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Laminotomy: A Minimally Invasive Procedure to Ease the Pain of Disk Disease

Herniation or degeneration of the disks in the vertebral column is a very painful and debilitating condition. Characterized by pain in the back or neck, pain radiating down the arms or legs, and numbness or tingling of the extremities, intervertebral disk disease most commonly affects elderly patients who have experienced degeneration of the joints between the vertebrae for a long period of time. However, it is also seen in younger individuals who have experienced back injuries. In either event, intervertebral disk disease is commonly treated using laser spine surgeries such as laminotomy.

What is a laminotomy?

The spinal cord exists within a protective canal of bone formed by the vertebral column. The individual vertebrae consist of a body, or thick, bony portion, that supports the shock-absorbing disks, and a thin arch of bone, called the lamina, that houses and protects the spinal cord. When a disk degenerates or ruptures, it can bulge into the space surrounding the spinal cord, placing painful pressure on cord and on the nerves that lead from the spinal cord to the arms and legs. This pressure causes the pain and numbness associated with disk disease. In order to relieve this pressure and allow the spinal cord and nerves to heal, spinal surgeons may remove a portion of the thin bone of the lamina and the ligaments that attach to it, giving them access to the spinal canal to safely remove disk material and giving the spinal cord more space. This procedure may be done on either the right or the left side of the vertebrae, depending on the location of the damaged disk material within the spinal canal. When the procedure is done on both the left and the right sides, it is called a bilateral laminotomy. A bilateral laminotomy allows the surgeon maximum access to the spinal canal while still leaving a stable, protective piece of bone in place to speed healing and protect the spinal cord.

How is a laminotomy done?

To perform a laminotomy, the surgeon first orders tests that determine that the patient is fully evaluated to make sure that it is safe to undergo anesthesia. These may include blood work, an EKG, and other preoperative tests. The patient is then anesthetized, and a small incision is made in the skin and muscle of the back overlying the affected area. Often, the surgery is done using laser and endoscopic technology, allowing the incisions to be very small and healing to occur rapidly. The surgeon then uses the laser to cut away a portion of the lamina on one or both sides of the spinal cord, removes any damaged disk material, and closes the incision. The bony arch over the spinal cord is left to heal on its own.

What to expect after laminotomy

After surgery, patients are usually hospitalized overnight or up to a few days, depending on their recovery process. Relief of disk disease symptoms is often very rapid. Patients will begin walking soon after surgery, although twisting and bending are not permitted for some time. Patients also usually begin some form of physical therapy to regain the function that they may have lost due to their disk disease.

  

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