An operation for spinal cord compression across several levels of the neck. Each lamina is cut on one side and hinged open like a door, then held there. The canal is enlarged and the neck keeps moving, with no bone removed and no fusion. It only works if the neck still has its natural forward curve.
Cervical Laminaplasty. Licensed patient-education animation, ViewMedica.
Cervical myelopathy is compression of the spinal cord itself. By the time it needs an operation, it is usually pressing on the cord at three, four or five levels, and the number of levels shapes the choice of operation.
Laminoplasty works from behind and makes room for the cord without removing the bone. Each lamina, the arch of bone at the back of the canal, is cut through on one side and thinned on the other so that it bends. The arch is then swung open on the thinned side and propped there with a small plate. The roof of the canal now sits further back, giving the cord more space.
Nothing is fused. The joints that let the neck turn and bend are left alone, and no screws cross a moving segment.
Open-door laminoplasty. Axial view of the cervical canal with the lamina hinged open on one side and secured with a plate, showing the enlarged canal and the spinal cord repositioned away from the anterior compression.
Compression of the cervical spinal cord at several levels, in a neck whose alignment suits the operation. Symptoms of myelopathy are often mistaken for ordinary aging, so they are listed here in everyday terms.
Myelopathy is diagnosed on examination and confirmed on MRI. Neck pain on its own is not myelopathy, and this operation does not treat it.
Over several levels, a fusion has drawbacks. Reaching three or four levels from the front means removing three or four discs, and each extra level raises the chance that one fails to fuse and reduces the neck movement that is left. Multilevel surgery from the front also causes swallowing difficulty afterwards in a significant number of patients.
Laminoplasty avoids these problems. There is no graft that has to fuse, so there is no risk of a fusion failing. The operation is done from behind, so the swallowing tube and voice box are not near it, and the neck keeps most of its motion.
Fusion is still the right operation for some necks. The number of levels and the alignment of the neck decide which one applies, and where a neck needs a fusion, that is the operation Dr. Zaidi performs.
A kyphotic neck rules it out. Such a neck has lost its curve and bends forward. The compression in cervical myelopathy is mostly in front of the cord. Laminoplasty does not remove it. Instead it opens the back of the canal so the cord can drift backward, away from the compression. In a neck that bends forward, the cord is stretched tight over the front of the canal and cannot move backward, so the extra room does not help.
Significant neck pain is the second reason. Laminoplasty treats the spinal cord and does not reliably help neck pain, which can even be somewhat worse afterwards. It is the wrong operation for someone whose main complaint is a painful neck.
This list is not complete and does not replace a consultation. Alignment in particular is measured on standing X-rays.
Both operations treat the same problem from behind. The choice between them depends mostly on the alignment of the neck and on neck pain.
Dr. Zaidi performs both, and which is better depends on the patient. See how the approach is chosen.
The patient is positioned face down with the head held and the neck set in its lordosis. Spinal cord monitoring is running before positioning is finalized, so that any change caused by the position itself is seen straight away.
A midline incision at the back of the neck. The muscles are moved off the laminae over the levels being opened, while the muscle attachments at the top are protected, because they help hold the neck upright afterwards.
A groove is cut on one side through the outer layer of bone only, leaving the inner layer intact so it bends without breaking. This is the hinge the door swings on, and getting its depth right is the most delicate step of the operation.
The opposite side is cut through completely and the laminae are eased open as a unit. An ultrasonic bone scalpel is useful here because it cuts bone while sparing soft tissue, which is important when the blade is millimeters from a compressed cord.
Small plates are fixed across the opened side at each level to hold the door open. Without them the arch can close again and undo the decompression.
If a nerve root is compressed as well as the cord, its exit is opened at the same sitting. Only as much of the joint is removed as the root needs, because taking more could make the unfused level unstable.
Open-door laminoplasty. The hinge trough, the opposite-side cut, the laminae easing open as a unit, the plates going on, and the cord drifting backwards into the enlarged canal.
The main purpose of surgery for cervical myelopathy is to stop it getting worse. A compressed spinal cord is being injured slowly, and decompressing it stops that. Some patients also recover function they had lost, often hand dexterity or steadiness on their feet, but that improvement cannot be promised.
Figures are general ranges from the surgical literature and cannot be guaranteed for any one person. Shoulder weakness from irritation of the C5 nerve root is a recognized complication of posterior cervical decompression. It is uncommon, usually appears in the first days after surgery and in most cases recovers over weeks to months. It is discussed with you before you consent to surgery.
This depends on measurements: the curve of your neck on a standing X-ray and where the compression sits on MRI. Please bring any imaging you already have.