Cervical Laminoplasty

Cervical laminoplasty is a surgical procedure to relieve pressure on the spinal cord and nerves at the level of the neck (cervical spine). The procedure involves enlarging the spinal canal by removing portions of the lamina (the bony “roof” of the spinal canal) to create more space for the spinal cord and nerve roots.

Anatomy of the Cervical Spine

The spine, also called the backbone, plays a vital role in stability, smooth movement and protection of the delicate spinal cord. It is made up of bony segments called vertebrae with fibrous tissue called intervertebral discs between them. The vertebrae and discs form the spinal column from the head down to the pelvis, giving symmetry and support to the body. The spine can be divided into 4 regions: cervical, thoracic, lumbar and sacral. The cervical spine comprises the first 7 vertebrae of the spinal column, which form the neck.

Indications

Cervical laminoplasty surgery is commonly recommended for patients with cervical spinal stenosis. Cervical spinal stenosis occurs when the spinal canal in the cervical area narrows, putting pressure on the spinal cord and nerve roots in the neck region. The spinal canal may narrow because of the degeneration of the joints and intervertebral discs. Cervical spinal stenosis can also be caused by the formation of bone spurs in the spinal canal or thickening of the connecting ligaments.

With the narrowing of the spinal canal, the pressure on the spinal cord and nerve roots can result in symptoms such as:

• Feelings of tingling, numbness, and weakness in the neck
• Pain in the neck
• Pain in the shoulders, arms or hands
• Problems with bladder or bowel function

For some patients, conservative treatments such as physical therapy and medications may be effective in relieving symptoms. However, if conservative treatment does not relieve symptoms, surgery may be recommended.

Preparation

Preoperative preparation for a cervical laminoplasty may involve the following:

• A review of your medical history and diagnostic tests, such as blood work and imaging of the cervical spine
• Informing your doctor of any medications or supplements you are taking
• Informing your doctor of any allergies to medications, anesthesia, or latex
• Disclosing any recent illnesses or other medical conditions you have
• Temporarily stopping some medications, such as blood thinners, for a defined period prior to surgery
• Refraining from solids or liquids at least 8 hours prior to surgery
• Arranging for someone to drive you home after the procedure
• Signing an informed consent form

Surgical procedure

Cervical laminoplasty surgery is usually performed under general anesthesia with you lying face-down on the procedure table. Your surgeon makes an incision at the posterior, or back, of the neck. Retractors are then used to hold the muscles away from the bones in the neck. Your surgeon then thins out the lamina on one side and cuts all the way through on the other side. This creates a “hinge” in the bone, allowing the cut side of the lamina to open like a door. This creates more space for the spinal cord and nerves, relieving pressure. Small pieces of bone are wedged into the space to hold the lamina in the “open” position, and fixation devices hold the bone in place. Finally, your surgeon returns the soft tissue structures and muscles to their normal positions and closes the incision.

Postoperative care

You may feel pain and discomfort in the neck area. Medications are provided as needed to address this. You are encouraged to walk as soon as possible to maintain normal blood circulation and thereby prevent the risk of blood clot formation in the legs. A soft collar may be prescribed for neck support and comfort, and to limit movement of the neck. Physical therapy focusing on the neck will be started 4 to 6 weeks after surgery and involves stretching and range-of-motion exercises. Instructions on surgical site care and bathing will be provided to keep the wound clean and dry. You should avoid strenuous exercise or activity until you receive your doctor’s consent. You will likely be discharged 2 to 3 days 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

Cervical laminoplasty is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

• Infection
• Bleeding
• Blood clots in the legs or lungs
• Adverse reactions to anesthesia
• Spinal cord or nerve root injury
• Injury to nerves or blood vessels
• Neuropathic pain

Summary

Cervical laminoplasty is a form of spinal decompression surgery performed to relieve pressure on the spinal cord and nerves in the neck caused by spinal stenosis. Cervical laminoplasty is usually only recommended if nonsurgical treatment methods have failed to relieve the symptoms associated with the cervical spinal stenosis.