What is Laminoplasty, How is it Done & What is it’s Recovery Period?

Laminoplasty is performed on the vertebrae in the cervical and thoracolumbar spine. It opens up the space within the spinal canal by creating a hinge on the lamina. Metal hardware bridges the gap in the opened section of the spine. In other words, a laminoplasty is a procedure in which the lamina are hinged laterally opened like a door, and secured in their new position with suture or bone to enlarge the spinal canal.

If you have a condition in your spinal column that puts pressure on your spinal cord or spinal nerves, your doctor may recommend a laminoplasty. There are various reasons for which this surgery is suggested including degenerative changes, arthritis, bone spurs, disc herniations, fractures etc. The spinal cord pressure also known as “spinal stenosis” can occur at multiple levels at the same time; and if the pressure is severe, it can cause various symptoms like neck pain, pain that radiates into the shoulders, arms and/or hands, numbness, tingling and muscle weakness in the neck and/or upper extremities.

Goal of Laminoplasty surgery is to relieve the narrowing of spinal canal. Laminoplasty procedure immediately relieves pressure by creating more space for the spinal cord and nerve roots. The main aim of performing Laminoplasty procedure is to prevent further worsening of the neurologic function.

Laminoplasty may be indicated in patients with myelopathy as well as multiple-level spondylosis, like in congenital stenosis. When spinal stenosis is severe, various symptoms may develop which include pain, weakness in arms and/or legs and unsteadiness in the gait (myelopathy).

For conditions that are mild in nature, conservative treatment may be sufficient. For severe or progressive symptoms, a surgical treatment like Laminoplasty may be necessary. Surgical goals include a decompression of all compressed levels of the spine and stabilization with solid fusion. Surgical techniques are dependent upon the specific problems of each patient. Anterior and posterior surgical approaches can be applied. In certain cases a decompression laminoplasty without fusion may be employed.

At present, the surgical methods of cervical laminoplasty are broadly divided into two types from the viewpoint of the site of osteotomy:

1. Open-Door Type Laminoplasty: Expansive open-door laminoplasty is widely accepted as a reliable procedure for cervical myelopathy. However, one acknowledged complication is spring-back complication or closure of the door which may result in restenosis of cervical canal and neurologic deterioration. The study aimed for addressing our cervical open-door laminoplasty technique with sutures and bone grafts and subsequently the follow-up outcomes.
2. Double-Door/French Type Laminoplasty: The double-door laminoplasty creates an opening in the midline of the spinous processes and a symmetrical expansion with hinges on both laminae. Bilateral troughs are drilled on each laminae using a bur, and opened liked a French-door, allowing the spinal cord to move posteriorly in the enlarged spinal canal. The space between the gapped laminae are then stabilized by allograft.

Your surgeon may ask you to refrain from taking any non-steroidal anti-inflammatory medicines 10 days before the planned laminoplasty surgery, and 10 weeks after laminoplasty surgery such as:

• Aspirin, Advil, & Aleve
• Herbal supplements
• Vitamins E & K
• Fish oil

In addition, you should discontinue all exposure to nicotine containing products 2 weeks before and at least 6 weeks after your laminoplasty surgery.

After the Laminoplasty procedure, patients need to undergo rehabilitative therapy to build up strength and flexibility in the area operated upon. Recovery time after laminoplasty varies depending on the age and medical condition of the patient. For several weeks after Laminoplasty surgery, the patients are restricted from activities that require bending or lifting. Most patients can resume normal activities within 2 to 6 weeks following Laminoplasty. Patients who perform labor intense jobs are more likely to be out of work closer to 4 weeks. Most Laminoplasty patients are able to begin driving, short distances, between 2-3 weeks after surgery. Laminoplasty patients may however be a passenger in a car as soon as you feel up to it.

Your activity will be limited to walking for several weeks after Laminoplasty surgery. The patients are encouraged to walk as long as they are comfortable. During this time the Laminoplasty patients may go up and down stairs, with the use of a railing, and may also sleep in a normal bed. The patient will be limited to lifting 5 pounds for the first 2 weeks after Laminoplasty procedure. After two weeks following Laminoplasty procedure they will be able to resume low-impact cardiovascular activities and increase the amount of weight they are lifting.

Laminoplasty, popularized in the 1980s, is now used to treat a variety of cervical disorders. Multiple variations of Laminoplasty have been developed, but all are similar in that they expand the cervical canal while leaving the protective dorsal elements in place to varying degrees. The Laminoplasty procedure has proven to be essentially equal to other cervical decompressive procedures, and outcome has been shown to be durable. Laminoplasty is an effective procedure for the decompression of multilevel cervical disease, cervical spondylotic myelopathy, and ossification of the posterior longitudinal ligament. Moreover, Laminoplasty may be used for certain spinal cord tumors, especially in children.