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Cervical Laminaplasty

Louis Jenis, MD
Newton-Wellesley Hospital, Boston MA

Anesthesia

  1. General anesthesia is given in the operating room

Positioning

  1. Patient is placed in the prone position
  2. Surgeons ensure that all bony prominences are padded
  3. If indicated, neuromonitoring is set up
  4. Patient is prepped and draped

Surgical Exposure

  1. Landmarks (base of skull, spinous processes C2-C7) are identified by palpation and marked
  2. Midline skin incision is made
  3. Midline dissection is made through subcutaneous fat with electrocautery
  4. Ligamentum nuchae is identified and divided in the midline to bone
  5. Subperiosteal dissection of paraspinal musculature off of bilateral spinous processes, laminate, and lateral masses from C2-C7 using Bovie electrocautery
  6. X-ray confirmation of the appropriate levels of dissection using a Kocher clamp on a spinous process and dental probe in a facet joint
  7. Facet joint capsules are preserved as much as possible during dissection

Osteotomies

  1. Left-sided bi-cortical osteotomies are made through the C2-C7 junctions of the laminate and lateral masses using a high-speed burr
  2. Underlying ligamentum flavum is palpated, but not violated at this point
  3. Bleeding by epidural vessels is tamponed with bone wax, FLOSEAL hemostatic matrix, and surgical sponges
  4. Right-sided uni-cortical osteotomies are made through the C2-C7 junctions of the laminate and lateral masses using a high-speed burr
  5. Cobb elevator, retractor, and fingers are used to open the left-sided osteotomy site through hinging on the right-sided uni-cortical osteotomy site
  6. Springiness/motion of the posterior elements is frequently checked, with further osteotomy of the hinge side as needed
  7. Partial release of the underlying ligamentum flavum with a curette is also performed as needed to further open the left-sided osteotomy location. The goal is an opening of 8mm

Fixation

  1. Laminoplasty plates are inserted in the left-sided osteotomy location at C2-C6
  2. Through each plate, 1 screw is placed into the lamina and 2 screws into the lateral mass
  3. A starting awl is used to start each hole and screws are self-drilling and self-tapping. They are 6-8mm in length

Inspect Repair/Supplement with Bone Graft

  1. Inspect repair at each level
  2. Morselized bone graft from the removed spinous processes (below) is applied to the right-sided uni-cortical osteotomies to assist bony healing

Closure

  1. Spinous processes are partially removed from C2-C7 in order to facilitate a tension-free closure
  2. Interrupted sutures are used to close the paraspinal muscle fascia
  3. Running, subcuticular dermal closure with a Monocryl stitch