What is Laminoplasty?
If the spinal canal is narrowed, such as in the case of spinal stenosis, the spinal cord and the nerves can become pinched or compressed. This causes irritation, pain and can lead to other serious complications. A Laminoplasty is a surgical procedure that makes more room in the spinal canal for the nerves and the spinal cord. The laminae can be compared to double doors. In this procedure, the laminae are surgically split and then the doors are held open by sutures or other surgical methods.
A Laminoplasty is most often performed in the neck area or the cervical spine. It can successfully make a significantly enlarged space for the spinal cord and the nerves. For some patients, a Laminoplasty a good option to consider instead of spinal fusion.
Laminoplasty is a surgical procedure which involves the process of increasing the space available to relieve abnormal pressure on the spinal cord and its nerve roots. It is done by reconstruction of the laminar arch via a posterior approach. Laminoplasty is a motion preserving surgery, in which no fusion is performed and motion is not changed.
Laminoplasty may be performed in several conditions like spinal stenosis, spinal tumors, and syringomyelia. It is the mainstay treatment of cervical stenosis due to ossification of the posterior longitudinal ligament. Patients with degenerative spinal stenosis due to Spondylotic Myelopathy also show benefit after spinal decompression with Laminoplasty. It is also a procedure used to access underlying spinal diseases like tumor or Syringomyelia (spinal cyst).
Contraindications of Laminoplasty
Laminoplasty is not recommended for patients with kyphotic deformity, instability of the affected segment, spinal pathologies like cervical disc disease or traumatic vertebral body fracture with canal compression. These types of spinal pathologies are best treated by an anterior approach.
Risks of Laminoplasty
Any spinal surgery has potential surgical risk involved. This should be discussed with the patient during his pre-operative appointment. Potential complications of Laminoplasty may include:
- Pain and numbness due to nerve manipulation
- Weakness or paralysis due to the spinal cord or nerve root damage
- Bowel or bladder incontinence
- Cerebrospinal fluid leak
- Bleeding or injury to major blood vessels
- Persistent or recurrent pain
Laminoplasty is done under general anesthesia. The patient is positioned face down on a special surgical bed. It is performed through a small incision on the back of the spine. Once the surgeon has safely created a window to expose the spine, the lamina is carefully cut all the way through. This allows the vertebrae to open, creating more space in the spinal canal. This immediately relieves pressure on the spinal cord and nerve roots.
The spinal canal is then inspected and any bone spurs or debris are removed. The bone flap is propped open using small wedges or pieces of bone so that the enlarged spinal canal will remain in place. Screws and metal implants may sometimes be used to keep the space around the spinal cord open. A soft cervical collar may be used for a short period after the Laminoplasty if the surgical location is in the neck.
Post-Operative Care for Laminoplasty
Each patient heals differently following a Laminoplasty but most patients are sent home after one to two days following Laminoplasty. Patients will be asked to walk on postoperative day 1 and adequate physiotherapy is prescribed to improve neuromuscular function unless there are neurological deficits.
Though walking exercises are advised, it is recommended to avoid excessive bending, lifting or twisting for several weeks to avoid breaking the sutures before the wound heals completely. A 6-week healing period with immobilization using a rigid collar or brace is recommended, particularly for children and young adults, to allow healing of the repositioned bone material after a Laminoplasty.
Adults do not need a brace or collar, though they may be offered a soft collar for 1 to 4 weeks. Wound care is administered according to standard protocols. Postoperative pain control will be achieved using oral or intravenous analgesics. The final goal postoperatively is to regain the normal function of the gastrointestinal and the urinary systems.
Success Rate of Laminoplasty
The success rate of Laminoplasty is generally favorable. This may, however, vary depending on their pre-operative baseline functional level. Some patients may have some improvement in function after a Laminoplasty; however, the main goal of the procedure is to prevent the worsening of the neurologic function or paralysis and not to improve its function.