As we age, our bodies will experience several changes. The spine is an organ that experiences quite a lot of changes as we age. One common condition experienced in the spine due to degenerative processes is nerve compression or commonly called cervical myelopathy. Cervical myelopathy is a condition of compression of the cervical nerve roots from the dorsal and/or ventral which causes different clinical presentations. When caused by degenerative processes or spondylosis changes, cervical spondylothic myelopathy is often seen in the elderly population with conditions of loss of intervertebral disc integrity, orthophytes in the facet and uncovertebral joints, and hypertrophy of the ligamentum flavum.
Cervical laminoplasty is a non-fusion surgical decompression procedure that is commonly performed to reduce nerve compression in the neck in cervical spondylothic myelopathy (CSM). The primary goal of laminoplasty is to reduce compression of the spinal cord. Laminoplasty offers several advantages over laminectomy with or without fusion. Laminoplasty does not carry the complications associated with arthrodesis, such as potential acceleration of adjacent segment disease and pseudoarthrosis.
Cervical Laminoplasty Indications
The ideal indications for laminoplasty are:
- Patients with multilevel myelopathy
- Lordosis position in cervical
- Minimal to no pain in axial spondylotic pain
It should be noted that the above are ideal indications, but patients who do not perfectly meet the above indications may still be considered for laminoplasty.
Contraindications for Cervical Laminoplasty
Contraindications to laminoplasty are severe instability of the spinal segment, especially if the instability is due to compression of the nerve roots. Laminoplasty can be successfully performed in mild spondylolisthesis.
Cervical Laminoplasty Complications
- Wound healing
Posterior surgical approaches are known to have higher rates of wound complications compared to anterior approaches. The use of vancomycin powder can reduce the rate of postoperative infections.
- Loss of sagittal alignment
Loss of lordosis can occur after laminoplasty, although this rarely results in the type of severe kyphosis seen after multilevel laminectomy.
- Neck pain
The development of neck pain is often influenced by a variety of variables and is likely multifactorial. Laminoplasty is not indicated for patients with significant preoperative neck pain as it may not provide effective symptom relief.
- C5 palsy
Postoperative C5 weakness is a multifactorial phenomenon that can occur in other spinal cord decompression operations. C5 weakness is generally a motor dysfunction of the deltoid and/or biceps muscles. This complication occurs not only in laminoplasty, but also in other cervical decompression operations.
- Neurological deterioration
Spinal cord injury is a rare but devastating complication following any spinal cord surgery.
- Recurrent stenosis
Recurrent stenosis has been reported in up to 10% of cases and usually occurs at the C5 or C6 level. This is often associated with suture or bone grafting techniques for fixation and is very rare.
Also read: Thoracic Outlet Syndrome (TOS) – Penatalaksanaan Fisioterapi
Reference:
- Weinberg DS, Rhee JM. Cervical laminoplasty: indication, technique, complications. J Spine Surg. 2020 Mar;6(1):290-301. doi: 10.21037/jss.2020.01.05. PMID: 32309667; PMCID: PMC7154346.
- Satomi K, Ogawa J, Ishii Y, Hirabayashi K. Short-term complications and long-term results of expansive open-door laminoplasty for cervical stenotic myelopathy. Spine J. 2001 Jan-Feb;1(1):26-30. doi: 10.1016/s1529-9430(01)00008-0. PMID: 14588365.
