What is Laminoplasty?
Cervical laminoplasty surgery is a technique used to increase the space available for the spinal cord in the cervical spine (neck) but without having to perform a spinal fusion.
This is typically performed when a patient has symptoms of a disorder called myelopathy, which causes pain, numbness, and weakness in the arms and legs, difficulty with hand dexterity, and difficulty with balance while walking.
Cervical laminoplasty surgery is typically recommended when patients have normal cervical alignment, and multiple levels of compression of the spinal cord causing symptoms of myelopathy.
Cervical Laminoplasty Procedure
Patients are positioned on their belly (face down) for cervical laminoplasty surgery which is performed under general anesthesia.
After cleaning the skin and placing sterile drapes, an incision is made in the back of the neck. After the cervical spine is carefully exposed, a high-speed burr is used to cut completely through the lamina (the roof of the spinal canal) on one side, while a partial cut is made on the other side.
The lamina is then carefully hinged open to create more space for the spinal cord, and then the hinged lamina is kept open by applying a small plate with screws. The incision is then closed.
Cervical Laminoplasty Recovery
After cervical laminoplasty, patients can typically go home from the hospital the day after surgery. A soft collar is provided for comfort but no collar at all is necessary after surgery.
This operation can be painful due to the exposure of the back of the neck, but typically patients can get off narcotic pain medications with 2 weeks of surgery.
Patients are restricted from heavy lifting and doing overhead activities for 4 weeks after surgery, but then patients can return to all activities as tolerated without any formal restrictions as there is no need to wait for a spinal fusion to heal.
The surgery is not meant to treat neck pain, but is meant to relieve myelopathy symptoms from spinal cord compression. If patients had neck pain prior to surgery, they often will continue to have neck pain that is similar to their pre-operative levels once they recover from the surgery itself.
Patients with cervical myelopathy can become fairly debilitated and weak from this condition, so recovery from the procedure can be prolonged if the patient was very weak and had severe spinal cord compression before surgery.
If, however, the patient only had mild myelopathy symptoms, patients typically notice significant improvement in their hand function and walking ability within a few days to weeks after surgery. The full extent of spinal cord recovery is not known until 1 year after surgery.
Patients with severe symptoms before surgery typically will not recover fully back to normal due to the limited ability of the spinal cord to heal. This is why it is important that patients with even mild myelopathy symptoms be treated before their symptoms worsen.
Laminoplasty vs Fusion
Not all patients are candidates for cervical laminoplasty and instead another procedure is recommended to treat their spinal cord compression.
Other procedures that are commonly used to relieve spinal cord compression include an anterior cervical discectomy and fusion (ACDF) or a cervical laminectomy and fusion.
ACDF is typically recommended when only 1 or 2 levels are affected, or there is spinal instability or kyphosis (abnormal forward alignment) of the cervical spine. If multiple levels are affected and there is spinal instability, or the area affected extends into the upper part of the thoracic spine, a cervical laminectomy and fusion is often the optimal procedure.
If there is a significant cervical deformity or malalignment of the spine, a combination of ACDF and a posterior cervical laminectomy and fusion may be recommended.
However, for patients with normal cervical alignment, no instability, and multiple levels of spinal cord compression, cervical laminoplasty surgery can successfully relieve pressure on the spinal cord without having to fuse the spine.
Risks of Cervical Laminoplasty
While all spinal operations carry some risks, the risks of cervical laminoplasty are relatively low. The risks include:
Infection - surgery through the back of the neck carries a somewhat higher rate of infection compared to procedures through the front of the spine, however the risk is still quite low (2-3%)
Post-operative neck pain that is worse than before surgery. This is likely technique dependent and varies greatly from one surgeon to another and from one patient to another. Performing a hybrid procedure with a C3 laminectomy and a laminoplasty of other levels has been shown to decrease post-operative neck pain as well as meticulous surgical technique to remove bone impingement that can cause post-operative neck pain
Cervical instability or cervical kyphosis. Because a decompression is being performed without a fusion, some patients will develop a malalignment of the spine where their head begins to fall forward (kyphosis). If this occurs then a spinal fusion may be necessary to correct and maintain appropriate spinal alignment. With good surgical technique, however, the risk of post-operative cervical kyphosis is fairly low.
Lack of improvement in myelopathy symptoms. In some patients, the pre-operative damage to their spinal cords does not recover even after surgery. However, surgery to remove the pressure from the spinal cord will prevent any further worsening of their myelopathy symptoms which can sometimes progress rapidly if the pressure from the spinal cord is not removed.
If you have more questions or would like to schedule an appointment with Dr. Nemani to see if you are a candidate for a cervical laminoplasty surgery, please call 919-781-5600 or book an appointment online.