This is a procedure performed in the neck, designed to relieve pressure on the spinal cord.
What causes pressure on the spinal cord?
There are a number of conditions that may pinch the spinal cord in the neck, including:
Who benefits from a laminoplasty?
When a person has spinal cord compression, it may or may not cause overt symptoms. It may lead to weakness in the upper extremities due to a nerve root being pinched.
When the spinal cord is compressed consistently, it may react and result in a condition called myelopathy. This may lead to numbness, pain or weakness in the arms or hands.
In addition, it may lead to balancing problems or dexterity issues. When a physician evaluates one for the need for surgery, the workup entails imaging studies, a physical examination and possible a nerve conduction study.
Surgery for the spinal cord compression helps relieve the symptoms and may lead to a reversal, or it may just stop the progression.
Laminoplasty is noted to be a particularly excellent procedure in elderly patients with spinal cord compression, as the incidence of airway compression is lower than with anterior surgery.
How is the procedure performed?
A cervical laminoplasty is performed under general anesthesia with an approach through the back of the neck (posterior). The patient will be laying face down, and typically spinal cord neuro-monitoring is utilized.
Once the bony area of the neck is reached, the surgeon will make partial cuts on both sides of the lamina at the level(s) where pinching is occurring. However, a full cut is only made on one side so that the other side will act as a hinge.
The open side is then lifted, and some sort of spacer is placed to give the spinal cord more room to “breathe”. The space may be made out of bone, metal or plastic. Effectively, this is a door stop and is called an “open door” technique. Some surgeons will apply a metal plate to make sure the door stays open.
The second technique is to utilize a hinge on both sides and not to fully cut either. Then to lift both sides up, which is called a “French door” laminoplasty.
While the laminoplasty procedure is performed worldwide, it was initially performed by the Japanese. It has a low complication rate and very good outcomes.
Most patients do not need a fusion at the same time as the decompression. This is great because patients are able to have preserved motion in the neck.
What are the outcomes?
Laminoplasty is not a procedure for neck pain. In fact, most patients have increased neck pain post-operatively.
The procedure does well for what it is intended, which is neurological improvement. A study in Journal of Spinal Disorders showed almost 30% neurological improvements, with a slightly better outcome with the open door technique as opposed to the French Door technique.
Most patients only need to spend one night in a hospital if that.
Complication rates are very low for a cervical laminoplasty. There is a low chance of infection or anesthesia complication. Unfortunately up to 60% experience increased neck pain after the procedure. Although the lack of fusion is supposed to preserve neck range of motion, it does decrease 50% on average of motion.
When compared with a laminectomy and fusion, studies have shown a similar beneficial outcome for neurologic recovery.