Overview
Laminoplasty
A laminoplasty is a procedure that reaches the cervical spine from the back of the neck, which is then reconstructed to make more room for the spinal canal.
For patients with painfully restricted spinal canals in their necks, this procedure immediately relieves pressure by creating more space for the spinal cord and roots.
The technique is often referred to as an "open door laminoplasty," since the back of the vertebrae is made to swing open like a door.
Laminaplasty - Step 1
The diagram at left shows one way to perform the laminaplasty. A cut is made of the lamina down the middle, then grooves are made at the edges of the lamina that allow the lamina to be hinged open. These cuts are shown in red in the diagram below. The compressed spinal cord is shown in blue.
When the lamina is opened in such a manner, it can be held open by using a spacer of bone as shown below. Note the free and expanded spinal cord (in blue).
Laminaplasty - Step 2
The result is a conversion of the area for the spinal cord from a small triangular area to a large rectangular area. This elegant reconstruction allows for the muscles to attach to the new lamina and to provide protection from direct trauma to the spinal cord and protection from the spine falling forward..
The Surgery
An incision is made on the back of the neck. A groove is cut down one side of the cervical vertebrae creating a hinge. The other side of the vertebrae is cut all the way through. The tips of the spinous processes are removed to create room for the bones to pull open like a door. The back of each vertebrae is bent open like a door on its hinge, taking pressure off the spinal cord and nerve roots. Small wedges made of bone are placed in the opened space of the door. The door of the vertebrae swings shut, and the wedges stop it from closing all the way. The spinal cord and the nerve roots rest comfortably behind the door.
Posterior Laminoplasty
In order to reduce the risk of post-operative instability and to avoid a fusion, some surgeons will recommend lifting the lamina on one side and leaving a hinge on the other side.
The advantage of this technique is that it increases the size of the canal but leaves the posterior tether that helps keep the spine stable.
The disadvantage is that it may not be as easy to decompress the nerves on both sides as they exit the foramen.
Possible Risks/Complications
A laminectomy or laminaplasty may not be successful in releasing compression on the spinal cord if the spine is not in lordosis (normal swayback). In such a case, anterior cervical corpectomy may be necessary to treat the spinal cord compression.
As with cervical corpectomy (also done for cervical stenosis with myelopathy) the principal risk is deterioration in neurological functioning after the surgery.
potential risks include : -
- Dural tear (cerebrospinal fluid leak)
- < 1% infection rate
- Bleeding
- Increased pain
- "collapse" of the hinge
- Instability in the spinal column
- Progressive kyphosis
- Death
After Surgery
If the surgery simply prevents progression of the spinal cord damage (myelopathy) and there is no loss of function due to the surgery, both the patient and surgeon should consider it successful.
Patients will feel some pain after surgery, especially at the incision site. While tingling sensations or numbness is common, and should lessen over time, they should be reported to the doctor. Most patients are encouraged to be up and moving around within a few hours after surgery. After surgery, your doctor will give you instructions on when you can resume your normal daily activities.
Signs of infection like swelling, redness or draining at the incision site, and fever should be checked out by the surgeon immediately. Keep in mind, the amount of time it takes to return to normal activities is different for every patient. Discomfort should decrease a little each day. Most patients will benefit from a postoperative exercise program or supervised physical therapy after surgery. You should ask your doctor about exercises to help with recovery.
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