Laminoplasty

What is Laminoplasty?

Spinal stenosis is a prevalent spinal condition that can cause neck or back pain and neurological symptoms. In some patients, spinal stenosis is debilitating and limits their day-to-day activities. 

If spinal stenosis symptoms don’t improve despite several months of non-invasive treatment, your physician may recommend surgery. There are many possible surgical methods for spinal stenosis, one of which is laminoplasty. 

In this article, we’ll discuss the surgical process for laminoplasty and what patients can expect from this spinal treatment. 

What is Laminoplasty Surgery?

Laminoplasty is a surgical procedure for treating spinal stenosis. The goal of the procedure is to alleviate pressure on the spinal nerves and the spinal cord by creating more room in the spinal canal.

The Incisions of Laminoplasty

The laminoplasty procedure is done through a small incision. Once the surgeon has accessed the spine, they will cut into the lamina of the vertebra that’s affected by spinal stenosis. The lamina can be thought of as the outer sheath of the vertebra. It protects and supports the posterior side of the spinal cord.

Creating a “Door” With The Lamina

Specifically, the surgeon will create two cuts that are positioned nearly opposite one another. One cut will extend through the entire lamina, while the second cut will simply act as a groove to create a hinge. This cut allows the lamina to swing open, similar to a door. In fact, this procedure is often referred to as an “open door laminoplasty.“ 

The tips of the spinous processes may be removed in laminoplasty to create room for the bone to pull open. The lamina is then closed, using small pieces of bones as wedges to ensure the spinal cord is no longer compressed at that level.

This surgical spinal stenosis procedure immediately relieves pressure on the spinal cord. Although it’s an invasive procedure and, therefore, involves certain risks, it can dramatically improve back pain and neurological symptoms for spinal stenosis patients. 

When is Laminoplasty Performed?

Spinal stenosis is the main condition for which laminoplasty is performed. Commonly referred to as an unnatural narrowing of the spinal canal, this spinal disorder is a common cause of mild to severe lower back pain and restricted mobility.

The most prevalent cause of spinal stenosis is osteoarthritis. This refers to the joint degeneration that occurs gradually with age. With osteoarthritis, the cartilage in the facet joints of the spine wears out, potentially leading to bone spurs that may press on spinal nerves. 

Spinal stenosis can also result from:

• A herniated disc

A herniated disc is a spinal condition that affects the intervertebral discs. With this condition, the interior of the disc protrudes from a crack in the disc exterior. The damaged disc takes up space in the spinal canal and, as a result, may cause spinal stenosis. 

• Spinal fractures

Spinal fractures, most commonly caused by osteoporosis, may encroach on the spinal nerves and lead to spinal stenosis symptoms. 

• Thickened spinal ligaments

The ligaments that support the spine can thicken as a result of age and arthritis. As the ligaments thicken, they take up more space in the spinal canal and may press on spinal nerves.

• Genetics

Some patients are born with a spinal canal that’s smaller than usual. This is known as congenital spinal stenosis. Additionally, patients who are born with scoliosis may experience spinal stenosis, as the abnormal curve of the spine can limit the space in the spinal canal. 

Non-Surgical Treatment Methods For Spinal Stenosis

A variety of conservative therapy methods for spinal stenosis are available, including spinal stenosis exercises, medications, and injections.

• Spinal stenosis exercises and physical therapy can help release tension in the back, improve spinal posture, and strengthen the spine’s supportive muscles. Many cases of spinal stenosis can be resolved with physical therapy. 
• Certain medications can be used to alleviate pain and inflammation caused by spinal stenosis. However, medications are rarely recommended as a long-term solution for chronic spinal stenosis-related back pain. 
• Epidural steroid injections can help with spinal stenosis pain by reducing swelling and pressure on the irritated spinal nerves. However, doctors recommend that patients receive no more than three to four steroid injections per year. At a higher frequency, steroid injections can cause tissue damage. 

These non-invasive therapies are often successful in relieving the symptoms of spinal stenosis. But, if they prove ineffective after several months, spinal surgery may be recommended to help the patient make a full recovery.

