Cervical open door laminoplasty
Cervical laminoplasty is a surgical procedure that removes pressure from the spinal cord in the neck. It is commonly performed to treat cervical myelopathy, a condition where pressure on the spinal cord produces neurologic changes.
As opposed to the more traditional surgeries, laminoplasty does not involve fusion of the neck bones and thus preserves almost normal range of motion. Patients tolerate this procedure much easier compared to traditional multilevel fusion surgery.
Indications: when is laminoplasty recommended?
The usual indication for laminoplasty is narrowing of the spinal canal in the neck at multiple levels. This narrowing, called stenosis, puts pressure on the spinal cord and causes myelopathy, abnormal function of the cord. Read more about myelopathy in this article.
How is laminoplasty performed?
The spinal canal is enclosed between the large bones in the front (vertebral bodies) and a thin layer of bone in the back (lamina). To widen the canal and remove pressure on the cord, the lamina is cut on one side and bent away from the cord like an open door on a hinge. The opening is then held in place with titanium plates and screws.
What is the success rate of laminoplasty?
There are two ways to define success of laminoplasty: prevention of neurological worsening and improvement of neurological symptoms. Scientific studies report improvement in up to 60% of patients. It is, however, sometimes difficult to tell exactly who will see improvement since sometimes the spinal cord may have permanent damage due to prolonged pressure.
The main goal of the early postoperative period is uncomplicated healing of the incision, which occurs around two weeks. Immediately after the surgery, there are no limitations in physical activity. Early range of motion is encouraged. A cervical collar is not needed.
Pain is usually present during the initial stages of recovery, for 3 to 5 days. As opposed to fusion surgeries, anti-inflammatory medications are permitted from day one.
What are the benefits of laminoplasty?
The main benefit of laminoplasty is preservation of motion, since compared to other techniques, it does not involve fusion of bones. Laminoplasty is less invasive than fusion and may be a reasonable option in patients who cannot tolerate bigger surgery.
Benefits of laminoplasty:
- preservation of neck motion;
- less pain and faster recovery;
- cervical collar not needed;
- ability to use anti-inflammatory medications;
- less expensive than fusion surgery.
Limitations of laminoplasty
- In some cases laminoplasty may not be the right option:
- significant deformity in the neck, scoliosis and especially kyphosis (forward bending of the neck);
- instability: abnormal movement between the spine bones;
- severe neck pain.
What are the risks of laminoplasty?
As with any surgical procedure, laminoplasty has risks. Risk of most of these complications is very small. However, when you make the decision to undergo a procedure, you need to weigh the benefits and risks.
Some risks are common with other spine surgeries:
- injury to the nerves;
- leakage of cerebrospinal fluid;
- failure of instrumentation;
- risks of anesthesia;
- collection of blood in tissues with pressure on the nerves.
Other complications are specific to laminoplasty itself:
- injury to C5 nerve root, which may cause weakness in the shoulder and elbow;
- failure to improve;
- recurrence of stenosis if the opening in bones closes.
How do I know if laminoplasty is right for me?
Laminoplasty may be recommended if there is pressure on the spinal cord at multiple levels causing your symptoms. Additional imaging will need to confirm the absence of severe neck deformity. You should also not have severe neck pain.
What are alternatives to laminoplasty?
Not every person with pressure on the spinal cord will require surgery. Physical therapy for strengthening and balance training is usually the first step in treatment.
If surgery is considered, there are several alternatives to laminoplasty, including ACDF (Anterior Cervical Decompression and Fusion), cervical laminectomy with posterior instrumented fusion.
How do I prepare for surgery?
In preparation for surgery, follow the standard instructions by following this link.
Find instructions by this link.