Has anyone had a Laminotomy, NOT Laminectomy

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

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DIAGNOSIS:
OSTEOPOROSIS based on the lowest T-score (-3.0) using the World Health Organization criteria
and ISCD guidelines for diagnosis.

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=================================================================

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
------------------

@annie1 Annie, my mom with severe osteoporosis has a DEXA scan of -4, and I see your lowest DEXA number is -3. The spine DEXA for you says -2.4 which is close to the score for osteoporosis that starts at -2.5. I can understand why the surgeon is concerned. From what I've read this can change for the worse. Only your treating specialist knows if your scores are changing for the better and how to interpret them for your care. You bone quality could be moving toward better or worse and has to be monitored because if you were to stop treatment for osteoporosis, it likely would begin to degrade again according to what I've read on Mayo's website. I've also read that if bone were to crumble after spine surgery, that may make the problem un-fixable.

I believe that when my mom broke her foot and her pelvis (when she fell on the kitchen floor) that her foot probably fractured when she stepped on it and caused the fall. She didn't twist her ankle, but just lost her balance and fell on her side which fractured her pelvis in 3 places. Several years later she had a spontaneous spine compression fracture in her lumbar spine. I hope that gives you a frame of reference for possible risks associated with DEXA scores. My mom does use a wheelchair, and doesn't have weight bearing exercise now because she can hardly walk. She has arthritic deformity in her feet.

Are you having difficulty walking? With the uneven gait due to spinal stenosis, I was wondering if that affected your ability to do weight bearing exercise that is beneficial for bone building? I know you like swimming, but that doesn't help osteoporosis as much because you don't stress the bones with added weight and pressure during movement.

In searching Mayo Clinic information I found that smoking, alcohol use, thyroid problems, steroid use, and some medications can contribute to thinning bones. I did find this interesting article describing regenerative medicine research at Mayo to try to fix thin bones in spine patients. At the end it has links to the labs and departments doing this research. I don't know what is possible today for patient treatment or if this is just an experimental stage, but you may want to look at this. Here are some of the links I found interesting.
https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/news/optimizing-bone-health-before-complex-spinal-surgery/mac-20542607
https://www.mayoclinic.org/medical-professionals/endocrinology/news/new-tools-to-predict-fracture-risk/mac-20430573
https://newsnetwork.mayoclinic.org/discussion/tuesday-q-a-treatment-for-bone-disorders-focuses-on-strengthening-bones-slowing-bone-loss/
Jennifer

Can I send you my MRI image ? That may make you think a little differently about this.

@annie1 My opinion isn't what counts here, and while we can discuss things, the decisions will be yours along with your doctors. I don't have an opinion about what your best choices will be because I don't have the expertise to judge that. Only a specialist who is treating you can properly advise your care. I am happy to help any way that I can if it helps gain insight and understanding.

You may post images from your MRI on Connect if you remove your personal information from them (name, birth date). I know you have spinal cord compression and that is hard to live with, and living with that brings uncertainty for the future. I would want to fix a spine problem too, but I don't have osteoporosis. I don't know how to judge bone quality or know if some places of your spine would be better than others. I looked at content on Mayo's website to understand some of the issues before writing my responses.

Did you see the links about Mayo's research on improving bone quality for patients who need spine surgery? I think that would be something to ask your bone specialist about in case there is anything new that is available to improve your bone.

Jennifer

I'm trying to find out who knows what these numbers mean.
I feel at the end of my rope with people telling me what to do. Last night I had a excruciating leg cramp that last almost 4 hours. I believe it is from my continued degenerative stenosis. The neuro surgeon who would do a minimally invasive laminotomy said the below numbers are more important than the first listed numbers. I have Osteopenia in three places and Osteoporosis in 2 places. I had a friend who had a Laminectomy, also has Osteoporosis and is doing fine. Also the surgeon who warned me against surgery gave me no hope except is referring me back for pain management for the rest of my life. So I am not going by his recommendation. As far as he is concerned, my quality of life dosen't seem to matter nor my future if the stenosis keeps going, which it has.
-----------------------------------------------------------------
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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Comparison With Previous Exams:
=================================================================
Region Exam Age BMD T-score BMD Change BMD Change
Date g/cm2 vsBaseline vsPrev
=================================================================

AP Spine (L1-L4)
01/03/2024 71 0.778 -2.4 10.1%* 13.3%*
07/22/2022 70 0.687 -3.3 -2.9% -2.9%
08/06/2020 68 0.707 -3.1

Total Hip(Right)
01/03/2024 71 0.646 -2.4 4.9%* -0.9%
07/22/2022 70 0.652-2.4 5.9%* 5.9%*
08/06/2020 68 0.615 -2.7

Femoral Neck(Right)
01/03/2024 71 0.515 -3.0 4.2% -1.2%
07/22/2022 70 0.521 -3.0 5.4% 5.4%
08/06/2020 68 0.494 -3.2
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*Denotes significance at 95% confidence level, LSC for AP Spine
= 0.022 g/cm2, LSC for Total Hip = 0.027 g/cm2

Follow up examinations must always be performed on the same DXA
machine to allow comparison.

Hi Annie

The T-score represent numbers that compare the condition of your bones with those of an average young person. The T-score is usually the most important number to pay attention to. T-scores are usually in the negative or minus range. The lower the bone density T-score, the greater the risk of fracture. Normal bone density is +1 to –1. If the numbers are between –1 and –2.5 you have osteopenia. A score of –2.5 or less is defined as osteoporosis.