Numerous surgical procedures are available for spinal stenosis. Tools and therapies have undergone great advances in recent years, providing better outcomes and fewer complications for patients. The open door laminoplasty technique is one example of these advances in treatments for spinal stenosis.

Where is Laminoplasty Performed?

Laminoplasty is most commonly performed in the cervical spine (cervical laminoplasty) or the lumbar spine (lumbar laminoplasty). The cervical spine refers to the neck region, while the cervical spine is located in the lower back. 

What Is The Difference Between Laminoplasty and Laminectomy?

Laminoplasty and laminectomy are both spinal surgical procedures involving the lamina. Additionally, both of these procedures fall under the category of spinal decompression surgery. However, there are key differences between these surgical methods. 

Laminoplasty vs. Laminectomy

• Laminotomy involves removing a small portion of the lamina in the injured section of the spine. 

• Laminoplasty involves severing one side of the lamina and opening it to create more space in the spinal canal. Unlike laminotomy, laminoplasty doesn’t fully remove the affected lamina.

What Can I Expect After Laminoplasty Surgery?

Laminoplasty surgery recovery is similar to that of other spinal procedures. Immediately after the surgery, patients may need to remain in the hospital for a few days.

After returning home from the hospital, patients will likely experience a mild discomfort and need to limit their activities for a few weeks. After two to four weeks, most laminoplasty patients can return to work.

Although patients need to rest after laminoplasty, gentle movement is encouraged to stimulate healing and prevent stiffness in the spine. Your doctor may prescribe a physical therapy program to help you recover from the procedure. 

The laminoplasty recovery process can continue for up to a year after the procedure, especially if the patient undergoes spinal fusion. 

Laminoplasty With Spinal Fusion

Spinal fusion back surgery may be performed in conjunction with laminoplasty to stabilize the vertebra. As a method for preventing spinal instability after surgery, spinal fusion has been performed since the early 1900s. Unfortunately, fusion also comes with numerous downsides. 

Arguably the most significant downside is that spinal fusion eliminates the natural flexion and rotation of the individual vertebra. This means that many patients lose the ability to partake in their favorite activities. In some cases, spinal fusion patients lose the ability to pick up items from the floor. 

Additionally, spinal fusion poses the risk of adjacent segment disease. This spinal fusion complication occurs when the vertebrae surrounding the fused segment undergo increased stress as a result of the fusion. This leads to an increased rate of degeneration in the adjacent segments. 

It’s also worth noting that spinal fusion can largely increase the laminoplasty recovery time. This may require patients to take more time off of work and physical activity after the procedure. 

Alternatives to Spinal Fusion For Laminoplasty Patients

Today, there’s a new option for preventing spinal instability in laminoplasty surgery: the TOPS™ System.

TOPS™ is a non-fusion spinal implant that stabilizes the vertebrae while permitting the natural flexion and rotation of the individual vertebra. It’s proven to provide superior clinical outcomes to spinal fusion surgery for spinal stenosis patients. 

Spinal problems and back pain are among the most common and debilitating medical ailments. If you suffer from the symptoms of spinal problems, you have a variety of treatment options. Talk to your doctor to ensure that you’re familiar with all of the medical procedures available to you.

How Safe Is the Laminoplasty Procedure for People Above 70?

Many people over the age of 70 require laminoplasty surgery and as an elderly person it is common to feel uneasy about such a procedure and you may worry about the possible complications, and whether the surgery is actually worth it.

In this article, we will discuss what a Laminoplasty actually is, why you may need it, possible complications and how long it may take to recover from the surgery. 

What is the laminoplasty procedure?

A cervical laminoplasty is a form of surgery that intends to relieve pressure on the spinal cord in the neck. This pressure can result from numerous issues such as; arthritis; bone spurs; herniated discs; spinal injuries such as fractures; and degenerative issues resulting from the aging process.

The issue is commonly known as cervical spinal stenosis and can affect just one level of the spine, or multiple levels simultaneously. If this issue becomes severe then the symptoms can have a big impact on a person’s quality of life, causing pain, discomfort, and a lack of mobility. 

