Laminotomy

When a nerve in your lower back is being pinched, removing just a small window of bone is often enough to free it. A laminotomy can often correct the problem while leaving most of the spine’s natural support in place.

What Is a Laminotomy?

A laminotomy is a minimally invasive surgery that removes a small portion of the lamina, the bony arch at the back of a vertebra, to relieve pressure on a spinal nerve. Unlike a laminectomy, which removes the whole lamina, a laminotomy creates only a small opening, sometimes called a window or keyhole.

That opening lets Dr. Grunch reach and remove whatever is pressing on the nerve, such as a thickened ligament, a bone spur, a synovial cyst or a herniated disc. A laminotomy is also the first step of a microdiscectomy.

Because so much of the bone, ligaments and muscle attachments are left in place, a laminotomy preserves the spine’s stability and usually allows a quick recovery.

Who Needs a Laminotomy?

• Leg pain, numbness or weakness from a pinched nerve (sciatica) that hasn’t improved with conservative treatment
• Stenosis that is limited to one or two levels, or mostly to one side of the spine
• Pain in the buttocks and legs that comes on with walking or standing and eases with sitting
• An MRI that shows narrowing, a cyst or a disc herniation that matches your symptoms

Laminotomies are most common in the lower back, but they can also be done in the neck. For narrowing that affects many levels, a laminectomy may be the better choice.

Call 911 or go to the nearest emergency room if you have new numbness in the groin or inner thighs, trouble controlling your bladder or bowels, or weakness in both legs. These can be signs of cauda equina syndrome, a surgical emergency.

Treatments to Try First

• Physical therapy: exercises to strengthen your core and improve flexibility
• Medications: anti-inflammatory or nerve pain medications
• Epidural steroid injections: anti-inflammatory medicine placed near the irritated nerve
• Activity changes: staying active while avoiding the positions that set off your pain

When these don’t bring lasting relief, or a nerve is losing strength, surgery can often correct the problem.

How a Laminotomy Is Done

1. Anesthesia: You’ll be fully asleep under general anesthesia and positioned face down.
2. A small incision: Using X-ray to confirm the level, Dr. Grunch makes a small incision in the lower back.
3. Gentle access: The muscles are gently separated, often with a small tube-shaped retractor, rather than cut.
4. Creating the window: Under magnification, a small opening is made in the lamina and the thickened ligament beneath it.
5. Freeing the nerve: Bone spurs, ligament, a cyst or disc material pressing on the nerve are removed.
6. Closing: The muscles fall back into place, and the skin is closed with dissolvable stitches and skin glue.

Benefits and Risks

Benefits

• Relief of leg pain and numbness for most patients
• A small incision and less muscle disruption
• Preserves the spine’s natural stability, with no implants
• Usually same-day discharge and a quick recovery

Risks

• A small tear in the lining around the nerves (a spinal fluid leak), usually repaired during surgery
• Infection or bleeding
• Nerve injury, which is rare
• Symptoms returning if the narrowing or disc herniation recurs
• Risks related to anesthesia

Why Choose Dr. Betsy Grunch for Your Laminotomy

• Duke-trained: Dr. Grunch completed her neurosurgical residency and a spine research fellowship at Duke University School of Medicine, one of the top neurosurgery programs in the country, where she received the Spine Young Investigator Award.
• Minimally invasive by design: Minimally invasive spine surgery is one of her signature areas. She works through the smallest opening that will safely do the job, so you can get back on your feet sooner.
• Experience you can count on: She has been in practice since 2013 and performs 400 to 600 surgeries a year, more than 5,000 procedures over her career.
• Second opinions and revisions: She regularly sees patients who had spine surgery elsewhere and want a second opinion or need a revision.
• A teacher at heart: As “Ladyspinedoc,” she is known for explaining spine conditions clearly. You’ll leave your visit understanding your imaging and every option in front of you.