The Z score represent numbers that compare the condition of your bones with an average person of your age. A negative Z-score of –2.5 or less should raise suspicion of a secondary cause of osteoporosis. Osteoporosis can be missed in a senior person if the diagnosis is based on the Z-score. The Z-scores help diagnose secondary osteoporosis, which is osteoporosis due to a clinical disorder rather than aging which is the primary cause of osteoporosis.

Your second chart is more important because it is showing your T-scores and that is what the doctors will pay attention to when determining the condition of your bones. It appears that your T-scores have improved in some areas from 2022 and 2020. Did you have all your DEXA scans taken at the same facility?

On January 1, 2024 at age 71 the Bone Mass Density measured at AP Spine (L1-L4) was 0.778 g/cm2 with a T-score of -3.0. I am guessing that the percentage numbers are your 10 year risk of fracture at that location. If I am reading this correctly the upper chart which represents says you have osteoporosis in your lumbar spine in L1-L3. The lower chart suggests that you have osteopenia at those same areas of your spine. I would suggest you ask a doctor to explain your results so that you can fully understand what they mean. I hope I was able to explain the DEXA report well enough for you to understand the basics of what it is telling you.

Osteoporosis has often been considered a contraindication for spinal surgery. Today, advances in surgical and anesthetic technology make it possible to operate successfully on elderly patients who don't want to accept disabling physical conditions. Recent literature suggests the outcomes of surgical treatment are more favorable than conservative treatment. I know you have been searching for some time to find a doctor to do the right surgery, a doctor that you can trust. Your doctor and his team will need to able to treat a person with osteoporosis and have a good deal of experience. Check with US News & World Report for hospital evaluations to find the best hospitals for spinal surgeries. Mayo Clinic has been cited as the #1 hospital in the world. But, there are other good doctors and hospitals around the country. I know that the Cleveland Clinic is well known for spinal surgeries and also fusions. I would look at a teaching hospital or one that has a lot of research going on. Ask your friend about the doctor she saw too. The orthopedic doctor who did my fusion surgery is widely known for his research on bone health, regeneration, and engineering human bone.

Taking time to decide on surgery is a good idea. Doing research and asking lots of questions is very important. If you are going to have surgery, I would recommend doing it sooner rather than later. My mother had osteoporosis in her hips and when she finally decided to have a needed surgery, it had to be repeated the next day because the bone damage wasn't found until the doctor was in the operating room. She had a successful surgery but it took months longer for her recovery.

By the way, I went to a surgeon who was totally against doing surgery, even though he is a surgeon.
So I asked what his recommendation was for my future progress and this is what his nurse practitioner said,

By having patients work on their core strength the symptoms of spinal stenosis are controlled. Increasing core strength will give the support the spine needs. In addition, the pain management portion helps alleviate the pain associated with spinal stenosis.
I have severe lumbar stenosis. Is this to be believed ?

My Surgeon teaches at Columbia University, in the Neurosurgery department. I think that's a pretty good credential. As well as doing surgeries. He did look at my DEXA scan and the numbers I posted and said he is not doing fusion, my numbers are pretty good and also he is doing minimally invasive laminotomy. He told me that the longer I waited to do surgery the more risk I take of becoming immobile. I already can only walk 2 blocks before I have pain. He said I do not need to be on bone building medications to do this surgery, although I have been on Reclast for 3 yrs already. What do you think of the numbers I posted ? As I said he didn't think I was at risk for something going wrong, vs waiting and losing more mobility.

If my comment comes up twice, I briefly left the page and it was gone!
It sounds like you have found an excellent surgeon. A minimally invasive laminotomy is about 90% effective and has about a 6 week recovery rate. There is less damage to the muscles around the bone with this procedure. A laminectomy is open surgery and the incision is 2 to 5 inches long depending on the number of levels involved.
A laminectomy does not bring the spine back to its complete normal functioning and flexibility. A small degree of stiffness is usually present and usually remains life-long.
The T-score numbers on your latest DEXA look good. The Reclast treatment appears to be helping you. Doing a minimally invasive laminotomy shouldn't be a difficult surgery for you.
I chose to do my surgery because I had no quality of life and the pain was overwhelming me. I had to give up dancing, gardening, bike riding, long hikes and skiing. I was only sleeping 3 to 4 hours per night in my recliner. I couldn't lie in bed in any position. I couldn't walk to the end of my driveway and my husband was doing our grocery shopping. I had to sit on a chair to cook. Working on your core strength is important and you will need to do that the rest of your life. There comes a point though when the exercises and pain management won't be enough to help you. It sounds like you are either close to or at that point. I was in physical therapy for two years without much success and then a disc ruptured and the pain was unbearable. Most back surgeries are elective. Your doctor has offered a surgery he feels will help you but you are the only one who can make the decision to have the surgery. Good luck to you...

Update, I did see the surgeon and I am scheduled in 2 days for minimally invasive surgery. The NP told me they stabilize with the piece of my own bone that was cut out during the laminotomy.
As of this morning a different concern came up, that is drinking chamomile tea two weeks before surgery. I had no idea this could cause potential bleeding. I googled it after being told to stop taking chinese herbs before my surgery and found a few articles saying it is not recommended, that it can cause potentially more bleeding, however the articles didn't say how much tea I would have to drink to pose a risk. The NP said since they are doing minimally invasive this wouldn't be a problem. I really want to do this surgery. It's alot of work doing all this research. I don't think the surgeon would want to risk any problems for me either. I am waiting to hear back again from the NP in the morning, after her first response. I like her alot more now than in the past.