Compare and contrast laminectomy and laminotomy for treatment of lumbar spinal stenosis

Laminectomy is the traditional procedure for surgical decompression for lumbar stenosis. It involves removal of the midline osseous and ligamentous structures including the lamina, spinous processes, interspinous ligaments, and portions of the facet joints. It provides excellent visualization of neural structures and facilitates complete decompression of involved neural structures. However, spinal instability is not uncommon following laminectomy and often requires treatment with spinal instrumentation and fusion. Laminotomy involves partial removal of the lamina and facet complex but preserves the midline structures including the spinous processes and interspinous ligaments. Preservation of the midline structures decreases the risk of developing spinal instability. The disadvantages of laminotomy include technical difficulty of the procedure and the risk of inadequate decompression due to limited exposure. An intermediate approach between laminectomy and laminoplasty is an interlaminar decompression, which enhances visualization of the neural elements for decompression but minimizes bone resection and is less destabilizing than laminectomy. Laminotomies are most appropriate for treatment of patients with spinal stenosis limited to the level of the facet joints and disc space. Laminectomies are most appropriate for patients with congenital stenosis and multilevel severe spinal stenosis. Regardless of which procedure is utilized, preservation of pars interarticularis and at least 50% of the facet joints bilaterally is recommended to prevent iatrogenic spinal instability.

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