11.2\ Spine Decompression

11.2.1\ Laminotomy

and Foraminotomy

11.2.1.1\ Discussion

Laminotomy consists of removing the margins of lamina and can be unilateral or bilateral. The spinous process and interspinous ligaments are often preserved; however, a partial resection of the spinous process may be necessary in order to facilitate the approach to the lamina. This procedure can be performed to provide access for forami-

notomy or discectomy. On imaging, widening of interlaminar space can be identified, which is often best identified in the coronal plane (Fig. 11.1). These surgical defects often have geometric margins. Sclerosis of the remaining portions of the lamina can be observed, as healing progresses. Similarly, foraminotomy, which is performed for neural foraminal stenosis, can appear as a generously sized neural foramen with circular or rectilinear contours and irregular margins from shaving away of the surrounding cortical bone, which are best appreciated in the sagittal plane (Fig. 11.2).

Fig. 11.1  Laminotomy. Coronal CT image demonstrates thinning and of the left L4 and L5 lamina (arrows) resulting in a widened interspinous space

Fig. 11.2  Foraminotomy. Sagittal CT image shows an artificially widening L5–S1 neural foramen (arrow)