Surgical Technique - Developed in conjunction with P. Mangione, M.D.

Partial Bilateral Arthrectomy After exposing the lamina, the inferior articular apophysis is resected with a Kerrison ronguer in an upward and diverging motion. This allows good visualization of the cancellous bone of the inferior part of the lamina and of the ligamentum flavum, which runs the length of the spine on the anterior aspect of the lamina.

Detachment of the Ligamentum Flavum
The ligamentum flavum is detached from the lamina using a Cobb elevator. One must be careful to hold the Cobb elevator with both hands in order to control its movement. Apply leverage to press the Cobb elevator onto the anterior surface of the lamina thereby releasing the ligamentum flavum from the anterior aspect of the lamina. The canal, between the ligamentum flava and anterior aspect of the lamina, having been enlarged by the insertion of the instrument now allows the surgeon to slightly rotate the elevator from left to right in order to progressively detach the ligament, while avoiding sudden movement into the canal.

Protection of Dura Mater
The dura mater can be protected by two small patties, which should be pushed upwards between the lamina and the dura mater.

Insertion of Laminotome Spatula
Insert the spatula of the Laminotome as laterally as possible and under the lamina, maintaining contact with the anterior surface of the lamina, until the stop of the Laminotome engages the lamina.
 
Laminectomy
Antero-posterior leverage (anterior pressure on the distal part of the handle) may help to correctly maintain bone contact with the Laminotome and anterior aspect of the lamina. Care should be used to maintain this leverage effect while using the mallet to push the blade of the Laminotome through the lamina. After the two laminotomies have been completed, the lamina can be removed with forceps. If the lamina is very large, there may be an apical fragment remaining. This can be easily resected with a Kerrison rongeur or bone-cutting forceps.

Lateral Decompression
After the laminectomy, which decompresses the central part of the canal, it is necessary to complete decompression laterally, using typical decompression techniques.

These steps comprise a recommended technique and should be adapted to suit the surgeon’s usual technique and practices. For the Laminotome to be used appropriately, it is advisable to go through every step in the surgical technique as described above.

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