European Spine Journal

, Volume 21, Issue 2, pp 364–372 | Cite as

Laminotomy in adults: technique and results

  • Andrea Ruggeri
  • Angelo PichierriEmail author
  • Nicola Marotta
  • Roberto Tarantino
  • Roberto Delfini
Original Article


The objective of this study was to describe step by step our surgical technique of laminotomy and analyze our series with regard to spinal deformities (risk and predisposing factors), postoperative pain and rate of postoperative contusions. Data regarding patients who underwent our technique of laminotomy (N = 40, mean follow-up: 52 ms) (N = 40) between 2002 and 2006 were retrospectively evaluated. The technique used is illustrated in depth. Chronic pain was present in 30% with a mean score of 3/10 cm (Graphic Rating Scale). Postoperative kyphoses occurred in three patients, all below 35 years of age and with laminotomies which involved C2 and/or C7. None of these deformities required further surgical treatment because they were self-limiting or asymptomatic at a mean follow-up of 52 months. Based on the results, our technique proved to be safe and effective in terms of late deformities, blood loss, early and chronic postoperative pain and protection from postoperative accidents over the surgical site.


Laminotomy Iatrogenic deformities Technique Outcomes 



The Authors are grateful to Giuseppe Nicodemo Pichierri (anatomical illustrator, for the drawings in Figs. 2, 3, 4, 5, 6.

Conflict of interest


Supplementary material

Supplementary material 1 (MPG 45268 kb) Cervical laminotomy: opening. After a posteriorlongitudinal skin incision, the posterior superficial cervical fascia is exposed for afew centimeters bilaterally. It can be cut unilaterally (on the same side of the tumor)and paramedian preserving the supraspinous ligament. The dissection proceeds alongthe nuchal ligament which is progressively displaced laterally. A high-speed drill isused to thin the laminae along a line which passes halfway between each spinousprocess and zygapophysial joint, where the laminotome will pass. The flap is thenelevated. It is therefore formed by the laminae, the spinous processes, the yellow andinterspinous ligaments

Supplementary material 2 (MPG 48632 kb) Cervical laminotomy: closure. Reconstruction is madeusing plates and screws. The cranial set can be used for this purpose. Attention mustbe paid to correctly shape the plates and to fix them in order not to violate thezygopophysial joints. The plates at the extremities of the flap are of utmostimportance in securing it in place but also in guaranteeing the symmetry of thelaminotomy. A deeper layer of absorbable stiches approximates the muscles fromeach side: each wiresuture crosses the interspinous ligament securing muscles andflap to one another. A more superficial muscular layer is sutured as usual. Thesupraspinous ligament is sutured to the superficial cervical fascia with a running suture

Supplementary material 3 (MPG 81910 kb) Thoracolumbar laminotomy: closure. Reconstruction ismade using plates and screws. The cranial set can be used for this purpose. Attentionmust be paid to correctly shape the plates and to fix them in order not to violate thezygopophysial joints. The plates at the extremities of the flap are of utmostimportance in securing it in place but also in guaranteeing the symmetry of thelaminotomy. The intermediate plates reinforce the fixation blocking each segmentand avoiding subsidenceof the flap: one screw per side is enough. Absorbable vicrylwiresutures reconnect the supraspinous ligament with a “Smead-Jones”-liketechnique: once positioned the suture will resemble a figure of eight. Muscles areapproximated using U-shaped stiches with their deeper branches crossing theinterspinous ligament and their superficial branches running just below thesupraspinous ligament. The thoracolumbar fascia is closed, preferably with runningsutures on each side


