There are 2 ways to perform laminectomy: open surgery and keyhole surgery.
This is the most common type of laminectomy surgery. A 5-12 cm incision is made in your spine and your surgeon removes the lamina (laminectomy) or a part of it (laminotomy). If the disc is pressing on the spinal nerves, your surgeon may also trim this as well (discectomy).
Keyhole surgery (also known as microlaminectomy) does the same job as open surgery but it uses smaller incisions. Your surgeon makes a small incision to access the part of your spine that is impinging on your spinal nerves. They then use a surgical microscope with a light source and magnification. The surgeon will make further small incisions. These incisions can be used to insert tools to trim away the lamina and/or protruding disc.
Which is better, open or keyhole surgery?
Keyhole laminectomy is less invasive compared to open surgery because it uses a smaller incision. You may be able to have the procedure done as day surgery. Your recovery time may be faster with smaller scars and shorter, less painful recovery. There’s a greater chance of needing a second surgery after a keyhole procedure.
However, as far as relieving symptoms goes, keyhole surgery has not shown superior results when compared to open surgery.
One drawback to keyhole laminectomy surgery is that there’s a higher risk of a dural tear especially for surgeons who aren’t so familiar with the technique. A dural tear happens when the surgeon accidently nicks the protective sheath around the spinal nerves (the dura) during the surgery, causing a leak of spinal fluid. Your surgeon would normally notice and repair this during your surgery but if the tear is missed, it can lead to long-term complications.
With keyhole surgery it’s possible that the surgeon will have to convert to open surgery if problems arise during your procedure.
It’s important to discuss details about the best type of surgery for you with your surgeon.
Laminectomy versus laminotomy
With laminotomy only a part of your lamina is removed. Your surgeon removes less bone and there’s potentially less interference with your back muscles and ligaments. Medical researchers think this should lead to better spinal stability and less risk of surgical complications. However, only limited studies have been done and so far the outcomes — in terms of pain relief and risks — appear to be similar for both types of surgery.
Conversion rates from laminotomy to open laminectomy surgery vary but can be high over time.
If your problem is referred pain from a herniated disc, you may be a candidate for a less invasive surgery called microdiscectomy.