11.2.5\ Laminoplasty

11.2.5.1\ Discussion

Laminoplasty is performed to widen the spinal canal while preserving as much of the anatomy as possible in order to conserve stability. Cervical laminoplasty is recommended for the treatment of cervical degenerative myelopathy or ossification of the posterior longitudinal ligament, with recovery rates of nearly 60% and improvement in about 80%. Commonly implemented surgical techniques consist of either performing bilaminar osteotomies and shifting the posterior elements backward or performing laminar osteotomy on one side and

a

using a burr to thin the contralateral lamina in order to create a hinge and rotating the posterior elements posterolaterally and often trimming the spinous processes (Fig. 11.14). Alternatively, “French door” osteotomy can be performed in which a trough is drilled bilaterally in the lamina and the spinous process is split in half, opening up the spinal canal. The osteotomy gaps (“open door”) can be filled using bone or hardware (laminar prosthesis). Imaging may be performed after laminoplasty in order to evaluate for patients with complications such as persistent neck pain and diminished cervical motion, which can manifest as canal restenosis and loss of cervical lordotic alignment.

b

Fig. 11.14  Laminoplasty. Axial CT image (a) shows bilateral laminar osteotomies with posterior translation of the posterior elements, which are secured using a metal prosthesis on the right side. Axial CT image (b) in a dif-

ferent patient shows a right laminar hinge and bone graft (arrow) interposed in the left laminar open door, In addition, there has been resection of the spinous process