15: Posterior Cervical Laminoplasty

Published on 21/04/2015 by admin

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Last modified 21/04/2015

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Procedure 15 Posterior Cervical Laminoplasty

Paul Dohyung Kim, Hyun Bae

Indications

image Multilevel cervical spondylotic myelopathy in three or more motion segments (Figure 15-1)

• Requires no postoperative bracing compared to fusion alternative
• Requires neutral to lordotic sagittal spine alignment
• Best in patients who have little or no preoperative neck pain

image Ossification of the posterior longitudinal ligament (OPLL) (Figure 15-2)

image Removal of subaxial spine mass lesions

image

FIGURE 15-1

image

FIGURE 15-2

Indications Pitfalls

• Preoperative kyphosis of greater than 10 degrees. Figure 15-3 shows preoperative cervical kyphosis not suitable for cervical laminoplasty.

• Significant preoperative axial neck pain

• Preoperative instability (Figure 15-4)

image

FIGURE 15-3

image

FIGURE 15-4

Indications Controversies

• Surgical approach for the treatment of spondylotic myelopathy (anterior, posterior, or combined)

• Type of laminoplasty (“open-door” vs. “French door,” etc.)

Examination/Imaging

image Upper motor neuron signs (Hoffmann, clonus, up-going Babinski reflex, and finger escape sign)

image Gait and balance problems

image Difficulties with any activities requiring fine motor movements (buttoning shirt, writing)

image Wasting of hand intrinsic musculature

image Imaging studies

• Radiographs: used to examine overall alignment, amount of spondylosis, instability, OPLL
• Magnetic resonance imaging (MRI): used to evaluate cord morphology and cord parenchymal changes, soft tissue structures

image Computed tomography (CT) myelography: useful in patients unable to be evaluated by MRI and may be better for osseous evaluation and previous hardware placement.

image Figure 15-5 shows axial MRI (A) and CT (B) myelogram demonstrating left-sided compression. The choice of opening side depends on the side of neurologic compression. In this example, the opening side would be the left side.

image

FIGURE 15-5, A-B

Treatment Options

• Anterior cervical diskectomy and fusion (ACDF)

• Anterior cervical corpectomy and fusion (ACF)

• Posterior cervical laminectomy +/− fusion

Surgical Anatomy

image C2, C7, and T1 spinous processes are prominent and palpable in the superficial cervical spine (Figure 15-6).

image The spinous process of C2 is bifid and a source of multiple muscular attachments that should be preserved (Figure 15-7).

image

FIGURE 15-6

image

FIGURE 15-7

Positioning

image The patient’s hair is shaved up to the inferior margin of the occiput.

image The patient is placed prone with Mayfield tongs onto an operating room table with a Mayfield attachment.

image The head is positioned with the “chin-tucked and slightly forward-flexed” to facilitate exposure.

image Operating room bed positioning

• Knees are flexed first to prevent patient from sliding.
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