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Laminoplasty

By

Sarah Lewis, PharmD

What is laminoplasty?

Laminoplasty is the surgical opening of a bony area of the spine called the lamina. There are two lamina on each vertebrae of your spine that form the back wall of your spinal canal. Your spinal cord runs through your spinal canal in the center of your vertebrae. 

Certain conditions of the spine can compress the spinal cord and cause pain. Laminoplasty hinges the lamina open like a door to create more space in your spinal canal without removing the lamina. Laminoplasty surgery can relieve pressure in your spinal canal or on your spinal cord of your neck or back by widening your spinal canal.

Laminoplasty is an alternative to laminectomy. Laminectomy is the removal of all of the lamina. Unlike laminectomy, laminoplasty surgery preserves spinal stability because the lamina is not removed. This may decrease the need for other procedures to stabilize the spine. It also helps maintain movement in your spine.

Laminoplasty is a common but major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having laminoplasty. 

Types of laminoplasty

When laminoplasty surgery involves one vertebra, it is called single level. When it involves more than one vertebra, it is called multilevel.

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The types of laminoplasty procedures include:

  • Cervical laminoplasty is the hinging of lamina in the neck area (cervical spine). This is the most common use of laminoplasty. Not all surgeons perform the laminoplasty procedure.

  • Lumbar laminoplasty is the hinging of lamina in the lower back (lumbar spine).

  • Sacral laminoplasty is the hinging of lamina in the back between your pelvic, or hipbones (sacral spine).

  • Thoracic laminoplasty is the hinging of lamina in the middle part of the back (thoracic spine).

Other procedures that may be performed

Your doctor may perform other procedures in addition to laminoplasty. These include:

  • Discectomy is the surgical removal of part or all of a spinal disc. A discectomy treats herniated or ruptured spinal discs.

  • Foraminotomy is the widening of the opening where the nerve roots leave the spinal canal. Your doctor may use this procedure when the opening (foramina) is also narrowed causing pressure on the spinal nerves themselves (as opposed to the spinal cord).

  • Spinal fusion is the permanent joining together of two vertebrae using a bone graft. Sometimes, your doctor will also use screws, rods or plates to hold your vertebrae in place. This procedure permanently stops movement between the two vertebrae and limits the motion of your spine.

Why is laminoplasty performed? 

Your doctor may recommend a laminoplasty to treat certain diseases and conditions of the spine. Your doctor may only consider laminoplasty for you if other treatment options with less risk of complications are ineffective, you suffer from spinal stenosis, and your quality of life is poor. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a laminoplasty. 

Your doctor may recommend laminoplasty when you have spinal cord compression with symptoms of myelopathy. Myelopathy is impaired function of the spinal cord due to compression from the bones surrounding the spinal cord. Symptoms include weakness, pain, numbness, clumsiness, poor balance, difficulty walking, and stiffness in the extremities. The goal of laminoplasty is to relieve spinal pressure to stop myelopathy progression and potentially reverse the changes.

Laminoplasty preserves the stability and movement of your vertebrae. This can be an advantage by potentially decreasing the need for additional procedures to stabilize your spine. However, in an arthritic spine, movement is often related to pain, so laminoplasty tends to have inconsistent results for pain relief. 

Your doctor may recommend laminoplasty for persistent spinal symptoms caused by: 

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  • Ankylosing spondylitis, a type of arthritis that causes inflammation of the spinal joints

  • Bone spurs, abnormal growths of bone on a vertebra, which can lead to compression of the spinal cord and nerves

  • Herniated spinal disc, displacement of the cushioning disc between the vertebrae 

  • Ossified posterior longitudinal ligament (OPLL), a thickening of the ligaments that run parallel to the spine

  • Spinal stenosis, a narrowing of the spinal column causing pressure on the spinal cord and nerves

Who performs laminoplasty?

An orthopedic surgeon or a neurosurgeon performs laminoplasty. An orthopedic surgeon specializes in surgical treatment of diseases and conditions of the muscles and bones, including the spine. A neurosurgeon is a doctor who specializes in the surgical treatment of diseases and conditions of the nervous system, including the nerves of the spine.

How is laminoplasty performed?

Your laminoplasty will be performed in a hospital or surgical center. Your surgeon will widen your spinal canal by creating a hinge-like movement in the lamina, the back part of your vertebra. This relieves pressure in your spinal canal or on your spinal nerves of your neck or back. 

Laminoplasty involves the following techniques:

  • French door or double door laminoplasty is the hinging of the lamina on both sides with an opening in the middle. Your surgeon may place a spacer to bridge the opening or hold the lamina open with a wire.

  • Open door or single door laminoplasty is the hinging of the lamina on one side like a single door with an opening on the other side. Your surgeon will place a spacer to keep the lamina open like a doorstop. Spacers can be made out of bone, metal or plastic.

  • Z-plasty laminoplasty is a technically complicated surgical procedure. It involves thinning the lamina and making a Z cut through it. Your surgeon then separates the lamina and holds it open with a wire. This procedure is not widely used because of the technical difficulty.

Surgical approaches to laminoplasty

Laminoplasty is performed using one of the following approaches:

  • Microlaminoplasty is a minimally invasive procedure. It involves inserting special instruments and an arthroscope through small incisions in your back or neck. An arthroscope is a thin, lighted camera that transmits pictures of the inside of your body to a video screen viewed by your surgeon while performing the surgery. Microlaminoplasty generally involves a faster recovery and less pain than open surgery. This is because it causes less damage to tissues. Your surgeon will make small incisions instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery. This is a technically challenging procedure and not offered by all spine surgeons.

  • Open surgery uses a larger incision in your back or neck over the affected vertebra. The length of the incision will depend on how many vertebrae require a laminoplasty. Open surgery allows your surgeon to directly see and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.

Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different procedures and ask why your surgeon will use a particular type for you.

Types of anesthesia that may be used

Your surgeon will perform your laminoplasty using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. 

You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

What to expect the day of your laminoplasty

The day of your surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or