Laminoplasty

What Is A Laminoplasty?

A laminoplasty is a surgical procedure designed to relieve the nerve pressure and pain caused by spinal stenosis. Spinal stenosis is a narrowing of the spinal canal that puts pressure on the spinal nerves and causes pain throughout the spine and extremities. It can develop as a result of certain genetic abnormalities, disease processes or simply due to natural aging.

Am I A Candidate For A Laminoplasty?

Spinal stenosis can occur anywhere in the spinal column, in the cervical (neck), thoracic (chest), or lumbar (low back) regions. Generally, the symptoms of spinal stenosis worsen over time, and conservative treatments. such as medication and physical therapy become less effective in treating the condition. When this occurs, a laminoplasty may become necessary. The procedure can provide relief from the typical symptoms of spinal stenosis, such as back pain and numbness or weakness in one or both arms or legs.

What Are The Benefits Of A Laminoplasty?

A laminoplasty is an alternative to a laminectomy. A laminectomy is the removal of the lamina. Because laminoplasty does not remove the lamina, it maintains more spine stability in the area. This should allow normal movement without the need for other procedures to stabilize the spine.

It is also an alternative to spinal fusion, another option for eliminating nerve compression. Spinal fusion, however, can reduce mobility and a laminoplasty does not.

What Conditions Is A Laminoplasty Used To Address?

Dr. Girardi uses laminoplasty to relieve spinal cord compression that is often leading to myelopathy, which is the term for impaired function of the spinal cord due to compression. This will show itself in symptoms that include pain, numbness, weakness, balance problems, difficulty walking, coordination issues, and stiffness in the impacted extremities.

Laminoplasty may be used to treat symptoms that aren’t responding to more conservative methods. These symptoms may be caused by:

• Bone spurs — These growths on the vertebrae begin to push on the spinal cord and nerve roots.
• Spinal stenosis — Compression caused by narrowing of the spinal column, which houses the spinal cord.
• Herniated disc — When a disc herniates, the outer shell ruptures and the soft interior pushes outward, often onto the spinal cord or nerve roots.
• Spondylosis — This is degeneration caused by osteoarthritis, commonly known as “wear and tear” arthritis. It thins the discs, allows the creation of bone spurs, and weakens the vertebrae.
• Ossified posterior longitudinal ligament — This is a thickening of the ligaments that run parallel to the spine.

Laminoplasty Procedure

During a laminoplasty, the lamina, a small section of bone that covers the back of the spinal cord, is cut through completely on one side and partially on the other, enabling it to swing open like a door. It is then held open with titanium spacers and plates, increasing the amount of room around the spinal cord and decreasing compression on the nerves.

A laminoplasty can be performed on the any of the three regions of the spine, depending on where the patient is experiencing the most intense symptoms. The operation may be performed from the back or the front of the body, depending on the particulars of the patient’s condition. If a bone spur is present nearer to the anterior of the body, for example, the surgeon may enter the body from the front.

A laminoplasty is sometimes performed using microsurgery which is less invasive than traditional methods, but which requires both specialized training and specialized operating equipment. A laminoplasty is a less intrusive alternative to another operation for stenosis called a laminectomy. Unlike a laminectomy, a laminoplasty does not remove the lamina and so manages to preserve spinal stability. This is an advantage because it helps the patient to maintain mobility and diminishes the need for future procedures to the spine.

Are There Different Types of Laminoplasty?

Laminoplasty with Dr. Girardi is most common in the cervical spine, the neck. But it can also be performed in the other sections of the spine, the thoracic (upper back) and the lumbar (lower back).

• Cervical laminoplasty — This is when the surgery is performed on the neck, the C1-C7 vertebrae that house the spinal cord coming out of the brain.
• Thoracic laminoplasty — This is surgery to the thoracic spine, the upper back. It is the section of the spine attached to the rib cage and encompasses 12 vertebrae, T1-T12. This area is less prone to the type of compression meriting a laminoplasty, as it is considerably less mobile than either the cervical spine or the lumbar spine.
• Lumbar laminoplasty — This is surgery to the lower back, the lumbar spine. This is the section of the spine that curves inward toward the abdomen and is made up of five vertebrae, L1-L5. It connects downward into the five fused vertebrae of the sacral spine. Because this section of the spine bears the most loads, it is prone to degeneration, compression, and pain.
• Sacral laminoplasty — Surgery on this part of the spine is rare. That’s because the sacral spine consists of five vertebrae that initially are separate, but as we move from childhood to adulthood, they permanently fuse together. This prevents the kind of movements that usually lead to bone spurs and other sources of spinal compression.

What Are The Results Of A Laminoplasty?

Cutting the lamina and opening up the “hinge” to create more space instantly removes the pressure that has been on the spinal cord in the area. The procedure basically widens the spinal canal.
By removing the source of compression, a laminoplasty removes the pain. Plus it also frees the compression that is causing myelopathy. This will allow the patient to regain strength and should correct the problems with numbness, balance, and coordination. Nerve function improves over the next 6-18 months after your surgery as the spinal cord heals. However, if your compression was severe, you could have some permanent nerve damage.

While not always successful in completely removing the pain, laminoplasty is usually a successful procedure and it allows patients to return to normal activities without pain.

Laminoplasty Recovery

After any type of laminoplasty, patients need to undergo rehabilitative therapy to build up strength and flexibility in the area operated upon. Recovery times vary depending on the age and medical condition of the patient. Patients are restricted from activities that require bending or lifting for several weeks after surgery.

What Are The Risks With A Laminoplasty?

Even when using microsurgery methods, this is still major surgery. As such, it involves all the risks that go with major surgery: excessive bleeding, reaction to anesthesia, formation of blood clots, and infection. Complications of a laminoplasty include:

• Leakage of cerebrospinal fluid leading to headaches
• Bone infection in the vertebra
• Failure/closure of the laminoplasty
• Nerve damage
• Blood vessel damage
• Nerve palsy/stunned nerves
• Failure to alleviate the targeted pain
• Spinal nerve injuries

Is There Anything I Can Do To Reduce The Chances Of Complications?

To reduce your chances of complications after this procedure, you need to follow Dr. Girardi’s recovery guidelines completely. These will include restrictions on activity and diet. You’ll need to notify us immediately if you have bleeding, fever, a sudden increase in pain, redness at the wound site, and swelling. For cervical procedures, you’ll need to be diligent with wearing your neck collar, if applicable.