Cervical Laminoplasty: A Spinal Fusion Alternative for the Right Patients

Learn about cervical laminoplasty from expert Dr. Mark M. Mikhael, M.D., and discover why it can be recommended as a spinal fusion alternative for some patients.

Advanced arthritic changes in the cervical spine can lead to spinal canal narrowing at multiple levels throughout the neck. When the narrowing becomes severe, it can lead to spinal cord compression, referred to as “myelopathy.”

Keep reading to learn more about myelopathy and how a procedure like cervical laminoplasty can be performed as a spinal fusion alternative for neck and back pain relief.

What Is Myelopathy?

Symptoms of myelopathy can include difficulty with walking and balance, trouble with handwriting and other fine motor skills, or shooting pains with numbness in tingling in the arms or hands. The most severe consequences of myelopathy include progressive weakness or even paralysis.

Several surgical procedures have been utilized with good results to treat this condition and prevent further decline.

Regardless of the surgical procedure performed, the goal of the operation is to take pressure off the spinal cord and create more space in the spinal canal.

Anterior Cervical Decompression and Fusion

When the disease is present at only one or two levels, a procedure commonly performed is called anterior cervical decompression and fusion.

During the procedure, the surgeon removes the disc and bone spurs compressing the spinal cord from the front of the neck and then fuses the two levels together. Several studies have shown this to be a very effective and reliable treatment for patients with one or two levels of compression.

A spinal fusion procedure relies on bone formation between two spinal levels until they are united. This process can take up to six months to be completely solid or healed. When a fusion fails to heal after eight to 12 months, this is then considered a “non-union.”

When attempting to perform an anterior cervical decompression and fusion procedure at three or more levels in the front of the neck, studies have shown that patients can be at slightly increased risk for non-union compared to patients with the same procedure for only one or two levels.

Laminectomy

To avoid a non-union, some surgeons prefer to take pressure off the spinal cord from the back of the neck when three or more levels of compression are involved.

To take pressure off the spinal cord from the back of the neck, the surgeon must remove portions of the bones—called a laminectomy—which creates more space for the spinal cord. Because the removal of these bones disrupts the attaching ligaments and structures in the neck, this can cause gradual neck deformity or instability.

To help prevent this from occurring, laminectomy is combined with a fusion procedure using screws and rods to hold the vertebral segments together until the bone grows and fuses them.

This treatment has also been very effective and reliable for treating patients with spinal cord compression at multiple levels.

What Is Cervical Laminoplasty?

Arthritis in any joint, including the spine, can cause significant pain with motion. Because spinal cord compression and myelopathy typically occur in the setting of advanced arthritis, the elimination of movement with a fusion procedure also may help decrease the pain associated with arthritis in the spine.

However, some patients have evidence of spinal cord compression at multiple levels with myelopathy but do not complain of any neck pain. These patients may be good candidates for cervical laminoplasty.

Cervical laminoplasty is a spinal fusion alternative that involves creating more space for the spinal cord while avoiding fusion and maintaining spinal motion. Several procedures have been described, but they all involve the same basic concepts.

Why Is Cervical Laminoplasty a Spinal Fusion Alternative?

This procedure is performed from the back of the neck. It involves creating an “opening door hinge” with the bones to create more space for the spinal canal instead of removing portions of the bones as done with laminectomy, thus avoiding disrupting some of the supporting structures.

Small plates and screws have been designed to hold open the door-hinge and maintain the increased space for the spinal canal. The spinal segments are not fused, and post-operative motion is encouraged to avoid residual stiffness following the procedure.

Who Is a Good Candidate for Cervical Laminoplasty?

While cervical laminoplasty is a novel and effective treatment for multi-level spinal cord compression while avoiding fusion and sparing motion, it is not for everybody. Patients must be carefully selected to ensure the best possible outcome following this procedure.

In particular, patients should have little or no neck pain before the procedure. Because this procedure avoids fusion and post-operative motion is expected, those patients suffering from neck pain related to spine arthritis will continue to have those complaints with maintained motion.

This procedure relies on indirect decompression to take pressure off the spinal cord. Any procedure that relies on indirect decompression requires that the patient have near-normal curvature to their cervical spine, specifically no excessive kyphosis, instability, or scoliosis. The surgeon can evaluate for this with X-rays taken before the operation.

Patient Outcomes

In appropriately selected patients, cervical laminoplasty is an effective treatment for multi-level spinal cord compression and myelopathy. The procedure can be a reasonable option for the relatively active patient who wants to maintain motion and is looking for a spinal fusion alternative.

You must carefully discuss the goals and expected outcomes of the procedure with your surgeon to ensure the best possible recovery.

Traditional front or back decompression and fusion procedures may be the more appropriate choice for patients with either one or two-level compression or significant neck pain from arthritis. Correct patient selection by the surgeon is the key to successful cervical laminoplasty.

As with any surgical procedure, patient safety and satisfactory outcomes should be the primary goal.

Get Relief From Neck and Back Pain with IBJI

IBJI’s spine surgeons are here to provide the necessary care for your ailment. See an expert to discuss if a spinal fusion alternative procedure like cervical laminoplasty is right for you.

Request an appointment with an IBJI spine specialist today.

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