Lumbar laminotomy is performed commonly for lumbar canal stenosis where thickened ligamentum flavum causing compression of the lumbar nerve roots is excised carefully. Only bone of the inferior margin of the lamina and medial part of the facet joint needs to be removed. Laminotomy can be performed, as has been our practice for the last 15 years, using the operating microscope through a small incision (MISS). It can also be performed endoscopically. Most often laminotomy is accompanied by foraminotomy (de-roofing the exiting nerve root).
CASE STUDY 1
A 68 years old female presented with difficulty in walking for two years due to numbness of the legs with a claudication distance of about 50 meters. She had mild weakness of dorsi flexion of both feet. MRI Lumbo-Sacral spine showed lumbar canal stenosis at L4-L5 secondary to disc bulge, hypertrophied facet joints and thickened ligamentum flavum. She underwent L4/5 microsurgical laminotomy and bilateral foraminotomies.
Pre-Operative saggital MRI Images
Axial MRI Images
Some cases of lumbar canal stenosis who have significant back pain with minimal or no listhesis may benefit from stabilization in addition to micro-laminotomy. Stabilization may be performed with pedicle screws if there is significant back pain with movement of one vertebrae on the other (listhesis). If there is no listhesis but with significant back pain then dynamic stabilization using interspinous devices may be used.
CASE STUDY 2
A 36 yrs old lady, who had L4-L5 canal stenosis with significant back pain underwent L4/5 bilateral laminotomy and decompression with inter-spinous dynamic stabilization after which she was pain free.
Pre-op saggital MRI image showing L4-L5 lumbar
canal stenosis with no listhesis.
Post op X-Ray of a patient following surgery
CASE STUDY 3
A 52 years old female, presented with history of low back ache since 2005 which had got aggravated since August 2011. She also had pain radiating down her left leg up to the foot. She had decreased sensation along the same distribution. Her pain increased after walking for 200-300 meters.
Procedure - L4-L5, L5-S1 laminotomy along with pedicle screw fixation L4 -L5.
Pre-op X-Ray in Flexion and Extension showing
Pre-op MRI Images showing lumbar canal stenosis
Post-op X-ray Image following stabilization