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Cervical Laminoplasty

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Abstract

Laminoplasty has had a successful track record as a posteriorly based motion-preserving comprehensively spinal cord decompressive procedure over several decades. Its indications have remained very clear – clinical myelopathy caused by compressive cervical spondylotic stenosis. Of its two general variants, the open-door technique has had a higher general acceptance, likely due to its perceived “easier” surgical technique involved, despite subtle clinical benefits reported in some more recent studies. Overall both techniques have shown relatively low rates of complications and neurologic improvements on par with more extensile anterior or posterior decompression and fusion surgeries. Laminoplasties have minimized a feared complication of laminectomies – specifically kyphosis – and allow for a virtually unrestricted return to activities. The most feared complications of laminoplasties are persistent pain beyond the expected postsurgical period and a modest amount of loss of lordosis and restriction of motion. The biggest limitation of a formal literature analysis remains with the very large variations of surgical techniques that have been – and continued to be – introduced over the years, which has resulted in an impossibly complex convolute of concepts that make specific comparisons very challenging. All in all, these authors continue to favor an open-door posterior arch expansion surgery with allograft interposition grafts and stable posterior laminar fixation through small plate and screw constructs while preserving key posterior ligamentous complex structures. With this surgical technique, patients can safely return to early unrestricted range of motion activities after the initial postoperative pain has settled down.

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Authors and Affiliations

  1. Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA

    Ronen Blecher, Emre Yilmaz & Jens R. Chapman

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  1. Washington Spine & Scoliosis, Institute at OrthoBethesda, Bethesda, MD, USA

    Joseph R. O'Brien

  2. Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA

    S. Bobby Kalantar

  3. Pacific Northwest University of Health Sciences, Yakima, WA, USA

    Doniel Drazin

  4. Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA

    Faheem A. Sandhu

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Blecher, R., Yilmaz, E., Chapman, J.R. (2020). Cervical Laminoplasty. In: O'Brien, J., Kalantar, S., Drazin, D., Sandhu, F. (eds) The Resident's Guide to Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-20847-9_7

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