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Cervical Laminoplasty

This is a surgical procedure to widen the space available for the cervical spinal cord. It is a useful procedure for patients with compressive cervical myelopathy wherein the spinal cord gets squeezed due to the degenerative changes in the cervical spine.

This procedure involves the use of plates and screws to widen the space for the spinal cord. Lamina is section of bone that cause a roof over the spinal canal. In the procedure, a hinge is created on one side of the lamina, and the other side is wedged to open by a small metallic plate or a bone strut.

Laminoplasty is generally performed in the neck on cervical spine. Also, it may be performed in the middle or low back on thoracic or lumbar spine, especially in pediatric or younger adult patients. The procedure is sometimes performed to treat compression or the pressue on spincal nerves or spinal chord, which is caused by narrowing spinal canal. Laminoplasty a type of decompression surgey. Compression on the spinal nerves can produce pain, weakness, or numbness in a single arm or hand. Compression on the spinal cord can cause serious problems. It can permanently damage the delicate tissues of the spinal cord. Myelopathy, that is spinal cord compression may produce weakness, or numbness in both arms or legs, difficulty walking, or bladder control or impaired bowel.

Decompression with Cervical Laminoplasty can treat conditions such as:

1.Cervical Stenosis: Narrowing of the spinal canal in the cervical spine
2.Cervical Spondylotic Myelopathy: degenerative changes that cause myelopathy in the cervical spine Ossification of the posterior longitudinal ligament: A condition in which a ligament in the spinal canal becomes thickened and inflexible

Advantages of laminoplasty

it keeps the normal bone and ligament structure intact as compared to laminectomy which removes the lamina instead of hinging it open.

It helps to keep spinal balance normal, especially in the patients with spinal degeneration.

It also provides a protective layer that prevents scar tissue formation on the nerve (dural) sac after surgery.

It is a useful treatment option in some pediatric patients, since they are at greater risk than adults for spinal instability following the more extensive bone removal in a laminectomy.

For, individuals who need a greater amount of decompression may be more effectively treated with the full removal of the lamina, a laminectomy, since laminoplasty provides lesser decompression.

Surgeons consider many factors when choosing the appropriate procedure: age and medical condition of the patient, spinal curvature, mobility of the spinal column as measured on flexion/extension X-rays, number of spinal segments involved, location of the major component of spinal cord compression (in front of or behind the spinal cord), and degree of calcification of bone spurs. In general, the most appropriate candidates for cervical laminoplasty are patients with two or more levels of spinal stenosis, normal cervical curvature or a straight cervical spine, no excessive motion on flexion/extension X-rays, and limited or no neck pain.

This surgical procedure is performed under general anesthesia. An incision is made down the middle of the back of the neck, and the back of the spinal column is exposed.

Using an operating microscope and very fine surgical instruments, the surgeon makes a thin cut in the bone at the junction of the lamina and a spinal joint called the facet joint. This cut extends through the outer and middle layers of bone. On the other side of the bone, a similar cut is made that extends through the outer, middle and inner layer of bone. Once both cuts have been made, the lamina is wedged open, immediately opening up the spinal canal and relieving pressure on the spinal cord. The wedged-open portion is kept open with a small metal plate or a piece of bone.

During a laminoplasty, the surgeon may also perform a foraminotomy. This procedure enlarges the foramina, the holes through which nerve roots exit the spinal cord. A foraminotomy can relieve pressure on the nerve roots.

The surgeon will then close the incision and dress it with a bandage.

How Should I Prepare for this Procedure?

Make sure to tell your doctor about any medications that you’re taking, including over the counter medication and supplements, especially medications that can thin your blood such as aspirin. Your doctor may recommend you stop taking these medications before your procedure. To make it easier, write all of your medications down before the day of surgery.

Be sure to tell your doctor if you have an allergy to any medications, food, or latex (some surgical gloves are made of latex).

On the day of surgery, remove any nail polish or acrylic nails, do not wear makeup and remove all jewelry. If staying overnight, bring items that may be needed, such as a toothbrush, toothpaste, and dentures.

What Should I Expect After the Procedure?

Any surgical procedure is like an injury. After a cervical laminoplasty, there will be some discomfort and limitation of motion for a few weeks. You will probably stay in the hospital for one to two days, and you may need some pain medication for a short period of time. Your activity may be limited for a few weeks. You may increase your level of activity as you feel comfortable. Activities such as driving and returning to work depend on your own personal comfort and safety level.

The surgeon will schedule a follow up visit, typically 4-6 weeks after surgery. At this time, the surgeon will check healing, range of motion, the balance of the spine, and any other symptoms.

  • Will I need to wear a collar?
    No collar is needed in adults, but some patients like to wear a soft collar for comfort for a week or two after the procedure. Children and young adults may wear a rigid brace or collar for 6 weeks.
  • When can I begin to resume exercises?
    Low level and aerobic activities such as walking, elliptical, stationary or recumbent bikes may be instituted as soon as you are comfortable, often within a few weeks after surgery. In most cases, more rigorous activities should be delayed until 4-6 weeks after surgery.
  • Will I need Rehabilitation or Physical Therapy?
    For patients with significant preoperative myelopathy, rehabilitation therapy early in the postoperative period is advisable. Physical therapy for the neck is usually recommended 4-6 weeks following surgery. This includes instruction for proper balance, mechanics, and posture, modalities such as heat, massage, and ultrasound to release the muscles, and stretching, strengthening, and training the muscles of the neck and upper back.
  • Will I have any long-term limitations due to laminoplasty?
    There are no long-term limitations or disability due to this procedure.