Cervical Laminoplasty
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Procedure Outline
Table of Contents
- General anesthesia is given in the operating room
- Patient is placed in the prone position
- Surgeons ensure that all bony prominences are padded
- If indicated, neuromonitoring is set up
- Patient is prepped and draped
- Landmarks (base of skull, spinous processes C2-C7) are identified by palpation and marked
- Midline skin incision is made
- Midline dissection is made through subcutaneous fat with electrocautery
- Ligamentum nuchae is identified and divided in the midline to bone
- Subperiosteal dissection of paraspinal musculature off of bilateral spinous processes, laminate, and lateral masses from C2-C7 using Bovie electrocautery
- X-ray confirmation of the appropriate levels of dissection using a Kocher clamp on a spinous process and dental probe in a facet joint
- Facet joint capsules are preserved as much as possible during dissection
- Left-sided bi-cortical osteotomies are made through the C2-C7 junctions of the laminate and lateral masses using a high-speed burr
- Underlying ligamentum flavum is palpated, but not violated at this point
- Bleeding by epidural vessels is tamponed with bone wax, FLOSEAL hemostatic matrix, and surgical sponges
- Right-sided uni-cortical osteotomies are made through the C2-C7 junctions of the laminate and lateral masses using a high-speed burr
- Cobb elevator, retractor, and fingers are used to open the left-sided osteotomy site through hinging on the right-sided uni-cortical osteotomy site
- Springiness/motion of the posterior elements is frequently checked, with further osteotomy of the hinge side as needed
- 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
- Laminoplasty plates are inserted in the left-sided osteotomy location at C2-C6
- Through each plate, 1 screw is placed into the lamina and 2 screws into the lateral mass
- 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 at each level
- Morselized bone graft from the removed spinous processes (below) is applied to the right-sided uni-cortical osteotomies to assist bony healing
- Spinous processes are partially removed from C2-C7 in order to facilitate a tension-free closure
- Interrupted sutures are used to close the paraspinal muscle fascia
- Running, subcuticular dermal closure with a Monocryl stitch
