What is Cervical laminoplasty surgery?
‘Cervical’ refers to the neck region. The vertebrae belonging to this region are the cervical vertebrae and have some structures associated with it. One of these is the ‘lamina’ which is the flat bony appendage that forms the boundaries of the cervical canal. These can sometimes cause compression to the structures within the spinal canal, viz. the spinal cord. This may be reflected as a neuropathic pain (tingling and numbness) or weakness of the muscle groups corresponding to the region which is supplied by these nerve roots.They predominantly supply the neck and the upper limbs.
Cervical laminoplasty is hence a neurosurgical procedure performed in order to relieve the pressure within the cervical canal by modifying the anatomical deformity that leads to compression of the spinal cord, secondary to narrowing of the spinal canal- also referred to as spinal stenosis.
Causes Of Cervical laminoplasty:
Spinal canal stenosis may occur due to various causes- whichever they be; it causes the anatomical narrowing of the spinal canal essentially. These can be:
- Arthritis and other degenerative disc changes or compression fractures: disc herniation, degenerative changes, secondary to inflammation or trauma, can cause spinal canal stenosis or cervical cord compression
- Pressure from any bony tumours or overgrowths like spurs: These may impinge on the cervical region of the spinal cord or create pressure effects that can damage the nerve roots or spinal cord segments.
- Ossification of the posterior Longitudinal ligament: This ligament runs posteriorly and hold the vertebrae in place and allow movements at the joints. However, degeneration of the ligament can increase the pressure within the spinal canal and decrease the range of movements; and thereby cause pressure related damage to the nerve roots that emerge from the spinal cord along the sides of two adjacent vertebrae (radiculopathy).
Signs and Symptoms:
Neck pain is very common:
- Axial neck pain can be due to degeneration of the vertebral facet or strain on the vertebral ligaments.
- Neck stiffness, shoulder pains, headaches, sometimes increased with neck movements.
- Compression at the nerve roots (radiculopathy) may present on a dermatomal fashion. We may be able to elicit a positive Spurling’s test (the neck is rotated and extended to the side of radicular pain and an axial force of compression is applied. A positive test creates pain along the dermatomal distribution of the nerve root tested).
The symptoms are usually neurological with reference to the neck region and the upper limbs, and maybe broadly classified into two:
- Sensory symptoms:tingling, numbness, paraesthesia
- Motor symptoms: weakness with regards to muscular movements
NB: It is important to note that at times if the compression effects are severe; it may even affect the tracts of nerves running down the spinal cord (myelopathy) to the lower limbs as well, and if left untreated may even result in irreversible neuronal damage resulting in paralysis, in the worst scenario.
Symptoms and signs suggestive of severity in advanced disease (myelopathy) include:
- Weakness and abnormal sensations
- Spasticity(increased tone and hyperreflexia) and disturbances with gait
- Decreased manual dexterity
- Positive Hoffmanns test:The distal end of the middle finger, when flicked downwards on the nail causes extension of the distal interphalangeal joint and flexion of the thumb
- Positive L’Hermitte’s sign: Neck flexion causes electric shock like sensation down the spine and the leg
- Inverted brachial reflex: striking on the tendon of brachialis muscle causes paradoxical flexion of fingers
It is important in distinguishing the cause of the neck pain from other urgent or emergency medical causes which may include a cardiac pain referred to the neck or hands, by considering the risks involved and also with a proper history and assessment
- History and Physical Examination: A complete systematic history and focussed physical examination is the key to understanding the exact aetiology for any disease. The reasons why an individual has spinal stenosis could vary depending on age, gender, occupation, or any key evidences that provide a clue towards the diagnosis.
- Xrays: A basic initial investigation to figure out any obvious abnormalities in an easy, inexpensive and non-invasive way. However, if it gives rise to any obvious abnormalities that would require surgery or the reports are inconclusive and the history and examination, suggests a pathology, we might have to do further investigations
- MRI: To look for any soft tissue changes or pressure effects to the nerve roots or the spinal cord.
- CT: To look for the bone anatomy in detail, in order to prepare well prior to surgery, so that the surgeon gets a clear picture as to what exactly is causing the problem and to avoid any unusual surprises on the operation table
- Others: As part of clearance of anaesthetic fitness, a series of routine investigations may be required depending on individual profiles and medical conditions. Any special tests may be a part of a complete assessment, taking into consideration a patient’s full medical history, to reduce any possible complications of surgery.
Types of Disease
- Anatomical defects or trauma causing compression: requires a surgical correction
- Inflammatory or degenerative conditions: would need medical and surgical managements and may even require additional surgeries as well, depending on the medical condition. Eg: in inflammatory disorders like rheumatoid arthritis
- Tumours causing compression: would require surgery and depending on the type and grade of tumour, may or may not require chemo or radiotherapy. However, the decision for surgery will be taken by a multidisciplinary team in this context by considering the risk- benefits of a surgery depending on an individual case.
