permanent nerve damage may occur. Common medical conditions at fault are:
- Degenerative disc disease
- Spondylosis (osteoarthritis of the spine)
- Ankylosing Spondylitis
- Bulging or Herniated discs
- Spinal Stenosis
- Bone spurs (Osteophytes)
Laminotomy and Laminectomy are surgical procedures performed on the spine to relieve pain and dysfunction. They are known as decompression procedures. Although these two terms are often used interchangeably and there are many similarities, there are some differences and I will discuss both in this article.
There are clues to the differences between the procedures in the terminology. Both include the word lamina – which is the thin bony covering across the back of the vertebrae that protects the spinal cord, nerves and arteries. Ectomy – means “to remove”. Otomy – means “cutting into or incising”. So, laminectomy means to remove or partially remove the lamina, which may also include removal of a portion of the facet joint as well as enlarged, thickened ligaments. Laminotomy means to create an opening in the lamina by removing a portion of it and also the removal of the thickened spinal ligament. This usually happens on one side or the other, but can be done on both sides.
Both minimally-invasive procedures are performed on an outpatient basis under general anesthesia in a hospital or ambulatory surgery center. Both require that the patient be positioned face down and a mid-line incision is made over the area of the spine which needs decompression. I will access the spine by lifting any soft tissues out of the way and removing the muscle attachments to the spine. Paying careful attention to the spinal nerves and spinal cord, I will make cuts to remove the lamina or make an opening in the lamina to relieve the pressure on the nerve root and/or spinal cord. I can also go in and clean up any bone spurs or pieces of disc material that may be causing inflammation.
Laminotomy is:
- A smaller surgery – the lamina is not fully removed
- Does not cause/exacerbate instability
Laminectomy is:
- A bigger surgery – the lamina is removed on one or both sides
- Can cause or exacerbate instability
- Is often accompanied by a spinal fusion or the insertion of a spacer or cage
Both procedures are considered quite safe and effective, but as with any surgery, carry risks for complications, such as bleeding, infection, nerve damage or dural puncture.
Patients usually are discharged a few hours after surgery to recover at home, with pain medication to manage discomfort. Their incision should be kept clean and dry. Walking is encouraged to help the recovery process, though patients will be asked to rest and limit activities, with no lifting, bending or stooping for about six weeks. Those who have had a fusion will need to wear their back brace while sitting, standing or walking.
In about two weeks, patients return to see me for a follow-up visit, to have staples or sutures removed and to see how they are progressing. Full recovery may take anywhere from a few weeks to few months, depending on the scope of the procedure. I may recommend Physical Therapy to help patients recover strength and mobility. It may take several weeks for the patient to report significant pain relief, due to post-surgical discomfort and the normal healing process.
Pain can be relieved and function restored by either a laminectomy or laminotomy. It is important to consult with a fellowship trained spine specialist about which procedure is appropriate for your spine condition.