  1. 1.
    Abbot R, Feldstein N, Wisoff JH, Epstein FJ (1992) Osteoplastic laminotomy in children. Pediatr Neurosurg 18:153–156CrossRefGoogle Scholar
  2. 2.
    Aebi M (2008) Outcome questionnaires and tools, chap 10.1. In: Aebi M (ed) AO spine manual, vol 2. Thieme, pp 755–767Google Scholar
  3. 3.
    Asazuma T, Yamagashi M, Sato M, Ichimura S, Fujikawa K (2003) Vertebral arch reconstruction based on 90 degree rotational laminoplasty after removal of spinal cord and cauda equina tumours. Acta Neurochir 145:495–500Google Scholar
  4. 4.
    Bakir A, Savas A, Yilmaz E et al (2006) Spinal intradural-intramedullary cavernous malformation. Case report and literature review. Pediatr Neurosurg 42(1):35–37PubMedCrossRefGoogle Scholar
  5. 5.
    Benglis DM, Guest JD, Wang MY (2008) Clinical feasibility of minimally invasive cervical laminoplasty. Neurosurg Focus 25(2):E4, 1–4Google Scholar
  6. 6.
    Bognar L, Madarassy G, Vajda J (2004) Split laminotomy in pediatric neurosurgical population. Child Nerv Syst 20:110–113CrossRefGoogle Scholar
  7. 7.
    Casha S, Engelbrecht HA, DuPleissis S, Hurlbert RJ (2004) Suspended laminoplasty for wide posterior cervical decompression and intradural access: results, advantages and complications. J Neurosurg Spine 1:80–86PubMedCrossRefGoogle Scholar
  8. 8.
    Cochrane DD, Steinbok P (1992) Laminotomy: a technical note. Childs Nerv Syst 8:226–228PubMedCrossRefGoogle Scholar
  9. 9.
    Constantini S, Siomin V, Epstein F (2006) Surgical management of intramedullary spinal cord tumors, chap 37. In: Fessler RG, Shekar L (eds) Atlas of neurosurgical techniques: spine and peripheral nerves. Thieme, pp 279–288Google Scholar
  10. 10.
    Goel A (1997) Vascularized pedicled laminoplasty. Surg Neurol 48:442–445PubMedCrossRefGoogle Scholar
  11. 11.
    Gropper MR, Kishan A (2006) Thoracic laminoplasty, chap 60. In: Fessler RG, Shekar L (eds) Atlas of neurosurgical techniques: spine and peripheral nerves. Thieme, pp 452–455Google Scholar
  12. 12.
    Guo Y, Yadav R (2002) Improving function after total sacrectomy by using a lumbar-sacral corset. Am J Phys Med Rehabil 81(1):72–76PubMedCrossRefGoogle Scholar
  13. 13.
    Hara M, Takayasu M, Takagi T, Yoshida J (2001) En bloc laminoplasty performed with threadwire saw: technical note. Neurosurgery 48(1):235–239PubMedGoogle Scholar
  14. 14.
    Hashimoto Y, Furumiya J (2009) Toothpaste artifact of the spinal cord observed in a victim of traffic accident who died of pulmonary thrombotic embolism after laminectomy. Leg Med (Tokyo) 11(Suppl 1):S523–S525CrossRefGoogle Scholar
  15. 15.
    Hejazi N, Hassler W (1998) Microsurgical treatment of intramedullary spinal cord tumors. Neurol Med Chir (Tokyo) 38:266–273CrossRefGoogle Scholar
  16. 16.
    Hida S, Naito M, Arimuzu J, Morishita Y, Nakamura A (2006) The transverse placement laminoplasty using titanium miniplates for the reconstruction of the laminae in thoracic and lumbar lesion. Eur Spine J 15:1292–1297PubMedCrossRefGoogle Scholar
  17. 17.
    Inoue H, Ohmori K, Ishida Y, Suzuki K, Takatsu T (1996) Long-term follow-up review of suspension laminotomy for cervical compression myelopathy. J Neurosurg 85:817–823PubMedCrossRefGoogle Scholar
  18. 18.
    Jenkins DHR (1973) Extensive cervical laminectomy. Long-term results. Br J Surg 60:852–854PubMedCrossRefGoogle Scholar
  19. 19.
    Kato M, Nakamura H, Konishi S et al (2008) Effect of preserving paraspinal muscles on postoperative axial pain in the selective cervical laminoplasty. Spine 33(14):E455–E459PubMedCrossRefGoogle Scholar
  20. 20.
    Kawahara N, Tomita K, Shinya Y et al (1999) Recapping T-saw laminoplasty for spinal cord tumors. Spine 24(13):1363–1372PubMedCrossRefGoogle Scholar
  21. 21.
    Kim P, Murata H, Kurokawa R, Takaishi Y, Asakuno K, Kawamoto T (2007) Myoarchitectonic spinolaminoplasty: efficacy in reconstructing the cervical musculature and preserving biomechanical function. J Neurosurg Spine 7:293–304PubMedCrossRefGoogle Scholar
  22. 22.
