Cervical laminoplasty: use of a novel titanium plate to maintain canal expansion--surgical technique.

Emory Spine Center, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Journal of Spinal Disorders & Techniques (Impact Factor: 1.77). 09/2004; 17(4):265-71. DOI: 10.1097/01.bsd.0000095401.27687.c0
Source: PubMed

ABSTRACT Cervical laminoplasty is a technique used to achieve spinal cord decompression in cases of myelopathy or myeloradiculopathy. The most common reason for failure of this technique is restenosis due to hinge closure. Various techniques have been employed to hold the laminar "door" open while the body heals the lamina hinge in the new expanded position. Ideally, a method of achieving laminar fixation should be technically straightforward, provide secure laminar fixation, and be rapid to minimize the risk of iatrogenic injuries, blood loss, and operative time. The authors describe the use of a novel plate designed to accomplish these goals. The technical issues relevant to performing the laminoplasty and securing the laminae are discussed. The plate has been proven biomechanically to be equal or superior to the currently used techniques. The use of this plate will allow the patient to engage in an early active rehabilitation protocol-while minimizing the risk of restenosis of the canal. This may ultimately lead to better preservation of motion and decreased axial neck pain following laminoplasty.

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    ABSTRACT: Ultrasonic surgical aspirators have been used mainly for removing brain tumors. Because of their longitudinal and torsional tip, they are used for cutting the bone structures in spinal surgery installing a scalpel-type tip. The purpose of this report is to describe the effectiveness and surgical pitfalls of an ultrasonic bone curette in laminoplastic laminotomy and hemilaminotomy. We present 12 patients who underwent laminoplastic laminotomy and hemilaminotomy. We used a SONOPET UST-2001 ultrasonic bone curette with HB-05S handpieces (M and M Co, Ltd, Tokyo, Japan). After a tumor was removed, titanium plates were used for the laminoplastic laminotomy and hemilaminotomy. The technical advantage of an ultrasonic bone curette and procedure-related complication were examined. There were no major procedure-related complications such as cord injury. Wound infection and subcutaneous fluid collection caused by cerebrospinal fluid leakage did not occur for reconstruction of posterior bony structure. In 1 patient with calcified dura mater associated with tumor, dural tear occurred. The width of the tip was narrow enough for resected laminae to be fused postoperatively, and spinal instability did not occur in all cases. The scalpel-type ultrasonic bone curette is useful for cutting bone and effective for reconstruction of the laminae. Laminotomy with an ultrasonic bone curette is safe and minimally invasive. To prevent dural tear, we recommend drilling laminae to make the bone thin as the first step, followed by cutting the remaining laminae using a bone curette especially in cases with calcified or tense dura mater.
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    ABSTRACT: Many commercially available hydroxyapatite (HA) spacers for cervical laminoplasty have been introduced but have disadvantages such as lack of plasticity, easy cracking, and occasional difficulty in fixation by sutures. Here we present the short-term results of a newly designed titanium spacer (Laminoplasty Basket) in open-door cervical laminoplasty, and evaluated clinically and radiologically. The titanium box-shaped spacer with two arms for fixation was easily inserted and fixed into the laminoplasty space with 4-mm or 5-mm length screws after the posterior cervical arch was repositioned for the canal expansion. Twenty-one patients with cervical myelopathy due to spondylosis or ossification of the longitudinal ligament or developmental narrow canal observed for more than 6 months postoperatively were enrolled in this study. The neurological condition of these patients improved from 9.4 points on the Japanese Orthopaedic Association scale preoperatively to 13.5 points at 6 months after surgery. Postoperative radiological evaluation showed no laminar closure or implant failure and cervical spine curvature was maintained. These results seemed to have no significant difference compared with those using HA spacers. This titanium spacer is a potential substitute for conventional HA or other similar devices in cervical laminoplasty.
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