A laminoplasty is a surgical procedure that helps relieve pressure on the spinal cord and nerves. It involves opening a section of the lamina, a bony structure that sits on top of the spinal canal.
Doctors may recommend a laminoplasty to help treat conditions that cause narrowing or “stenosis” of the spinal canal, or wear and tear of the spine. The procedure can also help treat nerve compression resulting from thickening and rigidity of the ligament within the spinal canal.
Laminoplasty is a surgical procedure that can help relieve compression of the spinal cord, which is known as myelopathy.
The spinal cord comprises nerve fibers that extend from the brain to the spine and nerve roots that branch out from the spinal cord to other parts of the body. It sits inside a space called the spinal canal.
Laminoplasty involves opening up a section of the lamina, the bony plate that sits on top of the spinal canal. This enlarges the canal in that area, thereby reducing pressure on the spinal cord.
Conditions that laminoplasty can help treat include:
- Spinal stenosis: This is a medical condition
in which the spaces between the spine narrow, creating pressure on the spinal cord. Doctors call this narrowing stenosis. - Cervical spondylotic myelopathy (CSM): This is myelopathy in the upper section of the spine, called the cervical spine. The condition can occur due to age-related wear and tear of the spine or as a result of being born with a narrower spinal canal.
- Ossification of the posterior longitudinal ligament (OPLL): In this condition, a ligament in the spinal canal, called the posterior longitudinal ligament (PLL), becomes thickened and rigid.
Surgeons may also perform a laminoplasty to access to the spinal cord when treating the following conditions:
- tumors
- tangles of atypical blood vessels called vascular malformations
- fluid-filled cysts within the spinal cord called syringomyelia
According to the United Kingdom’s National Health Service (NHS), laminoplasty involves completely cutting the lamina bone on one side and partially cutting it on the opposite side. This creates a hinge that allows the surgeon to lift one side of the lamina to an open position, similar to opening a door.
Once the lamina is in the open position, the surgeon uses small metal plates and screws to hold it in place. The new position provides more room inside the spinal canal, easing pressure on the spinal cord.
Finally, the surgeon closes the incision and dresses the wound with a bandage.
Before undergoing a laminoplasty, a person needs to inform their doctor of any medications or supplements they are currently taking. They may also need to stop taking certain medications before the procedure, including blood-thinning medications that could increase the risk of a bleed. However, a person should not stop taking medication unless their doctor advises them to.
People also need to let their doctor know if they are allergic to medications, foods, or materials such as latex.
A person who has undergone a laminoplasty must usually remain in the hospital for 1 to 2 days following the procedure. They may continue to experience discomfort and a limited range of movement for several weeks. Taking prescribed pain medications and limiting activity during this time can help with symptoms. A person may return to work if they feel comfortable enough, but only if it is safe for them to do so.
A person typically needs to attend a follow-up appointment 4 to 6 weeks after the surgery. During this appointment, a surgeon will ask about a person’s symptoms and carry out a physical examination to check the following:
- healing at the incision site
- range of motion in the neck
- the balance of the spine
The American Academy of Orthopaedic Surgeons (AAOS) lists some general risks of spinal surgery for myelopathy. These include:
- infection
- bleeding
- nerve or spinal cord injury
- a dural tear, which is a tear in the sac covering the nerves
- a failure to ease symptoms
- recurrent stenosis
- the need for follow-up surgery
- reactions to the anesthesia
- life threatening medical complications, such as:
In addition to the above, laminoplasty can pose specific risks, including:
- injury to one of the vertebral arteries, which are the arteries that carry blood to the brain and spinal cord
- degeneration of the intervertebral disks above or below the surgical site
- stretching of the nerves due to the spinal cord drifting back within the spinal canal
According to the NHS, a bleed into the spinal canal is a rare but serious complication of spinal surgery and may cause bladder or bowel incontinence or paralysis. Follow-up surgery can sometimes address these issues, but not always.
Read about treatments for spinal stenosis.
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According to the review, factors that may affect a person’s outlook following cervical laminoplasty include:
- the person’s age
- the severity of neurological problems before surgery
- the extent of condition-related changes within the spinal cord at the time of the surgery
- whether the person has any accompanying spinal injuries
According to the AAOS, one potential drawback of laminoplasty is that the hinged section of the lamina can occasionally close following surgery, leading to recurrent stenosis and associated symptoms. A
A 2018 review explains that the outlook for those undergoing cervical laminoplasty for OPLL depends on the extent to which the PLL has moved into their spinal canal. People whose PLL occupies more than 60% of their spinal canal tend to have a more negative neurological recovery compared to those whose PLL occupies less than this.
A person needs to contact a doctor if they experience symptoms of spinal stenosis in their upper or lower spine.
According to the
- neck pain
- numbness or tingling that radiates from the arms to the hands
- weakness in an arm, hand, or fingers
Symptoms of lumbar stenosis may
- lower back pain
- a burning or aching pain that radiates from the buttocks down the legs and typically worsens with standing or walking
- numbness, tingling, or cramping in the legs and feet
- weakness in the legs and feet
A person also needs to consult a doctor if they experience new, persistent, or recurrent neurological symptoms following a laminoplasty procedure. The doctor will work to determine the cause and provide any appropriate treatments.
A laminoplasty is a surgical procedure that involves opening up a section of the lamina to help relieve pressure on the spinal cord and nerves.
Doctors may recommend this procedure to treat conditions that cause spinal cord compression or “myelopathy.” Examples include spinal stenosis, cervical spondylotic myelopathy (CSM), and ossification of the posterior longitudinal ligament (OPLL).
The success rate of laminoplasty depends on the condition it is treating and other factors. A person can talk with a doctor about the potential risks and benefits of laminoplasty for their specific condition.