Preoperative lateral x-ray of the cervical spine. The black double arrow notes the reduced diameter of the spinal canal causing compression of the spinal cord.
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Post operative XP x-ray of the laminoplasty. Please note that the spinous processes (noted by the white lines) are “off center” in the area of surgery as the back wall of the canal that the spinous processes attach is rotated to the side to open the canal.
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Post-operative lateral x-ray of the laminoplasty. The black double arrow notes the enlarged canal. Compare to the pre-operative x-ray.
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Post operative CT myelogram of the laminoplasty. The black arrow points to the spinal cord and the white arrow points to the CSF. Note that the spinal cord is surrounded by CSF which means there is no compression of the cord.
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The laminoplasty is a procedure similar to the laminectomy, but instead of removing the lamina, the lamina is enlarged to allow more room for the spinal cord. The procedure is technically more demanding as the lamina must be partially cut, stretched and then fixed in its new position with a bone graft and a small titanium plate at each level. The usefulness of this procedure is similar to a laminectomy (cord compression and myelopathy) but may give more stability to the operated segments than a laminectomy can. Of course, the repaired lamina must heal in a laminoplasty and there is no healing required in a laminectomy.
In either procedure (cervical laminectomy, laminoplasty and posterior cervical fusion), there is a danger to the C5 nerve roots, not from the technical aspects of surgery but from the new displaced position of the cord. As noted above, the spinal cord should "drift" backwards with a successful laminoplasty or laminectomy. Of course, the nerve roots are attached to the spinal cord. The cord drifting back will by definition, stretch the nerve roots somewhat. The shortest and least easily stretched roots are the C5 roots that attach to the deltoid muscles (the shoulder muscles that raise and lower the humerus- the upper arm bone). Occasionally, there may be weakness of these muscles after surgery but they normally recover after a period of time. There are rare times that some weakness can be permanent.
Posterior cervical fusion is as the name implies, fusing the back of the neck. This procedure can be used because of fracture, deformity, pseudoarthrosis (lack of successful fusion in the front of the neck- ACDF) and to extend a fusion down to the thoracic spine. Since a fusion requires immobilization to work, screws, rods and wires are typically used. Bone graft is then placed along the facets and normally, within 3 months, a solid fusion occurs.
A posterior fusion can be used in conjunction with a laminectomy to decompress the spinal cord or a foramenotomy to decompress a nerve root (see section on posterior cervical foramenotomy for further description of that procedure).
To learn more about cervical laminectomy, laminoplasty and posterior cervical fusion as a treatment option for spine related conditions, please contact Dr. Donald Corenman at his Vail, Colorado office at 970-479-5895.
