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:
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 nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of laminoplasty?
As with all surgeries, a laminoplasty involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of laminoplasty
Complications of laminoplasty include:
Bone infection of the vertebra
Cerebrospinal fluid leak causing headaches
Closure of the laminoplasty
Nerve and blood vessel damage
Nerve palsy or stunned nerve after decompression. This condition typically causes arm weakness and pain after a cervical laminoplasty. It is usually temporary and will improve without treatment.
Failure to alleviate pain or recurrent symptoms
Spinal nerve injuries causing weakness, numbness or pain
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
Wearing a neck collar or back brace as directed after surgery
How do I prepare for my laminoplasty?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a laminoplasty by:
Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. For laminoplasty, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during their doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need a laminoplasty? Are there any other options for treating my condition?
Which type of laminoplasty procedure will I need?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
What kind of rehabilitation program and physical therapy will I need?
What medications will I need before and after the surgery? How do I take my usual medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my laminoplasty?
Knowing what to expect can help make your road to recovery after laminoplasty as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You may have a drain in your incision to monitor for bleeding. Your surgeon will generally remove this tube within 24 hours. In most cases, your care team will have you up and walking once you are alert. A hospital stay of up to four days is usually required if you have laminoplasty combined with spinal fusion.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors.
You may need to wear a neck collar or back brace for several weeks after your surgery. Your doctor will likely recommend rehabilitation and physical therapy to help you recover. Significant recovery with return of nerve function occurs within several months. Your nerve function can continue to improve for a total of six to 18 months.
Will I feel pain?
Pain control is important for healing and a smooth recovery. Pain in the back of the neck is the major complaint following laminoplasty of the neck. This pain can be severe and can last for several days. It should improve gradually over the coming weeks and months.
Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after laminoplasty. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Pain that is not controlled by your pain medication, worsening pain, or pain that is different or occurs in a new area, such as in your arm or leg
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness, tenderness or swelling of your incision
Weakness, numbness or difficulty moving a part of your body
How might a laminoplasty affect my everyday life?
Laminoplasty may significantly reduce your symptoms so you can lead an active, normal life. For example, laminoplasty may relieve or lessen your pain symptoms and improve function.
Laminoplasty will not cure your spine problems or reverse permanent nerve damage caused by long-term spinal cord compression. You can help prevent further spine problems by:
Following your doctor’s instructions about how to move, walk, sit and stand
Maintaining a healthy lifestyle, including an appropriate body weight
Practicing good posture
Strengthening your back and leg muscles with exercises as recommended by your healthcare provider
Using proper body mechanics when lifting or carrying objects
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