Cervical Laminoplasty

The lamina is the bony arch that forms the roof of the spinal canal. In cervical stenosis, the spinal canal narrows, compressing the spinal cord and causing cervical myelopathy  a  condition that can lead to hand weakness or clumsiness, difficulty with balance and walking, numbness, and loss of fine motor control.

During a laminoplasty, the surgeon creates a hinge on one side of the lamina and a full cut on the other. The lamina is then gently opened like a door, immediately enlarging the spinal canal and relieving pressure on the spinal cord. A small titanium plate or suture holds the lamina in its new position. The procedure is commonly performed across three to five cervical levels (typically C3 through C7) when spinal cord compression affects multiple levels.

Open-door versus French-door laminoplasty

Two primary laminoplasty techniques are used. In the open-door technique, the lamina is hinged on one side and opened on the other, creating a single expanded opening. In the French-door (double-door) technique, the lamina is split in the middle and both sides are opened outward symmetrically. Your surgeon selects the approach based on your anatomy, the location of spinal cord compression, and surgical goals.

For multilevel cervical myelopathy, both laminoplasty and posterior cervical laminectomy and fusion are well-established treatment options. The best procedure depends on the patient’s spinal alignment, stability, and the underlying cause of spinal cord compression.

• Motion preservation: Laminoplasty preserves motion at the treated levels, whereas laminectomy with fusion permanently eliminates motion at those segments.
• Stability: Laminoplasty preserves much of the spine’s natural anatomy while relieving pressure on the spinal cord. Laminectomy with fusion provides rigid stabilization and is often preferred when there is pre-existing spinal instability, deformity, or neck pain related to instability.
• Adjacent segment degeneration: Because laminoplasty preserves motion, it may reduce mechanical stress on adjacent spinal levels compared with multilevel fusion.
• Spinal alignment: Laminoplasty generally works best in patients with neutral or lordotic (backward-curved) cervical alignment. Patients with significant cervical kyphosis (forward curvature) are often better treated with fusion or another reconstructive procedure.

Your spine surgeon will recommend the approach that best matches your spinal alignment, degree of spinal cord compression, spinal stability, number of levels involved, symptoms, and overall health. Laminoplasty is an excellent option for many patients, but those with significant kyphosis, instability, severe neck pain related to instability, or compression that cannot be adequately relieved from a posterior approach are often better served with fusion or another reconstructive procedure.

Laminoplasty is most appropriate for patients who have:

• Multilevel cervical stenosis affecting three or more levels
• Signs or symptoms of cervical myelopathy, such as difficulty with balance or walking, hand clumsiness, weakness, or loss of fine motor control.
• Neutral or lordotic (backward-curved) cervical alignment.
• A stable cervical spine without significant deformity or prior laminectomy at the same levels.

Laminoplasty is generally not recommended for patients with significant cervical kyphosis (forward curvature), spinal instability, severe neck pain related to instability, or compression that is primarily located in front of the spinal cord and cannot be adequately relieved from a posterior approach. Careful evaluation of spinal alignment and the underlying cause of spinal cord compression is essential when determining whether laminoplasty or another procedure is the best treatment option.