Laminoplasty

Laminoplasty is a surgical procedure that has been developed as an alternative to cervical laminectomy, which is used to treat cervical myelopathy. Laminoplasty reconstructs the vertebral lamina to decompress the spinal cord. The term laminoplasty means, "to create a hinge to lift the lamina."[1]

To treat myelopathy and ossified posterior longitudinal ligament (OPLL), there are two approaches that can expand the spinal canal. These approaches are the anterior approach which is a direct removal of the cord compressing lesion, or a posterior approach which is an indirect decompression of the spinal cord. Laminectomy was one of the main methods for the posterior approach, however, the creation of laminoplasty was able to avoid several problems associated with the laminectomy procedure. Some risks of the laminectomy procedure include postoperative segmental instability, kyphosis, perineural adhesions, and late neurological deterioration.[1]

The laminoplasty procedure was created by Japanese orthopedic surgeons during the 1970s to 1980s. Over the years, laminoplasty has evolved its technique. The first laminoplasty technique developed was from modifying the Miyazaki and Kirita's technique for laminectomy.[1] This method was described by Oyama as Z-shaped laminoplasty. The name was given due to the z-shape formed when cutting the laminae. The next method is called, en bloc laminoplasty, and it was a modification of the en bloc laminectomy, which was developed by Tsuji. En bloc laminoplasty decompresses the spine by making the laminae act as a flap, and this flap hovered over the cord without sutures or bone grafts. Later in 1977, Hirabayashi and his colleagues introduced the open-door laminoplasty, which was inspired by the en bloc laminoplasty. This method uses sutures on the facet capsule to leave the flap open. After this method, Kurokawa and his team developed the double door laminoplasty. This procedure involves cutting the laminae midline, and hinges are made bilaterally.

Not only are there many other methods of laminoplasty being created, these new methods falling under the open door or double door laminoplasty category, but also, other techniques are being developed in order to preserve the cervical muscle attachment on the spinous processes.

Spinal column curvature-en

The spine is one of the main components of the central nervous system (CNS). This structure's function is to provide the body with support and to protect the spinal cord. The spinal cord serves 3 main functions for the body. It provides sensation, autonomic and motor control for all bodily functions and parts. The spinal cord is the most complex yet organized part of the CNS. The entire spinal structure may be divided into 4 sections that create an overall S-shaped curve. These sections include the cervical, thoracic, lumbar, and sacral regions. Intervertebral discs stacked on top of one another make up the structure of the overall spine. These discs are separate and cushioned in between them, and with age, these discs become brittle and flat. Sensory stimulation is recognized and processed through the spinal cord, these include pain and temperature, touch, and proprioception. Our body's entire neural network sends any of this sensory information to the spinal cord to process. In order to stabilize spinal movement, there are many ligaments throughout the spine to hold the vertebrae and intervertebral discs together. These elements all working together allow for spinal movement and overall bodily stability and support.[2]

The main purpose of this procedure is to provide relief to patients who may develop symptoms of numbness, pain, or weakness in arm movement. Patients may also experience difficulty with hand and finger movement, along with balance and walking difficulty. This surgical procedure is also commonly performed in order to remove pressure from the spinal cord in the neck, which may be due to various reasons. These include: tumors, fractures, arthritis, bone spurs, disc herniations, or degenerative problems.[3]

Complications of this surgical procedure can include nerve damage to either the nerve roots or the spinal cord, which would result in limb weakness or paralysis respectively. Other complications can include infection, spinal fluid leak, or unsuccessful relief of compression.[6] Upon review of over 60 studies, there has been evidence showing that these complications are greater in patients of older age, while it is less common that factors such as body mass index, smoking status, the duration of symptoms as well as baseline severity score contribute to perioperative complications. These studies have also indicated that neck pain is more prevalent in patients undergoing laminoplasty compared to that of other surgical techniques, whereas C-5 palsy occurs less in laminoplasty.[7] There is also a slower progression rate of OPLL in laminoplasty compared to laminectomy. Laminoplasty has a progression rate of only 45.4%, while 52.5% is associated with laminectomy. Other miscellaneous complications that were reported include hematoma, progressive kyphosis, and incomplete decompression. The probability of these complications range from 5-20% after this procedure.[8]

While the success rate of the laminoplasty procedure is dependent on the underlying condition that causes the need of surgery, the vast majority of patients that undergo this procedure see significant relief of pain and approximately 75% of patients see improvement.[7]

It is encouraged and sometimes required that patients partake in rehabilitative therapy after undergoing a laminoplasty in order to regain the strength and flexibility of the operated area. While factors such as the age of patients as well as the duration of symptoms prior to surgery influence recovery time, a study assessing the recovery process in patients showed evidence that the preoperative values of all parameters significantly improved 5 years after the surgery.[9]