Laminoplasty

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Spinal stenosis, bone spurs, herniated discs, degenerative changes, or tumors can intrude into the spinal canal, limiting the amount of space for the spinal cord and nerve roots. The alteration in anatomy may compress the spinal cord (myelopathy) or nerve roots (radiculopathy). Symptoms vary, depending on the affected area of the spine.  Extremity pain or numbness, gait and balance problems, and fine motor skill disturbances (i.e., difficulty buttoning a shirt) may indicate spinal cord compression.

Spinal cord compression may require surgical intervention. Laminoplasty is a procedure performed to create more space for the spinal cord and nerve roots. The lamina is a thin plate of bone located between the facet joints of each vertebrae. Located in the posterior spine, the laminae are part of the wall of the spinal canal. In laminoplasty, the laminar bone is cut so the back of the vertebra swings open like a door, easing pressure off the spinal cord and nerve roots. Small metal plates or bone are wedged into place to “fuse” the lamina into its new position.

The Procedure

Laminoplasty is performed under general anesthesia.  Throughout the procedure, a special nerve monitoring system checks the spinal cord, scanning for injury to sensitive structures. Laminoplasty can be performed using a minimally invasive technique or as an open procedure. The surgeon determines which approach is best.  The procedure, risks, and benefits are discussed with the patient well in advance of the surgery date.

The basic steps of a typical laminoplasty may be summarized as follows:

• One side of the lamina is scored; the other side is cut completely through creating a hinge.
• Portions of the spinous processes (bony finger-like projections) are removed to permit the lamina to swing open like a door.
• The laminar “door” is wedged open; the spinal cord is decompressed
• Intraoperative imaging ensures the “wedge” implant(s) are in proper position and secure

After Surgery

Most laminoplasty patients are discharged from the hospital within two to three days. The surgeon prescribes a brace to be worn after surgery for several weeks.  The brace helps to immobilize and support the spine as it heals.

Prior to outpatient or hospital discharge, the patient receives written instructions about pain control, activity restriction, and postoperative follow up.  During the early stages of recovery, most patients steadily progress and regain more functional ability in the weeks and months after surgery.