Suspended laminoplasty for wide posterior cervical decompression and intradural access: results, advantages, and complications

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> Cervical laminoplasty is a recognized technique commonly used for multilevel posterior cervical decompression, and it is favored over laminectomy for maintaining spinal stability. Traditional hinge techniques, however, limit lateral exposure on one side and can limit dural exposure. The authors present their experience with a modified laminoplasty technique incorporating complete laminectomy and placement of titanium miniplate instrumentation. This method allows wide bilateral posterior decompression and unobscured dural access.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> Twenty-eight patients (mean age 57 years) underwent cervical laminoplasty during a 4-year period. Twenty-seven patients presented with progressive cervical myelopathy. Seventeen patients (61%) had degenerative spondylotic stenosis; nine (32%) underwent resection of an intradural neoplasm. A mean of 3.5 levels were exposed and reconstructed. The follow-up period ranged from 4 months to 4 years (mean 15 months). The mean angular extension—flexion displacement measured between C-1 and C-7 was unchanged postoperatively, with preserved mobility across laminoplasty-treated segments in all patients. The anteroposterior diameter of the spinal canal increased 3.6 mm (27.2%) postoperatively (p = 0.004). In one patient an asymptomatic postoperative kyphosis developed. There were five cases of postoperative infection. One superficial infection resolved after intravenous antibiotic therapy alone, and four deep infections required surgical reexploration.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> The advantages of this technique over other laminoplasty methods include wide lateral spinal canal and intradural access, as well as preserved motion with partial restoration of the posterior tension band.</jats:p>

Laminotomy in adults: technique and results

“…As the Authors themselves say, this is not a physiological reconstruction: the lamina lie along a paramedian oblique plane and the muscle layers cannot be reconstructed perfectly. The main aim is to enlarge the spinal canal: we believe that this can also be achieved using longer plates, as also described by Casha [7].…”

“…Some confusion exists regarding the correct term to be used for laminotomy [38]: several studies in the literature refer to it as replacement laminotomy, non-expansive laminotomy, osteoplastic laminotomy, laminoplasty, opendoor laminoplasty, non-expansive laminoplasty, ''en bloc'' laminoplasty, recapping laminoplasty, etc [3,7,10,13,16,20,32,36]. The term ''laminotomy'' seems more appropriate to us, as also suggested in a brilliant commentary by Sonntag in 2000 [38] mostly for its analogy with the nomenclature used in cranial surgery (craniectomy/craniotomy/cranioplasty).…”

“…Therefore, every effort should be made to preserve the facet joint capsules when a laminectomy is planned [7,32,35]. Nevertheless, a reconstruction of the whole posterior complex, respecting the normal anatomy, should always be pursued.…”

“…This reflects the differences between the behavior of the supraspinal ligament and the wideness of the paravertebral muscle insertions on the posterior aspect of the vertebrae (thinner in the cervical region). Moreover, the spinous process of C2 is especially important owing to its attachments to the suboccipital, the splenius capitis and semispinalis cervicis muscles [7,12,21,32]. The suboccipital muscles contribute to occipito-cervical junction stability during movement, while the paraspinal muscles provide lever arms and actuators important in the dynamic tension band which maintains cervical lordosis and confers stability [5,7,21,32].…”

“…Moreover, the spinous process of C2 is especially important owing to its attachments to the suboccipital, the splenius capitis and semispinalis cervicis muscles [7,12,21,32]. The suboccipital muscles contribute to occipito-cervical junction stability during movement, while the paraspinal muscles provide lever arms and actuators important in the dynamic tension band which maintains cervical lordosis and confers stability [5,7,21,32]. The spinous process of C7 is also important because it is the point where the supraspinous ligament ceases to be tightly adherent to the spinal processes and becomes more superficial: a wide nuchal ligament interposes between it and the cervical spinous processes (Fig.…”