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Laminoplasty

Cervical Laminoplasty

Cervical Laminoplasty is a procedure to take pressure off the spinal cord in the neck and restore neurological function. Portions of the lamina, the thin bony layer covering the spinal cord (also referred to as the “roof” of the spinal cord), are removed to create more space for the spinal cord and nerve roots.

The most common cause of cervical spinal cord compression is age-related degenerative arthritis, that may include bone spurs and disc herniation. Other conditions that may pinch the spinal cord in the neck include:
  • Tumors
  • Fractures
  • OPLL, a calcification of the soft tissues that connect the spinal bones, which can narrow the spinal canal and compress the cervical spinal cord

What are the symptoms of cervical spinal cord compression?

Notice the spinal cord compression and how the spinal cord is turning “white” in areas.

A spinal cord compression may or may not cause overt symptoms. It may instead lead to weakness in the upper extremities because a nerve root is pinched.

When the spinal cord is compressed consistently, it may result in a condition called Myelopathy, which causes numbness, pain or weakness in the arms or hands. Sometimes it leads to balancing problems or dexterity issues, as well. Spinal cord compression can gradually paralyze you if not treated.

When a physician evaluates the need for surgery, the workup entails imaging studies, a physical exam and usually a nerve conduction study.

Surgery for the spinal cord compression helps relieve the symptoms and may lead to a reversal of the condition, or it may just stop the progression.

How is a cervical laminoplasty performed?

Cervical Laminoplasty is performed under a general anesthesia with entry through the back of the neck. The patient will be lying face down and typically spinal cord neuromonitoring is used during surgery to monitor the spinal cord function.

The lamina (indicated in green above) is often called the “roof” of the spinal column. Cervical Laminoplasty “raises the roof” to create more room in the spinal canal. Image courtesy of Ryan Johnson. Reproduced under a Creative Commons license with modifications allowed.

In an “open door” laminoplasty, the surgeon will cut one side of the lamina in the area of compression and make a “hinge” on the other side. The roof of the spine is then gently lifted up on the open side, hinging on the other side, to give the spinal cord and nerve roots room to breathe. A spacer and sometimes a metal plate are used to ensure the space stays open.

Most patients spend only one night in the hospital, and many go home the same day. A soft neck collar is usually worn for about 6 weeks after the surgery.

What are the results of a cervical laminoplasty?

One of the major advantages of laminoplasty, versus cervical fusion, is that it relieves pressure on the spinal cord while preserving range of motion in the neck. (So you don’t have to worry about your golf game suffering!)

Complication rates are very low for this procedure, including a low chance of infection or anesthesia complication. Laminoplasty is noted to be a particularly excellent procedure for elderly patients with spinal cord compression, as it restores neurologic function well and stabilizes the spine.

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