The
spinal cord and nerve roots in the neck are surrounded and protected by
the cervical vertebrae. These bones have an opening called the spinal
canal through which the spinal cord passes. Ligaments and blood vessels
are also present in the spinal canal. The nerve roots start at the
spinal cord and pass through an opening between the vertebrae called the
intervertebral foramen (or neural foramen). From there, they extend to
other parts of the body.
Spinal
stenosis is a condition where there is narrowing of the spinal canal
and often the neural foramen that causes compression of the spinal cord
and/or nerve roots. This narrowing is caused by numerous factors
including bone spurs, degeneration of the inter-vertebral disks and
facet joints, and thickening of the ligaments. Among the symptoms spinal
stenosis can produce are pain and/or numbness in the arms, clumsiness
of the hands, and gait disturbances.
Laminoplasty
is a procedure intended to relieve pressure on the spinal cord while
maintaining the stabilizing effects of the posterior elements of the
vertebrae.
The
laminoplasty procedure involves "hinging" one side of the posterior
elements of the spine and cutting the other side to form a "door". The
door is then opened and held in place with wedges. By relieving pressure
on the spinal cord it is the goal of laminaplasty to stop the
progression of damage to the spinal cord and allow for as much recovery
of function as possible.
What type of patients need this surgery?
Any
patient with the complaint of pain numbness and tingling in one or both
upper extremities, and /or disturbance in walking, or loss of control
in bowel and bladder for a considerable period of time despite
conventional treatment like rest, physical therapy and medications are
recommended for this type of procedure.
How is the surgery performed?
This
surgery is performed by sedating the patient under general anesthesia
and making him lie on his stomach. The head is kept slightly bent with
the help of Mayfield clamp to straighten the skin folds on the neck.A
midline incision is made on the back of the neck corresponding to the
affected spinal segment. The skin is cut open and the muscles are
separated to view the involved vertebrae.
The
lamina are cut through their thickness longitudinally on one side and
grooved on the other side to keep it hinged to the vertebral body. The
posterior part of the vertebra is swung open like a door. Small wedges
made of bone are placed in the opened space of the door. The door of the
vertebrae swings shut, and the wedges stop it from closing all the way.
The spinal cord and the nerve roots rest comfortably behind the door.
Since this increases the space in the spinal canal, it decompresses the
spinal cord with immediate relief of symptoms. Any presence of herniated
disc, thickened ligament or facet joint and osteophytes are identified
and removed.
After Surgery
If
the surgery simply prevents progression of the spinal cord damage
(myelopathy) and there is no loss of function due to the surgery, both
the patient and surgeon should consider it successful.
Patients
will feel some pain after surgery, especially at the incision site.
While tingling sensations or numbness is common, and should lessen over
time, they should be reported to the doctor. Most patients are
encouraged to be up and moving around within a few hours after surgery.
After surgery, your doctor will give you instructions on when you can
resume your normal daily activities.
Signs
of infection like swelling, redness or draining at the incision site,
and fever should be checked out by the surgeon immediately. Keep in
mind, the amount of time it takes to return to normal activities is
different for every patient. Discomfort should decrease a little each
day. Most patients will benefit from a postoperative exercise program or
supervised physical therapy after surgery. You should ask your doctor
about exercises to help with recovery.
Outcome
The results of the surgery are variable since some people have more extensive disease than others.
In general, after the surgery most patients can expect to regain :
- Some spinal cord function.
- Improvement in their hand function and walking/balancing capabilities.
- Surgery is very effective in reducing the pain in the arms and shoulders caused by nerve compression. However, some neck pain may persist.
- Decreased numbness in the hands (if there was a lot of numbness prior to the surgery, it probably won't go away completely).
The
outcome of treatment for myelopathy is more variable than surgery for
radiculopathy. Decompressive procedures such as laminectomy generally
arrest progression of myelopathy. The amount of recovery of neurologic
function such as balance, coordination, bowel or bladder incontinence
depends on the amount and duration of compression, as well as the
presence of any permanent damage to the spinal cord.
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