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Laminoplasty

Cervical Laminoplasty is performed to take pressure off the spinal cord which is gradually paralyzing the patient. It is performed for myelopathy. Myelopathy is caused by arthritic spurs of the spinal canal. Occasionally condition called OPLL or calcification of posterior longitudinal ligament of spinal canal will also cause pressure on the spinal cord. This procedure can be performed only if the cervical spine is in neutral position or lordotic position and is contraindicated in patients who have cervical kyphosis.

The surgery takes about 3 to 4 hours. A complete cut is created on one side of the roof of the spinal canal and a hinge is created on the other side. The roof of the spine or lamina is gently pried open hinging on one side creating more room for the spinal cord. Usually multiple small plates are used to prevent the lamina collapsing back down on the spinal cord. One can usually see the dural sac containing the spinal cord reexpand during the procedure.

Mayfield head tongs or pins into the skulls are used to stabilize the head and neck area during the procedure. Electronic monitoring of the spinal cord or SSEP or somatosensory evoked potential is used during the surgery to monitor the spinal cord function.

Since the spinal cord is already in jeopardy there is risk of paralysis during the procedure.

The more severely the spinal cord is already compromised the higher the risk of paralysis. However without the surgery patient will gradually get paralyzed. Other risks of surgery include wound infection, up to 10% chance of usually temporary paralysis of shoulder muscle called deltoid as the nerve root supplying this muscle called C5 nerve root gets stretched as the spinal cord migrates backwards after the roof of the spinal canal is opened. Laminoplasty rather than conventional laminectomy stabilizes the cervical spine better after the spinal cord decompression making a condition called postlaminectomy kyphosis of cervical spine less likely even though it can occur. After the laminoplasty many patients also complain of severe shoulder pains which usually subside with time. This may be also related to stretching of the C5 nerve root. Soft neck collar is usually worn for about 6 weeks after the surgery.

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