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Laminoplasty

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A laminoplasty is a surgical procedure that creates more space for the spinal cord and nerve roots to relieve abnormal pressure on the spinal cord. Laminoplasty is a motion preserving surgery, meaning that no fusion is performed and motion is not changed.



 

Anatomy

The spine is composed of individual bones called vertebrae. There are seven cervical vertebrae, twelve thoracic vertebrae, and typically five lumbar vertebrae. Vertebrae are stacked one on top of another and are separated by discs, which act as an elastic cushions or shock absorbers. The first two cervical vertebrae are an exception and do not have discs. Discs have a soft center, the nucleus, surrounded by a tough outer ring, the annulus. Discs allow motion between the vertebrae. The interbody space is the disc space that is located between the vertebral body bones.

Each vertebral segment creates a bony circle, called the spinal canal that protects the spinal cord and spinal nerves.  The vertebral body at each level of the spine protects the front of the spinal cord. The back of the spinal cord is protected by the pedicle and lamina bones. The lamina bones cover the back surface of the spinal canal creating a protective roof over the spinal cord. The lamina bones attach to the pedicles, and the pedicles connect to the vertebral body. These bones form a protective ring that surrounds all aspects of the spinal cord. This bony ring does not expand to accommodate more space. Any extra pressure in this confined space can place dangerous pressure on the spinal cord.

The spinal cord, which is the nerve center of the body, connects the brain to the rest of the body. The spinal cord and nerves travel from the cervical spine down to the lowest point of your spine, the sacrum. Spinal nerves exit the spinal canal between the vertebrae at each level. Two nerves exit each level, one on the left and one on the right. These nerves exit through openings called foramen. The discs, bony structures, ligaments and strong muscles all work together to stabilize the spine.

Laminoplasty

A laminoplasty may be performed to treat the following conditions:

Laminoplasty is performed to treat spinal stenosis in the neck or low back and may also act as a method to access underlying spinal disease such as a spinal tumor or syringomyelia, a spinal cord cyst.

This procedure is done under general anesthesia, meaning the patient goes to sleep. During the surgery the patient lies face down on a special surgical bed. The procedure is performed through a small incision on the back of the spine.  Once the surgeon safely creates a window to see the spine, the lamina is carefully cut all the way through. This allows the vertebrae to open like a door, creating more space in the spinal canal. This immediately relieves pressure from the spinal cord and nerve roots. The surgeon examines the spinal canal and removes any bone spurs and other sources of compression. The bone flap is propped open using small wedges or pieces of bone so that the enlarged spinal canal will remain in place. In some cases, screws and tiny metal implants secure the vertebrae and bone wedges to keep the space around the spinal cord open. If this is performed in the neck, a soft cervical collar may be used for a short time after surgery. This surgery is not recommended for someone with spinal instability.

Any spine surgery has surgical risks involved. You need to discuss these with your surgeon at your pre-operative appointment. Read about Preparing for Spine Surgery and General Complications from Spine Surgery.

Post-Operative Hospital Care

Patients usually remain in the hospital one to three days after a laminoplasty. Postoperative pain control will be achieved with the use of IV pain medication and/or oral pain medications. Patients are discharged home on oral pain medication. Patients need to be comfortable with walking. The final goal is to make sure the gastrointestinal and urinary systems are working appropriately. Patients must be able to tolerate foods and urinate without difficulty before leaving the hospital.

Read about Recovery from Spine Surgery and make sure you understand your post-operative plan before your surgery date.

Summary

Laminoplasty is an approved and effective method for reducing pressure on the spinal cord or spinal nerves. Complications may occur but are not common. The majority of patients are satisfied with their pain relief and results of their surgery. All patients should review their specific condition and surgical plan with their surgeon prior to surgery. All patients should stop smoking prior to their surgical procedure. Smoking is extremely detrimental to your spine health, impairs potential bone healing and reduces successful surgical outcomes. 

Tiny metal plates are used to hold the laminoplasty “door” open and preserve space around the spinal cord.

 

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