Laminoplasty

In order to reduce the risk of post-operative instability and to avoid a spine fusion, some spine surgeons will recommend lifting the lamina on one side and leaving a hinge on the other side, a procedure that is called a laminoplasty. An alternative to laminectomy is a procedure that hinges the lamina open, without complete removal of the bone. Laminoplasty can expand the spinal canal and also allows surgeon to address adjacent spine segments (levels) that are mildly affected.

Indication :-

• Multilevel cervical spondylotic myelopathy
• OPLL(ossified posterior longitudinal ligament)

Advantages :-

• This technique increases the size of the canal but leaves the posterior tether that helps keep the spine stable.So after this fusion is not require
• Laminoplasty preserves 30 to 50% of motion at the involved levels. This is more than laminectomy or anterior surgery
• May address more levels
• Avoids graft complications

Disadvantages:-

• The disadvantage is that the canal is not well visualized,and it is difficult to assess whether or not the canal has been well decompressed.
• Because pain is often related to motion, laminoplasty is not intended for patients with neck pain. This is because motion still occurs after the procedure.
• In some cases, the lamina that is hinged open can inadvertantly close.
• Cannot be used in unstable or kyphotic spines
• Late instability or deformity risk is their with laminoplasty

Contraindication:-

• These approaches cannot be used in patients with kyphotic (bent forward) spines, since the cord will not shift backwards.
• It should not be used for patient with predominant neck pain

Complication and risk :-

General Risks

The potential risks for cervical spine surgery include;

• Infection
• Bleeding
• Injury to the spinal cord
• Reactions to anesthesia
• Need for additional surgery in the future
• Failure to relieve symptoms
• Tear of the sac covering the nerves (dural tear)

Posterior Cervical Spine Surgery Risks

The potential risks for posterior cervical spine surgery include:

• Degeneration of disk levels above or below surgery level
• Injury to the vertebral artery
• Stretch on the nerves from the spinal cord drifting backwards

Outcomes

• The primary goal of surgery for CSM, regardless of approach, is to stabilize the spine and prevent neurologic problems from getting worse. The goal is not necessarily to restore normal function. A secondary goal is potentially improving the associated neck pain, motor (weakness), sensory (numbness/tingling), and gait (walking) disturbances.
• Final outcomes from the surgery vary. Typically, one-third of patients improve, one-third stay the same, and one-third continue to worsen over time, with respect to their pre-surgical symptoms.
• People with CSM are recommended for surgery to make sure that their symptoms do not get worse. In most cases, the symptoms they have going into the operating room are what they will have afterwards.