What Is Microlaminectomy and Microlaminotomy?

Two types of minimally invasive spinal decompression surgery performed to reduce neck or back pain.

Microlaminectomy and microlaminotomy are two types of minimally invasive spine surgery. Like microdiscectomy and microforaminotomy, they are spinal decompression procedures. Decompression spine surgeries may remove bone spurs, damaged discs or tissues that compress one or more spinal nerves and/or the spinal cord. Nerve compression is a common cause of pain in the neck or back that may travel into the arms and/or legs.

Both micro laminectomy and laminotomy involve the spinal column’s lamina. Each lamina is a thin plate of bone that covers and protects entry to the spinal cord. A primary difference between a microlaminectomy and microlaminotomy is ectomy means complete removal of the lamina, where otomy is partial.
spinal column structures labeledAn overhead view a vertebral body in the spinal column illustrates the lamina; a bony plate that protects the spinal cord. Photo Source: Shutterstock.

What is the difference between open laminectomy or laminotomy and microlaminectomy and microlaminotomy?

Spine surgeons have been performing traditional open laminectomies and laminotomies much longer than microlaminectomies and microlaminotomies. In both traditional and minimally invasive laminectomy and laminotomy, either the lamina is completely removed (a laminectomy) or partially removed (a laminotomy).

Your spine’s lamina is part of your spinal canal (the structure through which your spinal cord passes)—it’s the bony protective layer covering entry to the spinal canal. The lamina is located at the back (posterior) of your spinal canal and is sometimes referred to as the “roof” of your spine.

Though the goal of both a traditional open laminectomy and laminotomy and their minimally invasive counterparts are the same, the traditional open approach has a few drawbacks.

  • Traditional laminectomy and laminotomy often involve a large incision, as well as more cutting through back muscles and tissues. Because more of your body is affected by the procedure, recovery from open spine surgery sometimes can be more painful and slower.

On the other hand, microlaminectomy and microlaminotomy (micro, small) offer the benefits of a minimally invasive approach: These procedures use smaller incisions, minimize the disruption to nearby spinal muscles and tissues, help reduce post-operative pain, and afford patients a quicker recovery compared to traditional open laminectomy and laminotomy.

When may a microlaminectomy or microlaminotomy be recommended?

Your spine surgeon may recommend a laminectomy or a laminotomy to accomplish two primary goals:

  • Relieve nerve and/or spinal cord compression
  • Gain better access to other parts of your spine. For example, part of your lamina may be removed to enable your surgeon to access a damaged intervertebral disc that has herniated toward the side or back of the spinal column.

How is microlaminectomy or microlaminotomy surgery performed?

A microlaminectomy and microlaminotomy may be performed using one of these techniques:

Mini-open is the smaller version of a traditional open laminectomy or laminotomy. The incision(s) and surgical instruments are small.

Tubular technique involves your surgeon inserting a tube through a very small incision and gently guiding it through and between the muscles to your spine. Then, a series of progressively larger tubes are inserted to gradually open the surgical site enabling your surgeon to view your spine using an endoscope. The microlaminectomy or microlaminotomy are performed through the tubular retractor using small instruments designed for tubular endoscopic spine surgery.

Whether your microlaminectomy or microlaminectomy is performed open or minimally invasively, it is performed under general anesthesia (usually). You are positioned face down lying on your stomach as these procedures are performed using a posterior approach, simply meaning accessing your spine from the back of your body. Your body’s position is supported using special cushions during these procedures that take one and a half hours or less depending on the number of spinal levels treated.

What are the potential risks of microlaminectomy and microlaminotomy?

Any type of surgery or medical procedure has risks and the potential for complications during or after the surgery. Excessive blood loss and nerve damage are two different types of risks. Some patients have co-existing medical conditions, such as diabetes or heart disease that may pose increased risk. A few of the potential risks related to spinal decompression surgery—in this case, microlaminectomy or microlaminotomy—include the following:

  • Neck, back, and/or extremity pain (eg, arms, legs) may return.
  • The amount of decompression performed is not sufficient to reduce or relieve symptoms (eg, pain, tingling sensations).
  • The spinal cord, nerves, and/or blood vessels can be injured.

Who may be a candidate for microlaminectomy or microlaminotomy?

Unfortunately, not all patients are candidates for microlaminectomy or microlaminotomy. There are many reasons and factors your surgeon seriously considers even before recommending spine surgery. For example, your microlaminectomy may be combined with a discectomy that requires instrumentation and fusion to stabilize the spine. Possibly, several levels of the spine require surgical intervention. Besides the operation, your general health and existing medical conditions are vital considerations.

How do I take care of myself after microlaminectomy or microlaminotomy?

Your spine surgeon provides you specific post-operative instructions to follow throughout the weeks and months after surgery. Everything is covered—when and what medications to take to reduce discomfort or pain after you are discharged home, how to move safely to avoid injury, steps to gradually resume everyday activities of daily living, starting physical therapy and a home exercise program, and return to work instructions. Another important part of your recovery is periodic follow-up visits with your spine surgeon to monitor your progress.

Updated on: 11/26/18
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