expansive laminoplasty in cervical canal stenosis deepak agrawal, b s sharma, v s mehta deptt of...

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


LAMINECTOMY

KYPHOSIS SPINAL INSTABILTY LAMINECTOMY MEMBRANE



BEAUTY LIES IN SIMPLICITY


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


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

or infection)


RETROSPECTIVE STUDY

PERIOD: Jan 1999- Nov 2002


DEMOGAPHIC PROFILE

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


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)


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)


NEUROLOGICAL ASSESMENT

NURICKS SCALE WAS USED PREOPERATIVELY AND AT LAST

FOLLOW UP


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



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


2

9

12

14

43

0

2

4

6

8

10

12

14

Preop Postop

Grade 3 Grade 4 Grade 5


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)


COMPLICATIONS CSF leak 1

(resolved on conservative Mx)

Deterioration in power1

(compression by spacer- Reoperated-improved


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 deepak agrawal, b s sharma, v s mehta deptt of...

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