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Dr Daniel Park, Orthopedic Spine Surgeon, Royal Oak, Southfield, West Bloomfield, Oakland County, MI   |   Patient Info   |   Procedures   |  Cervical Laminoplasty

Cervical Laminoplasty

Disease Overview

Degeneration of the facet joints and intervertebral discs that connect vertebrae to one another results in narrowing of the spinal canal, known as spinal stenosis. In addition, the arthritic facet joints become bulkier and consume the space existing for the nerve roots. Besides, thickened ligaments and bony outgrowths are also known as bone osteophytes or bone spurs can also narrow the spinal canal. The condition of spinal stenosis, narrowing of the spinal canal, puts pressure on the spinal nerves and spinal cord, causing symptoms such as neck pain, tingling sensation, numbness or weakness that extends to the shoulders, arms and/or hands and bowel or bladder impairment.

What is Cervical Laminoplasty?

A cervical laminoplasty is an operative procedure that involves reshaping/repositioning the bone at the neck region (cervical spine) to relieve excess pressure on the spinal nerves. It can also be performed to relieve the symptoms of the narrowed spinal canal known as spinal stenosis.
Laminoplasty involves repositioning or reshaping of the lamina (roof), unlike laminectomy which involves the removal of the lamina. This procedure is also called an open door laminoplasty because it involves hinging one side of the vertebrae and cutting the other side to form a door, which is opened and placed with wedges made up of bone and instrumentation.
The objective of cervical laminoplasty is to relieve pressure on the spinal nerves by removing the source of pressure without disturbing the stability of the posterior elements of the vertebrae. 

Diagnostic Tests Performed before Cervical Laminoplasty 

Your surgeon recommends you for cervical laminoplasty after examining your spine, medical history, and imaging results of cervical vertebrae such as X-ray, CT (computed tomography) scan or MRI (magnetic resonance imaging). 

Indications for Cervical Laminoplasty 

Surgery is recommended only after non-surgical treatment approaches fail to relieve symptoms after a reasonable period.

Cervical Laminoplasty Procedure

The procedure is performed with you resting on your stomach under general anesthesia. Your surgeon makes a small incision near the center of the back of your neck and approaches the neck bones (cervical vertebrae) by moving the soft tissues and muscles apart. The spinal processes of the vertebra are removed. Then, a side of the cervical vertebra is cut to make a hinge. Later, the other side is also cut, allowing the bones to open like a door. The back of each vertebra is bent back to remove pressure on the spinal cord and spinal nerves. 
Other compression sources such as bone spurs, excess ligaments and/or disc fragments (discectomy) are also removed. Small wedges are placed in the open space of the door and sealed with proper instrumentation. After the procedure, your surgeon brings back the soft tissues and muscles to their normal place and closes the incision.

Postoperative Instructions following Cervical Laminoplasty

A specific postoperative recovery/exercise plan will be given by your physician to help you return to normal activity at the earliest. After surgery, your symptoms may improve immediately or gradually over the course of time. The duration of your hospital stay depends on the treatment plan. 
In a few instances, surgery may also be performed on an outpatient basis. You will be able to wake up and walk by the end of the first day after the surgery. 
Your return to work will depend on your body’s healing ability and the type of work/activity that you plan to resume. 

Risks and Complications of Cervical Laminoplasty

All surgeries carry potential risks and it is important to understand these so that you can make an informed decision to go ahead with the surgery. In addition to the anesthetic complications, spinal surgery may be associated with some potential risks such as infection, blood loss, blood clots, nerve damage, spinal cord injury, and bowel and bladder problems. Failure to fuse the vertebral bones with the bone graft (fusion failure) is an important complication of spinal fusion which usually requires an additional surgery.

Clinical Example

48 year old cook presents with dropping her kitchen tools and feeling clumsy. MRI shows severe spinal cord compression. The spinal cord is bruised as well (arrow). The left image is a side view. The middle view is a cross section of a normal spine. The right shows the spinal cord (arrow) being compressed.

  • Case Study
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Because of her age and wanting flexibility, we did a laminoplasty. We created more room for her spine and did not do a fusion. It is motion preserving. Left image is a side view MRI showing more space for the spinal cord. The middle picture is a cross section of the same level that showed cord compression now wide open.

  • Case Study
  • Case Study

What a laminoplasty does is reshape the bone and make the space for the spinal cord large and places a titanium door stop to prevent the space from reclosing. Left image is a normal cross section of the spine. The right image shows the space reshaped. The area for the spinal cord is much larger (arrows).

  • Case Study
  • Case Study

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