expansive laminoplasty in cervical canal stenosis

EXPANSIVE LAMINOPLASTY IN CERVICAL CANAL STENOSIS

Deepak Agrawal, B S Sharma, V S Mehta

Deptt of Neurosurgery,CN Centre, AIIMS,

New Delhi

SURGICAL OPTIONS

ANTERIOR CERVICAL DECOMPRESSION AND SPINAL FUSION (ACDF)

LAMINECTOMY/LAMINOPLASTY

Expansive laminoplasty in cervical canal stenosis

ACDF LENGTHY AND COMPLICATED IMMOBILIZES SEGMENTS HIGH MECHANICAL DEMANDS ON

ADJACENT SEGMENTS RADIOLOGICAL & CLINICAL EVIDENCE OF

DETERIORATION ON FOLLOW UP

Expansive laminoplasty in cervical canal stenosis

LAMINECTOMY

KYPHOSIS SPINAL INSTABILTY LAMINECTOMY MEMBRANE

Expansive laminoplasty in cervical canal stenosis

Expansive laminoplasty in cervical canal stenosis

BEAUTY LIES IN SIMPLICITY

Expansive laminoplasty in cervical canal stenosis

EXPANSIVE LAMINOPLASTY QUICK, EFFICACIOUS & DURABLE MANTAINS CERVIVAL MOBILITY PREVENTS KYPHOSIS LONG TERM RESULTS SURPASS

THAT OF ANTERIOR PROCEDURES

INDICATIONSCERVICAL CANAL STENOSIS

OPLL-continuous/ mixed Multisegmental cervical

spondylotic myelopathy (MSCS) Ligamentum flavum hypertrophy

Expansive laminoplasty in cervical canal stenosis

CONTRAINDICATIONS Focal anterior compression Established, absolute kyphosis Isolated radiculopathy Spinal instability (Trauma, tumour

or infection)

Expansive laminoplasty in cervical canal stenosis

RETROSPECTIVE STUDY

PERIOD: Jan 1999- Nov 2002

Expansive laminoplasty in cervical canal stenosis

DEMOGAPHIC PROFILE

24 patients M:F 21:3 (7:1) Mean age: 57 yrs (36-76 yrs)

Expansive laminoplasty in cervical canal stenosis

MRI FINDINGS OPLL (Continuous/ Mixed) 12 MSCS (Multisegmental cervical spondylosis) 18 Lig flavum hypertrophy 05 Cord changes 20

(11 pts had more than one pathology)

Expansive laminoplasty in cervical canal stenosis

Expansive laminoplasty in cervical canal stenosis

Expansive laminoplasty in cervical canal stenosis

SURGICAL PROCEDUREMODIFIED OPEN-DOOR LAMINOPLASTY

Number of pts Titanium miniplates and screws 22 Hydroxyapatite spacer 01 Autologous bone spacer 01

AVERAGE NUMBER OF LEVELS OPERATED- 5 (4-6)

Expansive laminoplasty in cervical canal stenosis

Expansive laminoplasty in cervical canal stenosis

NEUROLOGICAL ASSESMENT

NURICKS SCALE WAS USED PREOPERATIVELY AND AT LAST

FOLLOW UP

Expansive laminoplasty in cervical canal stenosis

NURICKS GRADE 0- Radiculopathy 1- Myelopathy+, No gait disturbance 2- Mild gait dist/ carry on with daily activity 3- Mod gait dist- works without assistance 4- Severe gait dist-works with assistance 5- Bedridden

Expansive laminoplasty in cervical canal stenosis

Expansive laminoplasty in cervical canal stenosis

NURICKSGRADE

PREOPERATIVE(No. of pts)

POSTOPERATIVE(No. of pts)

GRADE 1 0 2

GRADE 2 1 1

GRADE 3 2 14

GRADE 4 9 4

GRADE 5 12 3

Expansive laminoplasty in cervical canal stenosis

2

9

12

14

43

0

2

4

6

8

10

12

14

Preop Postop

Grade 3 Grade 4 Grade 5

Expansive laminoplasty in cervical canal stenosis

NURICKSGRADE

CORD CHANGES(No. of pts)

GRADE 1 0

GRADE 2 0

GRADE 3 1

GRADE 4 7

GRADE 5 12

RESULTS 21 PTS (87%) had improvement

3 pts remained unchanged in their Nuricks grade (All had severe cord changes)

Expansive laminoplasty in cervical canal stenosis

COMPLICATIONS CSF leak 1

(resolved on conservative Mx)

Deterioration in power1

(compression by spacer- Reoperated-improved

Expansive laminoplasty in cervical canal stenosis

CONCLUSIONS Laminoplasty is a valuable

procedure in multisegmental anterior compression (results =/> anterior procedures)

For best results- should be performed before cord changes develop

Expansive laminoplasty in cervical canal stenosis