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Laminoplasty

There are three main components to the spine. The nerve roots and spinal cord carry sensory information throughout the body and command your muscles to move. They are protected by the vertebrae, which are bones that encase the nerves. Between each pair of vertebrae, there are discs of softer tissue that act as cushions.

The spinal cord passes up the cervical spine—the section of the spine that comprises the neck—through a series of arches in the vertebrae called the foramen. Sometimes, pressure is exerted on the spinal cord by degeneration, arthritis, slipped discs, injury, or other causes. Spinal cord problems are known by the medical term myelopathy, and myelopathy must be surgically treated.

In laminoplasty surgery, a surgeon fixes the foramen so that the spinal cord has more space. The surgeon places a hinge or otherwise re-arranges the bone that makes up the foramen, and the spinal cord compression is relieved. In normal circumstances, this reduces symptoms and allows patients to resume their usual lifestyles.

First, you are placed under general anesthesia. This means you're unconscious and won't feel or be aware of what's going on. You will be lying face-down so the surgeon can operate from your back side. The surgeon will perform the operation through a small incision rather than a large opening. Guided by a small scope connected to a monitor, the surgeon will enter the foramen with surgical tools.

The surgeon doesn't remove any bone. Instead, cuts are made to create a "hinge", and when the hinge is open, space is created for the spinal cord to move away from the thing that was compressing it.

Spinal fluid flows more freely. A spacer is inserted to hold the hinge open, and the surgery site is closed.

The sort of myelopathy treated by laminoplasty often causes pain in the back of the neck.

Pain is typically reduced once the procedure has begun to heal, and it continues getting better for several months.

This can improve patient quality of life in several ways:

• Activities that were enjoyed before symptoms commenced may be resumed
• Day-to-day comfort will likely be higher
• Productivity at work may increase
• Knock-on effects of pain—sleep disruptions, distraction, etc.—may decrease

Normally, unless the spinal cord has been compressed for a long time, full recovery should be possible, and most patients say their quality of life improves after laminoplasty.

In the days right after the operation, pain may be severe. You will probably stay in the hospital for a couple of days. A neck collar will be given, and even after you're discharged, you should use it for a few weeks (your doctor will tell you how long to keep the collar on for). You may be required to do physical therapy to strengthen the neck.

In any surgery, there are risks, including bleeding, infection, and lack of results. With spine surgery, there is also the chance of nerve damage, as well as the chance that symptoms may come back in the future.

Here is an example of laminoplasty procedure performed on a patient with symptomatic cervical stenosis. He is asymptomatic one year after the procedure.

Preoperative Lateral X-Ray
Pre-op lateral x-ray, which demonstrates neutral
curvature of the cervical spine
with no instability.

Preoperative MRI
Pre-op MRI shows cervical stenosis with loss of spinal fluid (white)
posterior (behind) the spinal cord (dark).

Postoperative Lateral X-Ray
Post-op lateral x-ray shows expansion of spinal canal
with trap-door laminoplasty procedure being held open
with metal plates and screws.

Postoperative MRI
Post-op MRI shows restoration of spinal canal size and spinal fluid posterior to the spinal cord.