Cervical laminoplasty: Use of a novel titanium plate to maintain canal expansion – Surgical technique
Emory University, Atlanta, Georgia, United StatesJournal of Spinal Disorders & Techniques (Impact Factor: 2.2). 09/2004; 17(4):265-71. DOI: 10.1097/01.bsd.0000095401.27687.c0
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: Cervical myelopathy is a clinical entity resulting from external compression of the cervical medulla. The clinical course can be divided into the acute form (secondary to trauma) versus subacute (progression within weeks to months) and chronic cervical myelopathy (months to years). The clinical picture of myelopathy is that of unsteady gait with long-tract signs, such as hyperreflexia, spasticity and extensor plantar responses. Between 1997 and 2000, 359 consecutive patients have been operated on in our department presenting with a variety of symptoms related to compression of the cervical medulla. Beside of standard MRI for all patients we applied SSEPs, gait analysis and dynamic MRI studies as additional helpful tools in evaluating selected patients pre- and postoperatively. We prefer the anterior approach as first-line approach because in the majority of patients the osteophytic spurs are more dominant anteriorly, and after anterior decompression and stabilization the posterior approach appears safer. We also favor the more extended approach of spondylectomy versus multilevel decompression in patients with bisegmental or multisegmental spinal canal stenosis. However it seems to be that radicular decompression is better achieved through multilevel decompression than through spondylectomy.
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ABSTRACT: Purpose of review: The optimal treatment for multilevel cervical spondylotic myelopathy continues to be the subject of considerable debate. The emergence of cervical laminoplasty as a mainstay in the treatment of the cervical spondylotic myelopathy has been a recent trend. Historically, the North American experience had been primarily split between multilevel anterior decompression and fusion versus laminectomy and fusion. A comparison of laminoplasty with each of these techniques is important as one tries to refine the indications for choosing one procedure versus another in the treatment of such cases. Recent findings: Neurologic outcomes of the various surgical strategies for multilevel cervical spondylotic myelopathy are equivalent. When comparing between multilevel anterior procedures, laminectomy and fusion and laminoplasty, however, lower complication rates appear to favor laminoplasty in properly selected cases. Upon critical analysis of multilevel anterior procedures, as well as laminectomy and fusion, the surgical complications are more frequent than previously recognized. Laminoplasty offers the advantages of preserving motion and earlier active cervical motion while effectively decompressing the spinal cord. Summary: Cervical laminoplasty with or without fusion should be considered in cases of cervical spondylotic myelopathy.
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