Introduction
Laminoplasty (cervical laminoplasty) is a neurosurgical or orthopedic surgical procedure that treats spinal stenosis (spinal canal narrowing) by releasing pressure on the spinal cord. Spinal cord compression may cause symptoms like neck stiffness, numbness in the limbs, neck pain, and difficulty walking. The main objective of laminoplasty is to prevent the worsening of these symptoms. Researchers in Japan published the first description of laminoplasty in medical journals in 1972. Since then, numerous laminoplasty procedures have been created. Even though the details of each approach vary, they all involve relocating the lamina and fixing it in place with screws and a metal plate. The lamina, a bony part of the cervical vertebra, is relaxed and repositioned by surgeons during a cervical laminoplasty.
What Is Laminoplasty?
Laminoplasty is a surgery used to treat cervical myelopathy. It was made as an alternative to cervical laminectomy. It involves cutting the lamina to create more space and swinging it open like a door. Laminoplasty reconstructs the vertebral lamina to decompress the spinal cord. It involves the process of creating a hinge to raise the lamina. The first laminoplasty procedure was established by modifying Miyazaki and Kirita's laminectomy technique, and this method is known as Z-shaped laminoplasty.
What Is the Purpose of Laminoplasty?
Laminoplasty is primarily done to decompress the spinal cord's upper section that runs through the neck. Cervical myelopathy can result from compression of this area of the spinal cord. The primary goal of this surgery is to provide relief to patients who may suffer symptoms of numbness, pain, or weakness in their movements. Patients may also struggle with hand and finger mobility, as well as difficulty in balancing and walking. In addition, this surgery is often done to relieve pressure on the spinal cord in the neck, which a number of things can cause. Tumors, arthritis, fractures, bone spurs, disc herniations, and degenerative issues are examples of these.
What Are the Indications for Laminoplasty?
Cervical myelopathy, spinal cord compression, failure of non-surgical methods to relieve neck pain and stiffness, and congenital spinal canal stenosis are indications of laminoplasty. Laminoplasty is not advised for those with moderate to severe cervical kyphosis or an abnormally rounded upper spine.
What Are the Steps Involved in Laminoplasty?
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The surgeon will make an incision in the center of the neck and will use a specific device to keep the skin, fat, and muscle away from the bone.
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Then, a groove is placed in the lamina on one side of the spine using a special drill. This will result in the formation of a hinge.
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Using the special drill, a cut is placed through the lamina on the other side of the vertebra.
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Then the cut side of the lamina is lifted using the groove made on the other side as a hinge.
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To hold the repositioned component of the vertebrae in place, a metal plate will be placed with screws.
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A drain is used to stop bleeding. It is usually removed the following day. Following the treatment, the physician will heal the wounds with stitches or staples. Vancomycin, a topical antibiotic powder, may be used to reduce the risk of infection.
What Are the Different Types of Laminoplasty?
Z-shaped laminoplasty, open-door laminoplasty, and double-door laminoplasty are the common techniques used for spinal cord decompression.
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Z-shaped Laminoplasty - A drill is used to thin out the C2 to C7 laminae. It is critical to decompress more than one laminae region. A Z-shape is sliced on the laminae, and the laminae are lifted and sutured together.
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Open Door Laminoplasty - Drilling is done at the lateral boundaries of the C2 to C7 laminae. The bone is sliced on one side, while the other serves as a hinge. The laminae are then raised to make more room in the spinal canal. A suture attached to the facet capsule keeps the flap of the laminae open.
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Double Door Laminoplasty - A drill is used to cut the bone at the midline of the vertebral laminae. The lateral surfaces of the laminae act as a hinge, allowing the spinal canal to expand, specifically the inner cortex. To keep the aperture stable, an artificial spacer is used. Hydroxyapatite is a commonly used spacer.
What Are the Complications of Laminoplasty?
Complications of laminoplasty may include nerve injury to the nerve roots or the spinal cord, resulting in limb weakness or paralysis. Other complications include spinal fluid leakage, infection, and ineffective compression relief. The complications associated with laminoplasty are more common in older patients. Even though the success rate of a laminoplasty operation depends on the disease that led to the need for surgery, about 75 percent of people who have this procedure report a significant decrease in pain.
What Is the Difference Between Laminectomy and Laminoplasty?
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Laminectomy is a major spine operation. It is a surgical technique that removes the roof of the spinal canal by removing a part of a vertebra called the lamina. During a laminectomy, a small incision will be made in the back or neck above the damaged vertebrae. Tiny instruments will be placed via the incision to cut and remove the lamina. If the laminectomy is done with a spinal fusion, two or more vertebrae will be permanently joined together.
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Laminoplasty, also known as cervical laminoplasty, is solely performed on the neck area of the spine. The surgeon constructs a hinge with the lamina through a minor incision in the back of the neck, opening up the spinal canal area. Tiny metal plates are inserted to bridge the newly formed gap.
Conclusion
Laminoplasty involves reconstructing the laminar arch (posterior approach) and increasing the space available for the spinal cord. It primarily treats cervical myelopathy, which involves spinal cord compression. The main purpose of this surgical procedure is to reduce the symptoms of numbness, weakness in the arms, or pain due to spinal cord compression. Laminoplasty is contraindicated in patients with kyphotic alignment (round back) and substantial instability.
