LAMINOPLASTY

The OrthoCarolina Spine Center provides the highest level of care to patients suffering from all spine related conditions, from the neck to the lower back. Our surgeons and physiatrists work with a highly skilled team of physician assistants and nursing professionals to provide patients with state-of-the-art spine care.

LAMINOPLASTYInformation for Laminoplasty PatientsThe following is a series of the most frequently asked questions regarding laminoplasty. The answers are for the average case, with the understanding that there may be unusual circumstances, which would cause any one of these answers to be changed significantly. You need to understand from your orthopedic surgeon whether there is anything unusual about your particular case and have him/her explain why the answers to some of these questions might be different in your case.

What is a Cervical Laminoplasty?A laminoplasty is a surgical procedure intended to relieve pressure on the spinal cord while maintaining the stabilizing effects of the back part of the neck. This procedure is used to treat a painfully restricted spinal canal in the neck. It creates more space for the spinal cord and nerve roots, immediately relieving pressure from the pinched spinal cord. This technique is often called “open door laminoplasty” because the back of the vertebrae is made to swing open like a door.

What are the reasons for surgery?Spinal stenosis is a narrowing of the bony spinal canal causing spinal cord compression. This may lead to pain, weakness, numbness, clumsy hands, and difficulty walking.

How is the Operation Performed?The surgeon creates an incision on the back of the neck. A groove is cut down one side of the cervical vertebrae to create a hinge. The other side of the vertebrae is cut all the way through. See Figure 1. Courtesy of Cleveland Clinic Foundation.

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The tips of the spinous processes may be removed to create room for the bones to swing open like a door. The back of each vertebra is opened, taking pressure off of the spinal cord and nerve roots. Small wedges of bone and/or small plates are placed to “hold the door open” and allow room for the spinal cord and nerve roots to rest comfortably. See Figure 2a and 2b. Courtesy of Cleveland Clinic Foundation.

In addition to opening the spinal canal, the surgeon may perform a foraminotomy if indicated. This involves using instruments to remove small pieces of bone surrounding an exiting nerve root that travels to the arm.

What are the risks?

Anesthetic Complications:

You must be fully anesthetized.

Infection: There is a chance of infection with any operation.

Bleeding/Blood Clots: There is always some blood loss and a chance of post-operative blood clots with any operation.

Spinal Damage: Damage to the spinal cord producing paralysis.

Nerve Damage:This can occur, but happens in less than one percent of our cases. If a nerve is damaged, it does not mean paralysis. Each spinal nerve supplies only a small group of muscles.

C5 Nerve Palsy:Approximately 2 – 4% of patients will develop C5 nerve root palsy (weakness of the shoulder muscles). In almost all cases, this weakness will improve within 6 months, but some patients will require a full year to recover.

Hardware Complications:

In some cases where internal fixation devices (plates and screws) are to be used, there is always the possibility that one or more of the screws may break or the plate may come loose. This is a rare occurrence and if it does occur, in many cases it is not a problem.

Expectations:The final risk is that the surgery may not give you the results you hoped it would. We hope to give you significant relief from your Spinal Fusion symptoms, but it is unrealistic to expect 100% relief. It would be wise to get a clear understanding of what you can expect from your surgery.

BefOre LAMINOPLASTY

Spinal fluid

Spinal cord

Spinal fluid

Spinal cord

AfTer LAMINOPLASTY

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How long will I be in the hospital?You will be admitted to the hospital the day of surgery and observed closely. The day after, you will be encouraged to walk, and will begin range of motion exercises for the neck and shoulder. As you become more comfortable, you should be able to perform most of your daily tasks. Most patients are discharged between 2-3 days, though this is variable. Depending on how quickly you recover, you may require rehabilitation to get full recovery.

What outcome can I expect from this operation?Cervical spinal stenosis with spinal cord compression, or myelopathy, has a natural history of step-wise progression, with gradual decline in function. The goal of the operation is to prevent progression of myelopathy and further functional decline. However, most people experience an improvement in their symptoms.

What should I do when I leave the hospital?Upon discharge, you will need a ride home from the hospital. You are encouraged to walk, and gradually increase your activities as your tolerance allows. You may shower on the fifth day after surgery, or sooner if your incision has a waterproof dressing. If there are any problems with fever, drainage, increased weakness, or return of the symptoms prior to your appointment, call your physician’s office right away.

MrI images before and after a laminoplastyThe MRI images at right show the difference in the amount of space for the spinal cord. The white around the spinal cord is the spinal fluid. The more white there is, the more space for the spinal cord. On the postoperative image, the plate creates in artifact that appears to come into the space for the spinal cord. This is all artifact.

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OrthoCarolina Spine Center | 2001 Randolph Rd. Charlotte NC 28209 | 704.323.2225

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