What to Expect

Before surgery

You’ll meet with Dr. Grunch or one of her physician assistants to review your imaging, your exam and your goals, and to decide together whether a laminotomy is right for you. Our team will coordinate any pre-operative testing, review your medications (including blood thinners you may need to pause) and walk you through the day of surgery so nothing is a surprise. If you smoke or use nicotine, stopping before surgery lowers the risk of complications.

Procedure day

A laminotomy usually takes about an hour per level. Most patients walk the same day and go home that afternoon or evening with a responsible adult to drive them.

Recovery timeline

• First days: Leg pain often improves quickly. Some soreness at the incision is normal. Walking is encouraged from day one.
• First two weeks: Many people with desk jobs return to work within one to two weeks. Your first follow-up visit is about two weeks after surgery.
• Two to six weeks: Gradually increase your activity. Dr. Grunch may start physical therapy.
• Six weeks and beyond: Most patients return to normal activities. Numbness and strength can keep improving for several months.

Every patient heals differently. Your exact timeline will depend on your symptoms, your job and your overall health.

Caring for yourself at home

• Walking: Walk 30 to 60 minutes a day, broken into 10- to 15-minute sessions, and try not to sit for more than 30 minutes at a time.
• Restrictions for about six weeks: No bending at the waist, no twisting and no lifting more than 10 pounds. That includes household chores, yard work, golf and lifting young children or grandchildren.
• Your incision: You may shower the day after surgery without scrubbing the incision. Don’t use ointments or creams, and don’t soak in a bath, hot tub or pool for six weeks. Ice the incision twice a day for 20 minutes during the first week.
• Medications: Take pain medication with food and avoid alcohol while taking it. A daily stool softener helps prevent constipation. Blood thinners are held after surgery until Dr. Grunch’s team tells you to restart them.
• Driving: You may drive once you are no longer taking narcotic pain medication.
• Follow-up: Your first follow-up visit is about two weeks after surgery.

Call the office at 470-293-9800 if you have a fever over 101°F, redness, warmth or significant drainage from the incision, calf pain or swelling, constipation that medication doesn’t relieve, new trouble controlling your bladder or bowels, or back or leg pain that is worse than before surgery. Call 911 for chest pain or shortness of breath.

Download your patient instructions

Print these sheets or save them to your phone so you have them before and after surgery:

• Preparing for surgery: Lumbar Laminectomy (PDF)
• Post-operative guidelines: Minimally Invasive Lumbar Surgery (PDF)

You’ll find instructions for other procedures on our Patient Resources page.

Frequently Asked Questions

What’s the difference between a laminotomy and a laminectomy?

A laminotomy removes only a small part of the lamina to make a window. A laminectomy removes the whole lamina at one or more levels. Dr. Grunch chooses the smallest operation that will fully free your nerves.

Will I need a fusion?

Usually not. A laminotomy leaves the spine’s supporting structures in place. A fusion is only considered if your spine is unstable or slipping.

How soon will my leg pain improve?

Many patients feel a difference right away. Numbness and weakness can take weeks to months to improve as the nerve heals.

Can a laminotomy be done on both sides?

Yes. When narrowing affects both sides, Dr. Grunch can often reach both through a single small incision.

When can I drive and go back to work?

You may drive once you’re no longer taking narcotic pain medication, often within one to two weeks. Desk work often resumes in one to two weeks, while physically demanding jobs can take six weeks or more.

Take the First Step Toward Relief

Living with a pinched nerve is exhausting. Whether you need a treatment plan, a second opinion or a clear explanation of your imaging, Dr. Grunch and the Southern Neurosurgery team are here to help.

Call 470-293-9800 to schedule an appointment or contact us online.

Have a question first? Ask our virtual assistant anything, 24/7.

We see patients across metro Atlanta and North Georgia at our offices in Gainesville, Sandy Springs and South Atlanta (Riverdale). Find the office nearest you.

Related pages: Spinal stenosis · Sciatica · Lumbar laminectomy · Foraminotomy · Microdiscectomy

This page is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. Please talk with your own doctor about your symptoms. If you have bladder or bowel changes, groin numbness or rapidly worsening weakness, call 911 or go to the nearest emergency room.