A laminectomy is a surgical procedure that removes a portion of the vertebral bone called the lamina. At its most minimally invasive, the procedure requires only small skin incisions. The back muscles are pushed aside rather than cut and the parts of the vertebra adjacent to the lamina are left intact. Recovery occurs within a few days.
Laminectomy has normally been used as a standard approach for intradural spinal tumors but this procedure is associated with spinal instability and deformity. Laminoplasty was developed to overcome these limitations. Controversies still exist regarding its actual role in preventing spinal deformity in adults.
Epidural fibrosis and epidural adhesion after laminectomy are developed from adjacent dense scar tissue, which is a natural wound healing process 1) 2) 3) 4) , and ranked as the major contributor for postoperative pain recurrence after laminectomy or discectomy.
Posterior midline laminectomy is associated with risks of postoperative instability, spinal deformity, extensive bilateral subperiosteal muscle stripping, partial or total facetectomy especially in foraminal tumor extension, increased cerebrospinal fluid leakage, and wound infection. Minimally invasive approaches with the help of a microscope or endoscope using hemilaminectomy have been found to be safe and effective 5).
Laminectomy utilizing a high speed drill with an unprotected cutting drill bit can be rapid and effective, but it has been associated with known complications. Another technique utilizes a pediatric craniotome drill with the footplate attachment. Currently, there are no studies comparing clinical outcomes between these two stated decompressive techniques.
A retrospective review was conducted at a single institution. Two cohorts of patients were considered based on the technical method of laminectomy for decompression. One group had decompression with utilization of a high-speed drill while the other group had decompression with a pediatric craniotome drill with a footplate attachment. The outcomes from each group were compared based on the length of operation, estimated blood loss, and associated complications.
A total of 91 patients were included in the final analysis. Forty-five of the patients underwent laminectomy utilizing a footplate and forty-six utilizing a high-speed drill. The footplate group was associated with significantly shorter time of operation (159 minutes vs 205 minutes p=0.008). In addition, the footplate technique demonstrated less EBL (254 ml vs 349 ml), and less incidence of durotomies (2.2% vs 10.9%), however, neither of these two outcomes achieved statistical significance.
CONCLUSION: Despite being an older technique, the aforementioned cohort demonstrates shorter operative time in the footplate group without increased blood loss or incidence of durotomy. Although comparable results are operator dependent, this technique is a safe alternative for performing cervical and thoracic laminectomies 6).