Laminoplasty

Laminoplasty is an orthopaedic/neurosurgical surgical procedure for treating spinal stenosis by relieving pressure on the spinal cord. The main purpose of this procedure is to provide relief to patients who may suffer from symptoms of numbness, pain, or weakness in arm movement. The procedure involves cutting the lamina on both sides of the affected vertebrae (cutting through on one side and merely cutting a groove on the other) and then 'swinging' the freed flap of bone open thus relieving the pressure on the spinal cord. The spinous process may be removed to allow the lamina bone flap to be swung open. The bone flap is then propped open using small wedges or pieces of bone such that the enlarged spinal canal will remain in place. Laminoplasty is an orthopaedic/neurosurgical surgical procedure for treating spinal stenosis by relieving pressure on the spinal cord. The main purpose of this procedure is to provide relief to patients who may suffer from symptoms of numbness, pain, or weakness in arm movement. The procedure involves cutting the lamina on both sides of the affected vertebrae (cutting through on one side and merely cutting a groove on the other) and then 'swinging' the freed flap of bone open thus relieving the pressure on the spinal cord. The spinous process may be removed to allow the lamina bone flap to be swung open. The bone flap is then propped open using small wedges or pieces of bone such that the enlarged spinal canal will remain in place. This technique contrasts with vertebral laminectomy in the amount of bone and muscle tissue that has to be removed, displaced, or dissected in the procedure. 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.” 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. 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. 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.