laminoplasty

Laminoplasty is a posterior surgical procedure used to decompress the cervical spinal cord by enlarging the spinal canal. It reconstructs or reshapes the lamina to create more space for the cord while preserving most of the posterior elements, offering decompression without removing the entire vertebral arch.

Indications for laminoplasty include cervical spondylotic myelopathy with multilevel canal stenosis and patients with ossification of the posterior longitudinal ligament (OPLL). It is often chosen when there is a risk of postoperative instability after laminectomy. Contraindications include fixedkyphotic deformity that cannot be corrected with a posterior approach, primarily anterior compression without posterior relief, and poor bone quality or other factors that would compromise reconstruction.

Techniques commonly used are expansive open-door laminoplasty and double-door laminoplasty. In expansive open-door laminoplasty, the lamina on one side is thinned to create a hinge while the opposite side is opened like a door and held open with sutures, bone chips, or a small plate. Double-door laminoplasty splits the lamina to form two opposing doors. These methods aim to widen the canal while preserving posterior soft tissues to maintain stability and posture.

Outcomes generally include neurological improvement and increased canal diameter, with a lower risk of postoperative instability compared with laminectomy with fusion. Complications can include C5 palsy, wound infection, dural tears, and postoperative axial neck pain; rarely, progression of deformity if spinal alignment is not maintained. Postoperative care involves monitoring, mobilization, and radiographic follow-up to assess decompression and alignment.