Spinal Surgeries: Laminotomy versus Laminectomy

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

Peer Reviewed

The Universal Guide to Laminectomies: Everything you ever wanted to know, straight from the experts.

In This Article: Reasons for Decompression Surgery   |    Laminectomy Basics   |    Laminectomy Procedure   |    Candidates for Laminectomies and Laminotomies   |    Recovery   |    FAQs

“I need some space.”

You’ve probably said it to someone—spouse, parents, kids, coworkers—and they’ve probably said it to you (and if we’re talking the Covid-19 pandemic, you’ve definitely said it to someone!). But sometimes, back pain or sciatica is your nerve roots screaming, “I need some space!”

How do you let your nerves decompress, so to speak? Well, a spinal decompression surgery.

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.

There are two types: A laminectomy or laminotomy. .Both  involve your vertebrae’s lamina, an arch of bone that protects your spinal canal. In laminectomy, the lamina is removed in nearly its entirely. In laminotomy, it’s a partial removal.

Whole or partial, removing the lamina sounds scary, but it’s not. The large, powerful muscles of the back provide quite adequate protection for the nerves below. So your spinal nerves will remain safe and secure following laminectomy. It’s also more common than you think—especially if you’re north of 60.

Which one is right for you? It depends on your situation. Josh Ammerman, MD, a neurosurgeon at Washington Neurological Associates in Washington, DC, explains, “Laminectomy is usually performed to treat an arthritic condition of the spinal canal such as spinal stenosis. Laminotomy is used almost exclusively to enter the spinal canal to remove a herniated disc. Laminectomy and laminectomy are on a spectrum, with a laminectomy removing more bone and sometimes the inner edge of the facet joint.”

Ultimately, your surgeon will determine which of the two surgeries is best for your needs.

Why Have Decompression Surgery?

Most people with spinal stenosis—a narrowing of the spinal canal, usually caused by arthritis and overgrowth of the spinal discs and joints—or similar compression issues respond well to non-surgical treatment. But surgery may be necessary to treat certain uncommon but potentially severe situations. These kinds of situations include patients with:

  1. Bowel or bladder problems caused by pressure in the spinal nerves
  2. Worsening leg weakness
  3. An inability to walk or move for long distances or periods

The primary goal of decompression surgery is to create space around the spinal cord and surrounding spinal nerves by removing the compressing structure(s). When the spinal cord and/or nerve(s) are compressed, you may experience physical and neurological symptoms down the nerve’s pathway into a limb, such as:

  • Radiating pain
  • Numbness
  • Weakness
  • Tingling
  • Electric shock-like sensations

By freeing up the compressed nerves, your symptoms generally subside.

What is a Laminectomy?

Lumbar laminectomy is the most common surgical procedure to treat spinal stenosis in the lower back. It can also help treat herniated discs by allowing the surgeon to more easily access the disks in order to repair the damage. The surgery removes the lamina and any thickened ligaments that are also causing problems in order to create more space in the spinal canal.

The surgery actually enlarges the spinal canal so that pressure is relieved—that’s spinal decompression. By removing the source of the pressure, pain decreases, particularly pain caused by compressed nerves. 

Matthew Berchuck, MD, an orthopedic surgeon at Stony Brook Orthopaedic Associates in Stony Brook, NY, explains further. “In an open laminectomy, you're talking about making an incision of a couple of inches and exposing the spine,” he says. “Kind of stripping the muscles off the spine and back, therefore exposing the bone [for laminectomy]. Some of the other techniques that [surgeons] have for doing minimally based approaches are operating through a tube. They've adapted those techniques for being able to decompress this just by going on, say, the right side of the spine, and still being able to decompress then both the right and the left side.””

Both the minimally invasive and traditional open laminectomy procedures accomplish the same goals. The difference is the minimally invasive version involves one or more tiny incisions (or skin punctures) and small instruments designed to separate muscles and soft tissues instead of cutting through them. The traditional open approach requires a larger skin incision and instruments that retract, separate and cut tissues.

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: 123RF.com.

How Are Laminectomies Performed?

Laminectomies are performed most often under general anesthesia using a posterior approach—that is, you will be lying face down during the procedure. It can either be an open procedure or as a minimally invasive procedure sometimes called a microlaminectomy.

In an open laminectomy, the surgeon begins 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. Next, he or she removes or trims the lamina and thickened ligaments to enlarge the space surrounding or near the compressed nerves. Once that is completed, the retractor is removed and the incision is closed with sutures.

Microlaminectomy, a type of minimally invasive spine surgery or MIS, is performed using special instruments such as endoscopes and tubular retractors. These instruments allow for much smaller incisions and less cutting overall. In this case, once the incision is made, the surgeon uses tubular retractors to hold the tissue apart.

He or she will also be using special eyewear (loupes) in order to have a detailed view of the surgical field. Sometimes, instead of loupes, the surgeon uses either an endoscope or a microscope focused down the tube in order to perform the surgery. A portion of the lamina is removed, along with any bony overgrowths (osteophytes) and ligament tissue compressing the spinal nerves. Then the tubular retractors are taken out so the soft tissue moves back into place, and the incision is closed with dissolving sutures.

