Laminoplasty

Laminoplasty is typically recommended for patients experiencing spinal cord compression with progressive neurological symptoms. This is referred to as Cervical Spondylotic Myelopathy (CSM), which results from narrowing of the spinal canal that puts pressure on the spinal cord.

Patients with symptoms such as weakness, numbness, loss of coordination, difficulty walking, or loss of fine motor skills may be considered candidates for laminoplasty. However, the decision to proceed with surgery depends on the severity of the condition, failure of conservative treatments such as physical therapy and medications, and the presence of progressive neurological deficits. For patients with progression of symptoms requiring surgical intervention, Dr. Boden will evaluate imaging such as X-ray, MRI, and CT scans to determine if the anatomy is suitable for laminoplasty. Some patients may not be candidates for the motion-sparing laminoplasty procedure and may be offered an anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF) instead.

Laminoplasty is typically performed under general anesthesia and involves the following steps:

1. Incision and Exposure: A midline incision is made in the back of the neck, and the muscles are carefully retracted to access the cervical vertebrae.
2. Creating a Hinged Opening: A hinge is created on one side of the lamina, while the opposite side of the bone is carefully lifted to allow for expansion. This technique increases the space available for the spinal cord.

3. Securing the Lamina: Small metal plates and screws are used to secure the open position of the lamina to ensure long-term stability.
4. Closure and Recovery: The incision is closed with sutures or staples, and the patient is monitored in the recovery room before being transferred to a hospital room for further observation.

The entire procedure typically takes one to two hours, depending on the number of levels being treated. Laminoplasty is often performed as an inpatient procedure, with patients staying in the hospital for one to three days postoperatively.

Recovery from laminoplasty varies by patient but generally involves a gradual return to normal activities over several months. In the immediate postoperative period, pain is managed with prescribed medications and the use of a soft cervical collar for added comfort. Patients are advised to avoid heavy lifting, bending, and twisting during the early recovery phase. Walking and gentle range of motion are highly encouraged immediately after surgery. The goal of surgery for patients with myelopathy is to prevent further decline in neurologic function, though many patients will see some improvement in their symptoms after surgery. While improvement in neurological symptoms can be seen within weeks, full spinal cord recovery may take several months to a year. Regular follow-up appointments are necessary to monitor healing progress through clinical evaluations and imaging studies.

Many patients have difficulty with balance and coordination prior to surgery. Depending on the pre-operative level of function, patients may or may not need formal physical therapy or a structured rehab program to ensure safe mobility. If needed, programs for balance, ambulation, and safe mobility may be started the day after surgery. A structured physical therapy program is often initiated 6 weeks after surgery to strengthen neck and upper body muscles, improve posture, and enhance flexibility. Patients are encouraged to engage in gentle range-of-motion exercises, progressing to more advanced exercises as healing continues. Walking and low-impact aerobic activities can aid in maintaining overall fitness and preventing stiffness. Adherence to rehabilitation guidelines provided by the surgeon and physical therapist is essential for achieving the best possible functional outcome.