- Anti-inflammatory medications: NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
- Nerve root blocks: for radiculopathy
- Facet joint injections: for pains in the facet joint
- Cervical collars: for temporary ease of pain- may affect the musculature of the neck on long term use.
Surgery (Cervical laminoplasty):
1) Indications for surgery:
- Longstanding severe root pain
- Symptoms suggestive of myelopathy
- Severity of symptoms
2) Surgical procedure: there are options for anterior and posterior approaches for decompression surgeries. However, cervical laminoplasty is usually done via a posterior approach, due to decreased risks and added benefits. The steps of surgery are as follows:
- Pre-op positioning and anaesthesia: face down position supported on a head ring or clamp.
- Incision: A posterior midline incision is placed and an access is created by dissecting the ligaments and retracting the muscles to visualise the lamina
- Laminar hinge creation: The lamina is drilled on both sides to partially cut it, allowing the formation of a hinge of bone on which it is opened on one side, and thus relieving the compression at the spinal canal.
- Spacer material: may be used in order to allow the opened lamina to remain so and to prevent future stenosis(open door laminoplasty)
NB: French door laminoplasty (double door) is a variation in which, the midline of the lamina is cut, so that both the ends of the lamina serve as hinges, relieving the spinal stenosis.
Complications/Risk factors associated with treatment procedures:
In general, the outcomes of a cervical laminoplasty are quite good. However, for completion, we are enlisting the possible complications
- Bleeding: as with any surgery, bleeding is an expected complication. With cervical laminoplasty, sometimes excess bleeding may occur due to some major blood vessels in the neck and may require vascular repair
- Infections: especially when sterile precautions are not maintained; or more commonly inadequate wound care post-surgery can cause infections, which can become fatal if it tracks upwards to affect the neurovascular structures in the neck
- Post-surgical pain or nerve palsy: This is usually temporary and may be present for the initial days after surgery and gradually decreases over time. The resolution of symptoms is based on an individual’s biological response to the treatment procedures and physical therapy may aid in a faster recovery. In rare instances, where there is a pre-existing spinal cord damage, there can be a delay in recovery or even a permanent loss of function.
- Progressive cervical kyphosis or movement restrictions: may happen in some cases, but usually the prognosis is good.
Am I a Good Candidate for Cervical laminoplasty Surgery?
This needs a complete assessment to be answered, as all patients may not necessarily require an immediate surgery. We may try some conservative measures to assess the effectiveness, even though a definitive management would require a surgery in the future because it is an anatomical (or structural) defect.
An earlier consultation can help in being prepared and be planned in advance regarding any interventions required so that, any inadvertent mishaps in near-future can be avoided
However, any symptoms suggestive of myelopathy, demands an urgent surgical intervention.
The surgery usually requires an in-patient stay of few days provided there are no complications associated with the procedure.
Recovery takes couple of weeks to several months depending on the patient’s physiological response to the procedure.
Aftercare Of Cervical laminoplasty Surgery:
Wound care and physiotherapy are of utmost importance, to prevent infections and promote healing and improve neck movements.
Follow-up maybe required at 4-6 week intervals depending on the resolution of pain and improving mobility or any other complications post-surgery.
Success Rate Of Cervical laminoplasty Surgery:
On an average the success rate due to a pure anatomical defect is reasonably high because of a complete cure. However, any functional aetiology adding onto the symptoms may not necessarily have the same rates of success. However, a complete assessment helps in identifying the right candidates for the surgery, and the symptom parameters have shown significant improvements following surgery, in prospective studies over several years.
Benefits of Cervical laminoplasty Treatments
As already mentioned, the benefits of the surgical procedure is a permanent resolution to the anatomical component which has been causing symptoms of spinal cord or spinal nerve root compression, which cannot be achieved to a 100% cure with any alternative way of treatment.
Other added benefits include:
- Overall improvement of symptoms with time
- Permanent solution for the anatomical defect causing compression
- Prevention of future risks of cord compression around the operated segment
Why Choose MedcureIndia?
Our team of doctors and specialists make sure that a holistic care is employed with regards to patient care, and your satisfaction stays as the top priority.
MedcureIndia has helped so many people with permanent relief from these symptoms, due to its best available neurosurgeons and we base our practice on national and international protocols which are followed in clinical practice.
We make sure that you are in safe hands when you are with us and the treatment of your condition will be tailor-made based on your medical profile, with value for every hard effort that brought you to us. We achievethis, by providing quality care at an affordable expense.