Although it sounds rather gruesome, the procedure is often known as an ‘open door laminoplasty’ as during surgery, the vertebrae are effectively opened just like the opening of a door. 

Why would a person need a Laminoplasty?

A person requiring laminoplasty surgery is likely to be suffering from a narrowing of the cervical spinal canal which places pressure on the spinal cord and nerve roots causing significant pain and numbing and weakening of the limbs, sometimes impacting a person’s ability to walk. In extreme cases, this could also result in paralysis if left untreated.

The goal of a laminoplasty is to prevent this problem from worsening and relieve a person from pain. 

Is the Laminoplasty procedure safe for people above 70?

Laminoplasty surgery for people above 70 is no different from any other sort of major surgery and the patient would be considered high risk, however, this does not mean anyone should go into the operation fearing the worst outcomes.

Below is a list of potential complications which could occur as a result of surgery;

• The spinal cord, or nerve root damage, causes weakness, or in severe cases, some paralysis.
• Pain and numbness due to manipulation of the nerves
• Leaking of Cerebrospinal fluid
• Bowel or bladder incontinence
• Impotence
• A continuation, or a resumption of the pain experienced before surgery
• Blood Clots / Deep Vein Thrombosis
• Bleeding of major blood vessels
• Infections

Although any surgery can result in complications like the ones stated above, general anesthesia can also pose a risk to someone who is classed as elderly, as an aging brain can be more prone to problems that are related to the medication. 

A temporary issue caused by anesthesia is Postoperative Delirium which may only become apparent a few days after the surgery and can last around a week. This condition causes confusion and disorientation, as well as impacts memory and attention span.

A more serious condition that can be caused by the general anesthetic is Postoperative Cognitive Dysfunction (POCD) and can potentially lead to long-term memory loss as well as reduce a person’s concentration levels and learning capacity. The risk of this condition is increased if a person has previously suffered conditions such as; stroke, heart or lung disease, Alzheimer’s disease, or Parkinson’s disease.

What is the success rate of the laminoplasty procedure?

The success of a laminoplasty procedure, with the aim of preventing neurological functions or paralysis from worsening, is considered high. 

Improving a person’s functionality is not the aim of a laminoplasty but in some cases, this can happen, however, a patient should not expect this to be the goal of the procedure.

Reports show that some neurological functionality is improved in up to 60% of patients.

What is the average laminoplasty recovery time?

A patient can generally expect to return to the majority of activities within four-to-six weeks of the procedure taking place. Whereas a complete recovery is expected to take between six-to-twelve weeks. Although this time can likely be extended for someone who is over the age of 70, who should not rush the recovery process.

In some cases, a soft neck brace may need to be worn for two weeks following the operation. 

A person should be able to drive a car after two weeks of the surgery taking place. 

Physical therapy can also accelerate the recovery time in many cases.

Which procedure to choose? laminoplasty vs laminectomy

Cervical spinal stenosis is a condition that can affect many people around the world and if left untreated the symptoms can worsen considerably, sometimes requiring surgery. The two main types of surgery used to alleviate the symptoms and stop the condition from getting worse are a Laminoplasty lumbar and a Laminectomy.

But which operation is the best option? laminoplasty vs laminectomy.

Often, the decision depends on the severity of the condition and the extent of the deformity. Traditionally, a laminectomy would be the most common procedure used to decompress the spinal cord to improve functionality and reduce pain. 

However, a laminoplasty is much less intrusive, with only one side of the lamina being disconnected during surgery, better preserving the bone, as well as the surrounding tissue and muscles. 

As such, the benefits of a laminoplasty outweigh that of a laminectomy, purely from a recovery point of view, as usual, less tissue damage takes place and the vertebra is better preserved. 

Conclusion

• A laminoplasty is a procedure that alleviates pressure on the spinal cord.
• This procedure has a high success rate in terms of preventing neurological function from worsening.
• A laminoplasty causes less tissue damage and only one side of the lamina is disconnected, compared to a laminectomy. 
• This is a form of major surgery and complications are possible, with over 70s more at risk of encountering a complication than younger people. However, the chances of complications are still low. 

We hope this article has helped to answer any questions you may have about the laminoplasty procedure and its overall safety.