Laminoplasty

Overview of Laminoplasty in India

Laminoplasty is a non-fusion decompressive surgery used to cure cervical spondylotic myelopathy (CSM). The procedure is used as an alternative to Cervical Laminectomy to treat myelopathy of the cervical region. "Laminoplasty" is a general term that is applied to surgical procedures where the vertebral lamina is reconstructed after opening the spinal canal.

The aim of the procedure is to alleviate pressure on the spinal cord and its nerves by increasing the space occupied by the spinal cord. The lamina is the rear side of the vertebral bone which forms the roof over the spinal cord. In this procedure, hinges are made that facilitate the lifting of the lamina without removing it; this technique is termed "open door Laminoplasty."

Laminoplasty is usually performed on the cervical spine (neck); however, the procedure can be extended to the thoracic and lumbar spine (middle and lower back, respectively), especially in pediatric and young adults. Laminoplasty provides the benefit of maintaining stability of the cervical spine and prevents post-operative kyphosis.

What is a Laminoplasty?

Laminoplasty is an operation that helps you reduce the pressure on your nerves and spinal cord. This procedure will increase the space in your spinal canal (the area where your spinal cord runs) through your lamina. The lamina is a bone located on the back side of the vertebra. This surgery provides stability to your spine and helps avoid neurological problems such as paralysis.

This kind of surgery is mostly done on the bones of your neck region, which is known as the cervical spine.

Types of Laminoplasty:

Z-shaped laminoplasty, open-door laminoplasty, and double-door laminoplasty are three popular techniques employed during spinal cord decompression.

Z-shaped laminoplasty

This procedure involves the thinning of the C2 to C7 laminae through drilling. It is very important to decompress several regions of the laminae. The Z-shaped incision is created in the laminae and lifted up by sewing them together.

Open Door Laminoplasty

The drilling procedure is carried out along the lateral sides of the C2 to C7 laminae. One side of the bone is cut open, while another side acts as a hinge. Then the laminae are elevated to increase the space in the spinal canal. A suture fixed to the facet capsule helps in keeping the flap of the laminae open.

Double Door Laminoplasty

Drilling is performed to cut the bone in the midline of the vertebral laminae. The lateral sides of the laminae function as a hinge to expand the spinal canal, especially its inner cortex. In order to maintain the stability of the opening, an artificial spacer is used. Hydroxyapatite is a popular spacer.

Procedure:

Fulfilling the post-operation instructions provided by medical practitioners will be an effective way for patients to undergo a successful recovery process with optimum results after a laminoplasty operation.

Medical Examination:

Prior to the surgery, a medical examination will be performed on you by your physician to assess your overall health condition and identify any underlying medical conditions that may affect the surgery or the recovery period.

Medications:

Discuss with your doctor all the medicines that you are taking at the moment, including prescriptions, over-the-counter medications and dietary supplements, since some medicines, for instance, blood thinners, should be temporarily stopped to prevent uncontrollable bleeding.

Allergies:

Inform your doctor about any allergies to medication, food or latex.

Pre-Surgery Instructions:

Adhere to all the pre-surgical instructions given by your healthcare provider, which include dietary restrictions, fasting instructions, and medications.

Personal Hygiene:

On the day of surgery, you must remove all artificial nail polish and nails. Do not wear make-up or jewellery. Pack essential personal care items such as a toothbrush, toothpaste, and dentures in case of an overnight stay in the hospital.

Transportation and Accommodation Arrangement:

It is important to arrange for your transport to and from the hospital on the day of surgery. If you are not local, make sure to book a hotel near the hospital for an overnight stay.

Support System:

Create a support system for your recovery post-laminoplasty surgery. Arrange for someone to be with you on the day of surgery and assist you with daily tasks.

What is the Procedure for Laminoplasty in India?

The following are the steps taken when conducting a cervical laminoplasty procedure in India:

Administration of Anesthesia: The patient is administered general anaesthesia to make him/her completely unconscious during the operation.

Incision: Incisions are made on the neck area and are usually midline. They serve as entry points into the cervical region without disturbing the tissues as conventional surgeries would have done.

Exposure of the Lamina: With the help of the surgeon's instruments and operating microscope, the lamina – the roof bone of the spinal canal- is exposed by dissecting the surrounding tissue layer.

Bone Cut: After exposing the lamina, a thin slit is created in the lamina of the spinal canal on one side and another on the other side. This creates the hinging point on one side and leaves the other side rigid.

Lamina Elevation: The next step involves the lifting of the hinged lamina such that the whole spinal canal is opened and the pressure on the nerves and spinal cord is relieved. Bone struts or metallic plates are introduced to maintain the position of the lamina.

Closure: The incisions are sutured or stapled together depending on preference and dressed with a sterile cloth.