    Lunardi P, Licastro G, Missori P, Ferrante L, Fortuna A (1993) Management of intramedullary tumors in children. Acta Neurochir 120:59–65CrossRefGoogle Scholar
  23. 23.
    McGirt MJ, Chaichana KL, Atiba A et al (2008) Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty. J Neurosurg Pediatrics 1:57–62CrossRefGoogle Scholar
  24. 24.
    McLaughlin MR, Wahlig JB, Pollack IF (1997) Incidence of postlaminectomy kyphosis after chiari decompression. Spine 22(6):613–617PubMedCrossRefGoogle Scholar
  25. 25.
    Ohmori K, Ishida Y, Suzuki K (1987) Suspension laminotomy: a new surgical technique for compression myelopathy. Neurosurgery 21(6):950–957PubMedCrossRefGoogle Scholar
  26. 26.
    Raab P, Juergen K, Gloger H, Soerensen N, Wild A (2008) Spinal deformity after multilevel osteoplastic laminotomy. Intern Orthop (SICOT) 32:355–359CrossRefGoogle Scholar
  27. 27.
    Raimondi AJ, Gutierrez FA, di Rocco C (1976) Laminotomy and total reconstruction of the posterior spinal arch for spinal canal surgery in childhood. J Neurosurg 45:555–560PubMedCrossRefGoogle Scholar
  28. 28.
    Rogers L (1961) The surgical treatment of cervical spondylotic myelopathy. Mobilization of the complete cervical cord into an elarged canal. J Bone Joint Surg 43(B):3–6Google Scholar
  29. 29.
    Sakaura H, Hosono N, Mukai Y, Oshima K, Iwasaki M, Yoshikawa H (2008) Preservation of the nuchal ligament plays an important role in prevent ingunfavorable radiologic changes after laminoplasty. J Spinal Disord Tech 21(5):338–343PubMedCrossRefGoogle Scholar
  30. 30.
    Sani S, Ratliff JK, Cooper PR (2004) A critical review of cervical laminoplasty. Neurosurg Q 14(1):5–16CrossRefGoogle Scholar
  31. 31.
    Suzuki F, Nakajima M, Matsuda M (1999) Cervical cord compression caused by a pillow in a postlaminectomy patient undergoing magnetic resonance imaging. Case report. J Neurosurg 90(Suppl 1):145–147PubMedGoogle Scholar
  32. 32.
    Takeshita K, Seichi A, Akune T, Kawamura N, Kawaguchi H, Nakamura K (2005) Can laminoplasty maintain the cervical alignment even when the C2 lamina is contained? Spine 30(11):1294–1298PubMedCrossRefGoogle Scholar
  33. 33.
    Tandon N, Vollmer DG (2006) Cervical laminectomy, chap 27. In: Fessler RG, Shekar L (eds) Atlas of neurosurgical techniques: spine and peripheral nerves. Thieme, 233–238Google Scholar
  34. 34.
    Thomas NWM, Rea GL, Pikul B, Mervis LJ, Irsik R, McGregor J (1997) Quantitative outcome and radiographic comparison between laminectomy and laminotomy in the treatment of acquired lumbar stenosis. Neurosurgery 41(3):567–575PubMedGoogle Scholar
  35. 35.
    Truumees E, Herkowitz HN (2002) Cervical laminectomy C1–C7, chap 2. In: Vaccaro AR, Alberto TJ (eds) Spine surgery: tricks of the trade. Thieme, pp 4–6Google Scholar
  36. 36.
    Wiedemayer H, Schoch B, Stolke D (1998) Osteoplastic laminotomy using titanium microplates for reconstruction of the laminar roof: a technical note. Neurosurg Rev 21:93–97PubMedCrossRefGoogle Scholar
  37. 37.
    Yasuoka S, Peterson HA, MacCarthy CS (1982) Incidence of spinal column deformity after multilevel laminectomy in children and adults. J Neurosurg 57:441–445PubMedCrossRefGoogle Scholar
  38. 38.
    Yucesoy K, Sonntag VKH (2000) Terminology confusion in spinal surgery: laminotomy, laminoplasty, laminectomy. J Neurosurg 92:371PubMedGoogle Scholar
  39. 39.
    Yucesoy K, Karci A, Kilicalp A, Mertol T (2000) The barrier effect of laminae: laminotomy versus laminectomy. Spinal Cord 38(7):442–444PubMedCrossRefGoogle Scholar
  40. 40.
    Yukawa Y, Kato F, Ito K et al (2007) Laminoplasty and skip laminectomy for cervical compressive myelopathy. Spine 32(18):1980–1985PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Andrea Ruggeri
    • 1
  • Angelo Pichierri
    • 1
    Email author
  • Nicola Marotta
    • 1
  • Roberto Tarantino
    • 1
  • Roberto Delfini
    • 1
  1. 1.Department of Neurological Sciences, Neurosurgery“Sapienza” University of RomeRomeItaly

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