“In a minimally invasive [surgery], [we can] substantially reduce the trauma of the operation to the patient and thereby shortening the recovery and reducing the risk profile,” explains Dr. Ammerman.

What Other Spine Procedures Are 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.

Who Are Candidates for Laminectomies and Laminotomies?

Laminectomies and laminotomies are among the most common procedures performed by neurosurgeons and orthopedic spine surgeons. Laminectomies in particular are considered one of the most effective treatments for spinal stenosis and spinal canal issues such as tumors, certain kinds of infections and abscesses, and spinal issues involving bowel or bladder dysfunction. Patients who have not gotten good results from non-surgical treatments could also benefit from a laminectomy.

The primary indication for laminectomy is spinal stenosis, a condition most common in people over the age of 60. But that is not the only reason someone might be a good candidate for laminectomy. Other considerations and conditions include:

  • Failure of previous treatments, including medication, fusion surgery, physical therapy, and injections
  • The presence of tumors in or near the spine
  • Certain types of infection including peridural abscess
  • Neurologic defects
  • Bowel or bladder dysfunction, especially if in combination with cauda equina syndrome

It’s important to ask your surgeon questions before your procedure to ensure you are comfortable moving forward with the operation. Here are some questions to ask:

  • What are the risks associated with this procedure?
  • Will this surgery relieve all my symptoms?
  • What are the risks if I don’t have surgery?
  • What will my recovery look like?

What Is Recovery from Laminectomy or Laminotomy Like?

Whether open or micro, recovery from laminectomy takes time. It’s important to follow doctor’s instructions carefully in order to make a full recovery.

In general, patients should be careful for about a month following their surgery. But this doesn’t mean laying down or keeping still. In fact, movement is key to recovery.

“The important thing is early mobility,” says Dr. Ammerman. “We don’t want the patient in bed or lying on the couch. We wait a week or two to start physical therapy [if needed]. Most people have developed a weak core, poor posture and body mechanics, so we want to help develop that.”

Laminectomy recoveryGetting up and moving ASAP and starting physical therapy about a week after surgery are both critical in helping you recover from laminectomy surgery.

Things you can do to help with recovery include:

  • Using ice or cold packs to reduce swelling and pain.
  • Avoiding sitting for too long—according to Dr. Berchuck, “Usually sitting is the least comfortable position post-surgery.”
  • Being mindful of body mechanics—while you should be avoiding too much bending or lifting, it’s important to use the right body mechanics if you must bend or lift.
  • Post-operative ambulation—Moving the body after surgery is vital and helps prevent post-surgical issues. “In uncomplicated cases, we want patients up and walking immediately after surgery,” says Dr. Ammerman.

There are also things you can do before surgery to make recovery easier:

  • No smoking – This is good advice all the time, by especially before surgery. Quitting entirely or at least abstaining from smoking for at least six weeks prior to surgery will make recovery easier.
  • Lose weight – Speak with your doctor about your weight; a loss of as little as five pounds can make a big difference for recovery.
  • Watch your blood sugar – if you have diabetes, having an A1C under eight prior to surgery is ideal.

Remember that each patient’s recovery is different—including yours. The time needed to recover depends on the complexity of the surgery, your personal medical history and health issues you may have. Your doctor will monitor your recovery and advise as necessary.

“In general, folks are recovered from the trauma of the operation by about two to four weeks after surgery,” explains Dr. Ammerman. “But overall it depends on the reason for the laminectomy.”

If you have debilitating nerve pain in your low back or legs associated with lumbar spinal stenosis, talk to your doctor about whether spine surgery is right for you. If it is, a decompressive lumbar laminectomy may help restore your activity level and reduce your symptoms.

FAQs

What is post-laminectomy syndrome?

Post-laminectomy syndrome (PLS), sometimes known as “failed back syndrome,” is a condition where a patient continues to have pain post-surgery. There is some debate over whether PLS or “failed back syndrome” are accurate terms, however. Patients who are still having symptoms after a laminectomy should speak with their doctor to determine next steps.

How soon after laminectomy can I exercise?

Returning to the gym or getting back into an exercise routine after laminectomy surgery will take some time. It is important to follow all doctor’s orders and complete your full course of physical therapy before any additional exercise activity is attempted. Discuss your workout plans with your doctor to determine the best timeline for you and your spine.

How long does it take to fully recover from a laminectomy?

A return to some activity is possible within about four weeks after surgery. Full recovery, however, takes longer and each patient’s recovery is different. Depending on the complexity of the surgery, most patients return to all activities within six to nine months.

Updated on: 03/01/21
Continue Reading
How to Choose a Spine Surgeon
Joshua M. Ammerman, MD
×
SHOW MAIN MENU
SHOW SUB MENU
Cancel
Delete
Continue Reading:

How to Choose a Spine Surgeon

It is important for patients to be as involved as possible in their own medical care. If you are able to choose your physician, here are some guidelines on what to look for in a spine specialist.
Read More