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Has anyone had a Laminotomy, NOT Laminectomy
Spine Health | Last Active: Mar 9 5:37pm | Replies (55)Comment receiving replies
@annie1 Annie, Spine surgery is something you do NOT want to rush into unless it is emergency surgery for a serious condition. Once done, you cannot undo it. Most spine surgeries are elective and come after years of spine degeneration. You have to make sure that you are picking a solution that is beneficial, and sometimes there are different choices. I have heard of surgeons asking patents to do a year of bone building injections before undergoing spine surgery. You also cannot rush healing and the body takes it's own sweet time.
Have you considered working with a physical therapist? They can't fix stenosis, but they can try to keep the spine aligned and address issues with muscle spasms and that may help reduce symptoms. I also had gait disturbances from spinal cord compression and that was cured by my surgery. One question to ask is are if you are taking any drug prescriptions that have side effects that can be contributing to osteoporosis? I don't know if drinking alcohol contributes, but these are good things to know and ask about if there are things to do or change to improve your chances. I have bioidentical hormone replacement that according to my doctor should help prevent osteoporosis. There is an active group for osteoporosis here too if you wanted to read some patient experience.
I had worries of a wheelchair in my future too. My parents were both in wheelchairs and I took care of them. Having that degree of disability is hard and it doesn't just happen overnight with a gradual spine change. If you can make a plan that can improve bone quality and then address spine issues, it would be the best of both worlds. You need to know what your bone scores mean and how much it may be possible to improve them and how to go about improving things. I have read that laminectomy can cause spine instability. A laminectomy is kind of like raising the roof on a house when you want to build a 2nd floor. They cut through the top side part of the bone that arches over the back of the spinal cord. That leaves the disc intact between the vertebrae and the facet joints supporting the spine. If those are failing as in a bad disc or arthritis in the facets, it creates a problem and that may be why it leads to a fusion. Often with fusion, they screw a plate on the front of the spine and screws can be bad for osteoporosis as they can pull out. I don't have a front spine plate because I requested no hardware and that was possible with a singe level fusion.
Jennifer
Replies to "@annie1 Annie, Spine surgery is something you do NOT want to rush into unless it is..."
This is my DEXA scan. Please let me know what you think.
Dual-Energy X-ray Absorptiometry (DXA)
A DXA scan was performed on January 03, 2024 using a Hologic
Horizon W densitometer.
Indication: postmenopausal osteoporosis; monitoring
treatment;
Bone Density Results:
TECHNICAL LIMITATIONS:
None
------------------------------------------------------------------------------
DIAGNOSIS:
OSTEOPOROSIS based on the lowest T-score (-3.0) using the World Health Organization criteria
and ISCD guidelines for diagnosis.
------------------------------------------------------------------------------
=================================================================
Region BMD T-score Z-score Classification
=================================================================
AP Spine(L1-L4) 0.778 -2.4 -0.2 Osteopenia
Femoral Neck L 0.521 -3.0 -1.1 Osteoporosis
Total Hip L 0.644 -2.4 -0.9 Osteopenia
Femoral Neck R 0.515 -3.0 -1.1 Osteoporosis
Total Hip R 0.646 -2.4 -0.8 Osteopenia
=================================================================
World Health Organization criteria for BMD classify patients as:
Normal (T-score at or above -1.0),
Osteopenia (T-score between -1.0 and -2.5), or
Osteoporosis (T-score at or below -2.5).
FRAX(R) Estimated 10-year Fracture Risk:
10-year fracture risk estimate was calculated using the FRAX(R)
fracture risk assessment tool using your reported risk factors
and femoral neck BMD if you meet the following National
Osteoporosis Foundation (NOF) criteria: are an untreated
postmenopausal woman or man older than 50 years with T-score
between -1.0 and -2.5 with no prior hip or vertebral fracture
and current bone mineral density measurement in the hip.
10-year Fracture Risk:
=================================================================
FRAX not reported because:
Some T-score for Spine Total or Hip Total or Femoral Neck at
or below -2.5
Treated for osteoporosis
=================================================================
All treatment decisions require clinical judgment and
consideration of individual patient factors, including patient
preferences, comorbidities, previous drug use, risk factors not
captured in the FRAX model (e.g., frailty, falls, vitamin D
deficiency, increased bone turnover, interval significant
decline in bone density) and possible under- or overestimation
of fracture risk by FRAX.
Extended Spine:
-----------------------------------------------------------------
Region Area BMC BMD T-score Peak Z-score Age
cm2 g g/cm2 Reference Matched
-----------------------------------------------------------------
L1 11.46 7.84 0.684 -2.8 69 -0.8 88
L2 13.94 9.70 0.696 -3.0 68 -0.8 88
L3 14.35 10.84 0.756 -3.0 70 -0.7 91
L4 19.31 17.58 0.910 -1.4 86 1.0 113
L1-L2 25.40 17.54 0.691 -2.6 71 -0.6 92
L1,L3 25.81 18.68 0.724 -2.6 71 -0.5 93
L1,L4 30.77 25.42 0.826 -1.9 80 0.3 104
L2-L3 28.28 20.55 0.726 -3.0 69 -0.8 89
L2,L4 33.24 27.28 0.821 -2.3 76 -0.1 99
L3-L4 33.66 28.42 0.844 -2.3 77 0.0 100
L1-L3 39.75 28.39 0.714 -2.8 70 -0.6 91
L1-L2,L4 44.70 35.12 0.786 -2.3 76 -0.1 99
L1,L3-L4 45.12 36.26 0.804 -2.3 76 0.0 99
L2-L4 47.59 38.13 0.801 -2.5 74 -0.3 97
L1-L4 59.05 45.97 0.778 -2.4 74 -0.2 97
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I did have three years of Reclast infusions that did improve my DEXA but I guess not enough according to the more conservative surgeon. I still had Osteopenia and Osteoporosis in the head of my femur on both sides. I was taking Tymlos and Forteo injections for a few years before the Dr put me on the Reclast.
I Have gone to physical therapy many different places it didn't really help with my throbbing calf muscles after walking. That has been the most predominant symptom since this all started in 2016. Yeah as far as the laminectomy actually I would be getting laminotomy, during which they don't cut as much of the bone, they just cut into the lamina. I think you know this, but the other surgeon still thought that could create instability. He suggested I try Ablation again, I had it done once and it didn't help my symptoms, but he wants me to try again with a different Dr.
I'm going to the Surgeon who would have been doing the Laminotomy tomorrow and I will be sure to have him give me very direct answers about the spine instability possibility as well as the probability of needing fusion.