laminotomies

Laminotomy is a spinal surgical procedure in which a portion of the lamina, the vertebral arch bone forming the posterior wall of the spinal canal, is removed to decompress neural elements. Unlike a laminectomy, which removes the entire lamina, a laminotomy preserves most of the lamina and often preserves adjacent facet joints, reducing the risk of postoperative instability.

Typical indications include cervical or lumbar spinal stenosis producing radicular symptoms or myelopathy, foraminal stenosis, herniated discs compressing a nerve root, intradural tumors, or metastases requiring exposure. It can be performed unilaterally (hemilaminotomy) to access a targeted nerve root, or bilaterally for central canal decompression.

Techniques range from open microsurgical laminotomy to minimally invasive approaches using tubular retractors or endoscopy. The procedure is usually performed through a posterior approach with careful dissection, identification of the dura and nerve roots, and removal of a portion of the lamina with a drill or Kerrison rongeur. Surgeon may preserve the facet joints and other posterior elements when possible to maintain stability.

Complications include dural tear and CSF leak, infection, vascular injury, hematoma, neurologic injury, and, when excess bone is removed or fusion is not performed, spinal instability or adjacent-segment degeneration. Overall outcomes focus on relief of compression symptoms and maintenance of stability; laminotomy often carries less risk of instability than a full laminectomy, though multilevel disease or extensive bone removal may necessitate fusion.

Recovery timelines vary; hospital stay may be short for minimally invasive cases. The procedure is one of several decompression options in spinal surgery and is often chosen to minimize disruption to spinal stability while achieving decompression.