EXPANSIVE LAMINOPLASTY IN CERVICAL CANAL STENOSIS

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EXPANSIVE LAMINOPLASTY IN CERVICAL CANAL STENOSIS

• Deepak Agrawal, B S Sharma, V S Mehta
• Deptt of Neurosurgery,
• CN Centre, AIIMS,
• New Delhi

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Expansive laminoplasty in cervical canal stenosis

• SURGICAL OPTIONS
• ANTERIOR CERVICAL DECOMPRESSION AND SPINAL FUSION
  (ACDF)
• LAMINECTOMY/LAMINOPLASTY

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Expansive laminoplasty in cervical canal stenosis

• ACDF
• LENGTHY AND COMPLICATED
• IMMOBILIZES SEGMENTS
• HIGH MECHANICAL DEMANDS ON ADJACENT SEGMENTS
• RADIOLOGICAL CLINICAL EVIDENCE OF DETERIORATION
  ON FOLLOW UP

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Expansive laminoplasty in cervical canal stenosis

• LAMINECTOMY
• KYPHOSIS
• SPINAL INSTABILTY
• LAMINECTOMY MEMBRANE

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Expansive laminoplasty in cervical canal stenosis
BEAUTY LIES IN SIMPLICITY
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Expansive laminoplasty in cervical canal stenosis

• EXPANSIVE LAMINOPLASTY
• QUICK, EFFICACIOUS DURABLE
• MANTAINS CERVIVAL MOBILITY
• PREVENTS KYPHOSIS
• LONG TERM RESULTS SURPASS THAT OF ANTERIOR
  PROCEDURES

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Expansive laminoplasty in cervical canal stenosis

• INDICATIONS
• CERVICAL CANAL STENOSIS
• OPLL-continuous/ mixed
• Multisegmental cervical spondylotic myelopathy
  (MSCS)
• Ligamentum flavum hypertrophy

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Expansive laminoplasty in cervical canal stenosis

• CONTRAINDICATIONS
• Focal anterior compression
• Established, absolute kyphosis
• Isolated radiculopathy
• Spinal instability (Trauma, tumour or infection)

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Expansive laminoplasty in cervical canal stenosis

• RETROSPECTIVE STUDY
• PERIOD Jan 1999- Nov 2002

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Expansive laminoplasty in cervical canal stenosis

• DEMOGAPHIC PROFILE
• 24 patients
• MF 213 (71)
• Mean age 57 yrs (36-76 yrs)

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Expansive laminoplasty in cervical canal stenosis

• MRI FINDINGS
• OPLL (Continuous/ Mixed) 12
• MSCS (Multisegmental cervical spondylosis) 18
• Lig flavum hypertrophy 05
• Cord changes 20
• (11 pts had more than one pathology)

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Expansive laminoplasty in cervical canal stenosis
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Expansive laminoplasty in cervical canal stenosis
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Expansive laminoplasty in cervical canal stenosis

• SURGICAL PROCEDURE
• MODIFIED OPEN-DOOR LAMINOPLASTY
• Number of pts
• Titanium miniplates and screws 22
• Hydroxyapatite spacer 01
• Autologous bone spacer 01
• AVERAGE NUMBER OF LEVELS OPERATED- 5 (4-6)

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Expansive laminoplasty in cervical canal stenosis
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Expansive laminoplasty in cervical canal stenosis

• NEUROLOGICAL ASSESMENT
• NURICKS SCALE WAS USED PREOPERATIVELY AND AT LAST
  FOLLOW UP

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Expansive laminoplasty in cervical canal stenosis

• NURICKS GRADE
• 0- Radiculopathy
• 1- Myelopathy, No gait disturbance
• 2- Mild gait dist/ carry on with daily activity
• 3- Mod gait dist- works without assistance
• 4- Severe gait dist-works with assistance
• 5- Bedridden

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Expansive laminoplasty in cervical canal stenosis
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Expansive laminoplasty in cervical canal stenosis
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Expansive laminoplasty in cervical canal stenosis
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Expansive laminoplasty in cervical canal stenosis

• RESULTS
• 21 PTS (87) had improvement
• 3 pts remained unchanged in their Nuricks grade
  (All had severe cord changes)

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Expansive laminoplasty in cervical canal stenosis

• COMPLICATIONS
• CSF leak 1
• (resolved on conservative Mx)
• Deterioration in power 1
• (compression by spacer- Reoperated-improved

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Expansive laminoplasty in cervical canal stenosis

• CONCLUSIONS
• Laminoplasty is a valuable procedure in
  multisegmental anterior compression (results /gt
  anterior procedures)
• For best results- should be performed before cord
  changes develop

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THANK YOU