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Laminoplasty
Dr Keith Goh
What is Laminoplasty?
Laminoplasty, a surgical procedure primarily focused on the spine, is designed to relieve pressure on the spinal cord. The primary goal of laminoplasty is to create more space for the spinal cord and nerves. This is achieved by reshaping or repositioning the lamina, the roof-like part of the vertebra that covers and protects the spinal cord. Unlike laminectomy, which involves the removal of the lamina, laminoplasty maintains the integrity of the spinal structure by leaving the lamina in place, albeit modified.
Indications for Laminoplasty
Laminoplasty is a surgical procedure primarily indicated for patients experiencing spinal canal stenosis, a condition characterized by the narrowing of the spinal canal. This narrowing can compress the spinal cord and nerve roots, leading to various symptoms.
The primary candidates for laminoplasty are those with spinal canal stenosis in the cervical (neck) region, although it may also be considered for thoracic or lumbar stenosis in certain cases. Spinal canal stenosis can arise from several different conditions:
- Cervical Spondylotic Myelopathy: This condition, often resulting from age-related changes, involves the compression of the spinal cord in the cervical region due to degenerative changes in the vertebrae and intervertebral discs. Patients with this condition might experience symptoms like numbness, weakness, unsteady walking and difficulty in coordination, particularly in the hands and legs.
- Ossification of the Posterior Longitudinal Ligament (OPLL): In OPLL, the main ligament which gives stability in the spine becomes thick and stiff, sometimes hardening into bone. This causes narrowing of the spinal canal and compressing the spinal cord. Laminoplasty can relieve this compression by expanding the spinal canal.
- Multi-Level Spinal Canal Stenosis: Laminoplasty is also considered for patients with stenosis at multiple levels of the spine, where more than one segment of the spinal cord is compressed.
- Degenerative Conditions and Trauma: Besides age-related degeneration, spinal injuries or certain diseases can also necessitate a laminoplasty if they lead to spinal cord compression.
Preoperative Preparation
Before undergoing laminoplasty, several important preparations are carried out, as they are crucial in planning the surgical approach and help minimize risks before the laminoplasty procedure.
- Diagnostic Imaging: Advanced imaging techniques such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans are carried out to capture detailed images of the spinal anatomy, helping to pinpoint the exact areas of spinal cord compression and plan the surgical approach.
- Preoperative Tests Routine: Preoperative tests, such as blood tests, electrocardiogram (EKG), and chest X-rays, are performed to assess the patient’s fitness for laminoplasty and anaesthesia.
- Lifestyle Modifications and Preoperative Rehabilitation: Patients might be advised to engage in preoperative rehabilitation to improve physical fitness and facilitate a quicker postoperative recovery. Smoking cessation and weight management are also encouraged, as these factors can significantly impact surgical outcomes.
Laminoplasty Procedure
- Preparation and Anaesthesia: The patient is placed under general anaesthesia. Needle electrodes for intraoperative neurophysiologic monitoring are inserted at this time.
- Patient Positioning: The patient is usually positioned face down (prone). This positioning ensures optimal access to the affected area of the spine.
- Incision and Retraction: A midline incision is made over the affected spinal segments. The muscles and soft tissues are carefully retracted to expose the laminae (the roof of the spinal canal).
- Creating the Hinge: In laminoplasty, the laminae are not removed but are cut on one side (hinged) and partially opened like a door. This is typically done using a high-speed drill and specialized surgical tools.
- Enlarging the Spinal Canal: The hinged laminae are gently lifted and held in place with spacers or small bone grafts. This effectively expands the spinal canal, relieving pressure on the spinal cord and nerves.
- Stabilization: The position of the laminae is secured using small plates, screws, or wires. This stabilization is critical to maintain the new shape of the spinal canal and to support the spine as it heals.
- Closure: Once the decompression and stabilization are complete, the muscles and soft tissues are repositioned, and the incision is closed with sutures or staples.
- Postoperative Imaging: After the surgery, imaging studies such as X-rays or a CT scan may be performed to confirm the successful expansion of the spinal canal and proper placement of hardware.
Postoperative Care and Recovery
- Immediate Postoperative Care - After the surgery, the patient is typically monitored in a recovery room. Vital signs, neurological function, and the surgical site are closely observed for any signs of complications, such as bleeding, infection, or neurological deficits.
- Physical Activity and Mobilisation - Early mobilisation is encouraged to prevent complications such as blood clots and to promote healing. The extent and pace of physical activity are carefully guided by the medical team, often involving gentle walking and specific exercises under the supervision of a physiotherapist.
