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Review of Cervical Laminaplasty
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Posted on: 01/17/2008
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In this article, the procedure called cervical laminaplasty is discussed in detail. It is a relatively new procedure for cervical disease. The first operation was done in 1982 with good results. Laminaplasty is an indirect way of taking pressure off the spinal cord.
The lamina is a thin layer of bone located between the spinous process and the pedicle. The spinous process is the bone that projects out from the vertebra. It can be felt along the back of the spine and is referred to as the backbone. The pedicle is a bridge of bone between the vertebral body and the arch that forms a circle of bone around the spinal cord.
Laminaplasty is done by opening the lamina just on one side. This creates a hinge joint that makes more room for the spinal cord inside the spinal canal. The procedure has been changed many times over the last 25 years.
One of the more popular modifications is the French door approach. A thin trough or channel is made in the lamia on each side of the spinous process. Then the spinous process is split down the middle. The two sides of the lamina (each with half a spinous process attached) open outward like French doors. The doors are held open by metal plates and ceramic spacers.
There are many advantages and disadvantages of the laminaplasty technique compared to the anterior approach. Anterior means the operation is done from the front of the spine rather than the back.
With a laminaplasty, the patient does not have to be put in a brace afterwards. No bone graft is used so there's no risk of graft failure. There are no problems with swallowing or loss of vocal cord control. Both of these complications are possible with an anterior approach.
Laminaplasty may be better than a laminectomy where the lamina is removed. With laminaplasty, the bone is still there to protect the spinal cord. There's less chance for deformity of the cervical spine (neck) after laminaplasty compared with laminectomy.
The main disadvantages of laminaplasty are neck pain after the operation, nerve damage, and poor cosmetic appearance. Neck pain occurs because the muscles are stripped away from the bone.
The authors provide a detailed description of the procedure. Photos of the patient's position, traction and frame used, and dissection of the tissues are included. Videos are also available to show surgical technique and modifications of the procedure.
Pearls and pitfalls of laminaplasty are listed to guide the surgeon. Tissue closure of the wound is discussed along with specifics of postoperative care.
Patients can expect to stay in the hospital for up to 48 hours. Range of motion is started right away. Rehab continues at the time of discharge. Full return to normal activities (including aerobic exercise) is possible by the end of six weeks.
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References:
Ronald A. Lehman, Jr, MD, MAJ, MC, et al. Surgical Techniques: Cervical Laminaplasty. In Journal of the American Academy of Orthopaedic Surgeons. January 2008. Vol. 16. No. 1. Pp. 47-56.
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