Laminotomy
Laminotomy | |
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Specialty | neurosurgeon |
A laminotomy is an
Anatomy overview
The spinal cord is housed in a bony hollow tube called the vertebral column.[3] 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.[3]
The
Types
Different types of laminotomy are defined by the type of instrument used to visualize the procedure, what
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[1]
- Endoscopic/Microendoscopic decompression laminotomy uses an endoscope,[1] 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.[3]
- Thoracic laminotomy is performed on thoracic (middle) vertebrae.[3]
- Lumbar laminotomy is performed on lumbar vertebrae, the ones closest to the sacrum.[3]
- Bilateral laminotomy is removal of a part of the bone from both lamina of a single vertebra.[1]
- Unilateral laminotomy is removal of a part of the bone from only one lamina.[1]
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.[1]
Procedure
The procedure of a laminotomy remains largely the same regardless of the instrument used, or the level of vertebrae operated on. Laminotomies require general or spinal anesthesia and frequently require a hospital stay following the procedure—although the duration of the stay depends on the physical condition of the individual and their reason for having a laminotomy.[1][2] A laminotomy takes about 70–85 minutes depending on the type of procedure used.[1] Unilateral laminotomies typically require less time because bone is removed from only one lamina, whereas bilateral laminotomies usually take more time because bone is removed from both laminae. The level of the vertebrae that the laminotomy is performed on and what instrument is used produce no significant differences in the length of the procedure.[1] Both unilateral and bilateral laminotomies are performed in a shorter time period compared to a conventional laminectomy which takes over 100 minutes on average.[1]
During a laminotomy, the individual lies on his or her stomach with the back facing up towards the physician.
A slightly different, but commonly used procedure of laminotomy is the unilateral laminotomy for bilateral spinal decompression.
Reasons for performing a laminotomy
A laminotomy is typically used to relieve pressure from the
Laminotomies are also performed to create a window into the spinal canal.[2] Laminotomies are frequently used as a way to surgically repair a spinal disc herniation at any level of the vertebral column (cervical, thoracic, lumbar).[1] A herniated disc can compress spinal nerves and cause intense pain and impaired sensation.[4] Removing a portion of the lamina allows physicians to be able to access and repair the herniated disc. Laminotomies may also be used to treat intraspinal lesions such as spinal tumor or problems with the blood vessels supplying the spinal cord.[4] In any scenario where the inside of the spinal canal must be accessed or there is an increase in pressure in the spinal canal, laminotomy may be used to treat the disorder or alleviate symptoms.[1]
Benefits
The laminotomy procedure has many benefits as to why it is a preferred spinal surgery since it is less invasive than other spinal procedures such as a laminectomy or a spinal fusion.[2] Once a laminotomy procedure is done, patients have a great improvement in their pain and mobility.[2] Laminotomies are usually safer than other surgeries that are open or invasive.[2] This surgery usually is shorter than other spinal decompression procedures by having an average duration of 70–85 minutes, whereas other decompression surgeries can have a duration anywhere from 90 to 109 minutes. Laminotomies are usually more cost efficient than other surgical decompression surgeries. In 2007, it was seen that laminotomies were around $10,000, whereas other surgical procedures were around $24,000.[2] Smaller skin incisions and scarring as well as less surgical trauma are also a benefit of laminotomy.[4] With this procedure there is usually a faster recovery time, and a shorter hospital stay if one is necessary at all.[4] During the surgery there is also a benefit of minimizing the injury to muscles, ligaments, and bones in the spine since more invasive surgeries have a greater risk of damaging them.[4] General anesthesia is usually required, but postoperative spinal instability is typically limited.[4]
Risks and potential complications
Since this procedure is a surgical technique there are many complications that can occur either during or after the surgery. Some major complications that can occur are
Laminotomy versus laminectomy
Historically, laminectomies have been the primary way to treat lumbar spinal stenosis.[5] A laminectomy is a more invasive method with the aim to decrease the total amount of pain and numbness associated with lumbar spinal stenosis.[2] It is a surgery that eliminates the entire lamina to allow the nerves around this region to function properly.[2] Laminectomies also often produce a longer recovery time as well as a greater risk for post-operative complications. There is typically more damage to the surrounding muscle tissue accompanied by a laminectomy.[5] Since a laminectomy involves the excision of the entire lamina, a laminectomy will usually cause more spinal instability than a laminotomy.[5] When going with the option of laminotomy, the procedure reduces the total amount of muscle severed. Because a laminotomy does not damage the spinous process and critical ligaments, there is not as much muscle weakness, pain, and lumbar instability seen with laminectomies.[4] Laminotomies are fairly new compared to laminectomies, and it involves using less invasive methods with precise instruments to minimize the risk of tissue damage.[5]
Radiographic imaging
X-Rays
For radiographic imaging, an x-ray is the least effective way to collect information when observing a patient with lumbar spinal stenosis. A CT scan provides a 360-degree compiled view of the vertebrae that is more precise than an x-ray.[2]
MRI
Since an
CT scans
A
Other than static imaging processes, a CT scan can also be used for observing changes in spinal canal features before and after a laminotomy. One of the main signs of lumbar spinal stenosis is the thickening of the ligamentum flavum, causing it to expand towards the spinal canal.
Alternative minimally invasive procedures
Spinal microsurgery
Spinal microsurgery is a minimally invasive unilateral laminotomy used to correct bilateral lumbar spinal compression. Spinal microsurgery is the most common and effective microsurgical decompression treatment for patients who present with moderate to severe spinal stenosis.[4] Spinal microsurgeries are performed with high magnification 3-D imaging of the fixated area of the spine, reducing the potential risk of harming the architecture of the spine itself.
Endoscopic spine surgery
Endoscopic spine surgeries can be used to treat thoracic lesions, and have been proven to be a much safer option than a thoracotomy. However, an endoscopic spine surgery can be performed to treat other spinal conditions, such as a herniated lumbar disc.[4] Recovery time from this type of surgical treatment is often very quick, with patients ambulating within a few hours of the procedure.[2]
Spinal fusion
Spinal fusion involves fusing two vertebrae together using a spacer, and is intended to prohibit movement at that particular segment. Screws are typically inserted to assure that the spacer is held in place. The most common lumbar spinal fusion occurs between L4 and L5.[4] A lumbar spinal fusion may be recommended when non-surgical treatment options for severe degenerative disc disease are ineffective. A laminotomy would not be effective in this case, since this procedure is concerning a degenerated disc that needs to be removed in order to relieve certain symptoms.[2]
See also
References
- ^ —via Web of Science.
- ^ —via Web of Science.
- ^ ISBN 9780073525730.
- ^ a b c d e f g h i j k l m n o Spetzger, Uwe; Von Scilling, Andrej; Winkler, Gerd; Wahrburg, Jürgen; König, Alexander (2013). "The past, present and future of minimally invasive spine surgery: A review and speculative outlook". Minimally Invasive Therapy & Allied Technologies. 22 (4): 227–241—via Web of Science.
- ^ a b c d e f g h Levy, Robert; Deer, Timothy (2012). "Systematic Safety review and Meta-Analysis of Procedural Experience Using Percutaneous Access to Treat Symptomatic Lumbar Spinal Stenosis". Pain Medicine. 13: 1554–1561—via Web of Science.
- PMID 22643390.