TIPS FOR LAMINOPLASTY OF CERVICAL SPINE

The following are the practical tips, tricks and hints from Hirabayashi.


What is it?
Laminaplasty is an operation to enlarge the spinal canal simply and safely to promote the consolidation of the spinal laminae at the laminar hinge.

Key Principle:

* It preserves the laminae and spinous processes and prevents dural adhesions
*maintains the attachment of the post. spinal muscles
* adequate decompression can be achieved without sacrifising the spinal stability due to post spinal ligament complex

When to think of Laminaplasty?
* cervical canal stenosis due to dvelopmental, spondylotic and OPLL causes when the alignment is lordotic or straight
* some pts. of tumour of spinal cord

C/I: established kyphosis

pre-op:

do CT and MRI
look for *thickness of laminae
* shape of spinal canal
*localise spinal lesions

TIPS AND HINTS:

*Keep the head-up tilted position to keep the neck flexed in a horizontal plane

*Make the hinge-side gutter after all the procedure on the open side to avoid the breakage of the hinge

*if the hinge breaks then laminectomy should be done

*make a drill hole on the level caudal to the distal laminaplasty limit and bend the tip of the spinous process on the hinge side in order to dissipate the tension in hte inter and supraspinous ligaments

*use a diamond burr than a steel burr to avoid the injury to the dura

*remove the thineed cenral wall of the gutter using a Kerrison rongeur

*make the gutter on the hinge side a little laterally in order to make it more stable

*when making the hinge gutter, occassionaaly apply a bending force to the spinous process to check the stability of the hinge

*stay sutures are taken through the facetal capsule and deep muscles before the hinge is opened

*after the hinge is opened, the position of neck is changed form flexed to extended to maintain the lordosis

*use the tip of the rongeur to elevate the laminar door

*stay sutures are passed through the interspinous ligamensts and tied around hte spinous processes

PROBLEMS:

epidural bleeding-- pack off with fibrin

hinge break

post op- paresis at C-5-6 usually resolves by 5-6 months