- Neurological Monitoring - Continuous assessment of neurological function is crucial. Any new symptoms, such as numbness, weakness, or changes in bowel or bladder function, should be promptly reported to the medical team.
- Rehabilitation Therapy - Rehabilitation plays a vital role in the recovery process. A tailored rehabilitation program, often involving physiotherapy, helps to improve strength, flexibility, and function.
- Follow-up Appointments - Regular follow-up appointments with the surgeon are scheduled to monitor the progress of recovery, assess the healing of the surgical site, and address any concerns.
- Long-term Care - The long-term focus is on maintaining spinal health. This may involve ongoing physiotherapy, lifestyle adjustments, and possibly modifications in activities to avoid strain on the spine.
Potential Risks and Complications of
Laminoplasty
Laminoplasty, like any surgical procedure, carries certain risks and potential complications, which may include:
- Neurological Complications: There is a risk of damage to the spinal cord or nerve roots during surgery, which can result in weakness, numbness, or paralysis. The risk is minimised by the use of intraoperative monitoring techniques.
- Hardware Failure: Laminoplasty often involves the use of hardware, such as plates and screws, to stabilise the spine. There is a small risk of these hardware components becoming loose or failing, which might require additional surgery.
- Cervical Instability: While laminoplasty aims to preserve motion, it can sometimes lead to instability in the cervical spine, requiring further treatment or surgery.
- Spinal Cord and Nerve Damage: While rare, there is a risk of spinal cord and nerve damage, which can result in loss of sensation or motor function.
- Cerebrospinal Fluid (CSF) Leak: During surgery, there is a risk of inadvertently opening the dura mater, the covering of the spinal cord, leading to a CSF leak. This may resolve on its own or require surgical repair.
- Postoperative Hoarseness and Dysphagia: Some patients may experience temporary hoarseness or difficulty swallowing due to manipulation of the neck structures during surgery.
Long-Term Outcomes and Effectiveness of Laminoplasty
Improvement in Symptoms
Laminoplasty is generally effective in alleviating symptoms related to spinal cord compression and myelopathy, such as pain, numbness, and limb weakness. Most patients report significant improvement in these symptoms post-surgery.
Preservation of Neck Mobility
One of the primary advantages of laminoplasty over some other spinal surgeries is the preservation of neck mobility. By avoiding fusion of the vertebrae, laminoplasty allows for a more natural range of motion in the neck. Multiple levels of spinal stenosis can be relieved.
Decreased Risk of Adjacent Segment Disease
By maintaining the natural dynamics of the spine, laminoplasty reduces the risk of adjacent segment disease, a condition where segments above or below a spinal fusion undergo degenerative changes.
Durability and Stability
Long-term studies show that the improvements gained from laminoplasty are durable. The procedure provides stable decompression of the spinal cord and nerve roots, with low incidences of requiring additional surgeries.
Mount Elizabeth Medical Centre,
#09-10, 3 Mount Elizabeth
Singapore 228510
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Mount Elizabeth Medical Centre,
#09-10, 3 Mount Elizabeth
Singapore 228510
Frequently Asked Questions (FAQ) about Laminoplasty
Is Laminoplasty Suitable for Lower Back Pain?
Laminoplasty is primarily performed on the cervical spine (neck region) and is less commonly used for lower back issues. For lower back pain, other surgical options may be more appropriate, depending on the underlying cause. Consult your neurosurgeon for the best treatment to combat your lower back issues.
How Long Does Recovery from Laminoplasty Take?
The recovery period can vary, but most patients can expect to return to normal activities within 2-3 weeks to a couple of months. Full recovery, including complete nerve healing, may take up to a year or longer. Consult your neurosurgeon to obtain a detailed analysis of your expected post-laminoplasty recovery timeline.
Can Laminoplasty Prevent Future Spine Problems?
While laminoplasty can effectively relieve current symptoms by decompressing the spinal cord, it can delay and sometimes prevent future spine problems related to age or other degenerative conditions, especially if there is proper rehabilitation therapy and avoidance of risk factors.
Will I Experience Pain After the Laminoplasty Procedure?
Some individuals experience a combination of post-surgical pain, stiffness, and discomfort in the operated area. The pain is typically localized around the surgical site in the neck. The pain generally decreases significantly within the first few days after surgery. However, some degree of stiffness and muscle ache can persist for several weeks to a few months as the body heals. Incorporating physical therapy as part of the recovery process can significantly aid in reducing pain. Contact your neurosurgeon if severe pain persists after the surgery.