Minimally Invasive Laminotomy
& Foraminotomy

A standard open laminectomy removes the entire lamina and spinous process through a large midline incision, requiring extensive stripping of the paraspinal muscles from the bone on both sides. The muscles are cut, retracted forcefully, and devascularised over a significant area — causing substantial postoperative pain, prolonged recovery, and in some cases long-term muscle weakness and spinal instability. A minimally invasive laminotomy through a tubular retractor removes only the portion of lamina that is causing compression, through an 18-mm port, with the muscles spread rather than cut along natural tissue planes. The spinous process, the supraspinous and interspinous ligaments, and the majority of the facet joint are preserved. The patient goes home the same day. Based on articles retrieved from PubMed, the complication rate with MIS laminotomy was 8% versus 56% for open laminectomy in a prospective comparative study, with equivalent clinical outcomes for pain and disability.

For the right anatomy, yes — and based on articles retrieved from PubMed, a 7-year follow-up study published in Spine found that minimally invasive posterior cervical foraminotomy (MI-PCF) produced superior neck and arm pain scores compared to ACDF at final follow-up, with equivalent revision and complication rates. The posterior foraminotomy is appropriate when: the compression is unilateral (one side only), the dominant compression is foraminal rather than central disc herniation, there is no significant instability, and the disc height is maintained. It is particularly effective for cervical radiculopathy from foraminal stenosis or a soft-to-moderate lateral disc herniation. The key advantage: no disc removal, no cage, no fusion, no plate — motion at the operated level is completely preserved. A second opinion consultation determines whether your specific anatomy is appropriate for a posterior approach.

An ultrasonic bone scalpel cuts bone through rapid oscillatory vibration rather than the rolling motion of a standard high-speed rotating drill. This distinction is clinically important during spine decompression because the bone being removed is immediately adjacent to the dura mater and nerve roots — structures that can be injured by an inadvertently applied spinning instrument. The ultrasonic tip selectively cuts mineralized bone while largely sparing soft tissue — if the tip contacts dura or a nerve root, the cutting effect is substantially reduced compared to a rotating burr. Based on articles retrieved from PubMed, a 2025 comparative study found that ultrasonic bone scalpel use in cervical and lumbar surgery produced significantly lower blood loss and significantly better clinical improvement compared to high-speed drill. A thermal study comparing the Stryker Sonopet and Masonix devices found the Sonopet maintained temperatures well below the threshold for thermal neural injury during laminectomy. Both devices are available here and used selectively based on the anatomy of each case.

Not if the procedure is performed correctly and you are an appropriate candidate. Laminotomy and foraminotomy are decompression procedures that do not destabilise the spine when performed with the MIS tubular approach — because the stabilising posterior ligaments (supraspinous, interspinous), the spinous process, and the majority of the facet joint are preserved. Fusion is added when instability is present — either pre-existing (as in spondylolisthesis) or when the decompression itself must remove enough facet joint to risk destabilisation. For straightforward central stenosis without instability, and for foraminal stenosis without spondylolisthesis, decompression alone is appropriate and fusion adds risk without benefit. The pre-operative assessment specifically evaluates for instability on standing flexion-extension X-rays to ensure that decompression alone is appropriate for your anatomy.

Yes — multilevel MIS laminotomy can be performed through separate small incisions at each level, one per level, each with its own 18-mm tube. Up to three levels can typically be decompressed in a single outpatient procedure. For bilateral stenosis requiring bilateral decompression at each level, the contralateral side can be addressed by angling the tube across the midline after ipsilateral decompression at each level, achieving bilateral canal decompression without bilateral incisions. The total number of skin incisions equals the number of levels treated, each approximately 1.5–2 cm. Even three-level decompression typically remains a same-day outpatient procedure with this approach. The decision to decompress multiple levels is based on the imaging findings and the clinical pattern — not every level that appears abnormal on MRI requires surgery.

Fusion is added to decompression when instability is present or when the decompression needed would create instability. The specific situations: spondylolisthesis — a vertebral slip indicates pre-existing instability that decompression alone does not address; degenerative scoliosis or lateral listhesis — significant coronal plane malalignment requires correction; large facetectomy required — when severe foraminal stenosis requires removing more than approximately 50% of the facet joint to adequately decompress the nerve root, stability is at risk; multilevel disease with global instability — diffuse segmental hypermobility on flexion-extension X-rays; and revision decompression after prior extensive laminectomy — a spine already significantly destabilised by prior surgery. For cases that sit at the boundary, Dr. Katsevman discusses the decision explicitly with the patient before surgery. Fusion is not added reflexively — it is added when the anatomy specifically requires it.