expansive laminoplasty in cervical canal stenosis
TRANSCRIPT
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
