CERVICAL LAMINOPLASTY & LAMINECTOMY
Posterior decompression of the cervical canal (cervical laminoplasty or cervical laminectomy) is commonly performed when there is cervical canal stenosis at multiple levels.
The causes of cervical spinal stenosis may be congenital or degenerative due to compression from OPLL, multiple level bony discs or osteophytes and thickened ligamentum flavum posteriorly. In the laminectomy operation, multiple laminae at the back of the spine posterior to the spinal cord, are removed and in laminoplasty the laminae on one side is hinged up, hence widening the canal, and held in that place by titanium mini plates.
CASE STUDY 1
A 65 years old male presented with walking difficulty for 2 years. He had weakness of all four limbs (grade 3/5). MRI done revealed multiple level cervical canal stenosis. He underwent cervical laminoplasty. He needed extensive rehabilitation to start ambulating independently post-op.
Pre-op cervical X-ray showing marked degenerative changes with
anterior osteophytes bridging the vertebral bodies.
Post laminoplasty X-ray (arrow pointing at titanium mini plate used to keep
laminae in a hinged position.
CASE STUDY 2
A 71 years old was admitted with complaint of weakness of lower limbs. He was investigated with MRI of the cervical spine which revealed cervical spondylotic compression from C3/4, C4/5, C5/6 disc / osteophyte resulting in canal stenosis. He underwent C3 –C6 laminectomy and has had significant improvement with return of power in the limbs and ambulating without support but with a stick, because of unsteady gate from posterior column sensory impairment. He has been warned that further anterior surgery may be necessary in future.
Pre-op MRI Image showing cervical canal stenosis
Post-op MRI Image showing good cervical cords decompression
CASE STUDY 3
A 66 yrs old gentleman presented with history of trip and fall on 26th Nov. 2014. He was able to walk with support after 10-15 minutes. He had residual burning sensation in right hand medial aspect with persistent difficulty in walking and a diagnosis of cervical spondylitic myelopathy (C5-6 and C6-7 disc / osteophyte) was made. He had a history of having had coronary angioplasty in 2014 after which he was on aspirin.
Pre-op MRI Image showing cord compression at C5-C6 and
Post-op MRI Image