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Expansive laminoplasty in cervical canal stenosis

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Expansive laminoplasty in cervical canal stenosis

  1. 1. EXPANSIVE LAMINOPLASTY IN CERVICAL CANAL STENOSIS Deepak Agrawal , B S Sharma, V S Mehta Deptt of Neurosurgery, CN Centre, AIIMS, New Delhi
  2. 2. <ul><li>SURGICAL OPTIONS </li></ul><ul><li>ANTERIOR CERVICAL DECOMPRESSION AND SPINAL FUSION (ACDF) </li></ul><ul><li>LAMINECTOMY/LAMINOPLASTY </li></ul>Expansive laminoplasty in cervical canal stenosis
  3. 3. <ul><li>ACDF </li></ul><ul><li>LENGTHY AND COMPLICATED </li></ul><ul><li>IMMOBILIZES SEGMENTS </li></ul><ul><li>HIGH MECHANICAL DEMANDS ON ADJACENT SEGMENTS </li></ul><ul><li>RADIOLOGICAL & CLINICAL EVIDENCE OF DETERIORATION ON FOLLOW UP </li></ul>Expansive laminoplasty in cervical canal stenosis
  4. 4. <ul><li>LAMINECTOMY </li></ul><ul><li>KYPHOSIS </li></ul><ul><li>SPINAL INSTABILTY </li></ul><ul><li>LAMINECTOMY MEMBRANE </li></ul>Expansive laminoplasty in cervical canal stenosis
  5. 5. Expansive laminoplasty in cervical canal stenosis BEAUTY LIES IN SIMPLICITY
  6. 6. Expansive laminoplasty in cervical canal stenosis <ul><li>EXPANSIVE LAMINOPLASTY </li></ul><ul><li>QUICK, EFFICACIOUS & DURABLE </li></ul><ul><li>MANTAINS CERVIVAL MOBILITY </li></ul><ul><li>PREVENTS KYPHOSIS </li></ul><ul><li>LONG TERM RESULTS SURPASS THAT OF ANTERIOR PROCEDURES </li></ul>
  7. 7. <ul><li>INDICATIONS </li></ul><ul><li>CERVICAL CANAL STENOSIS </li></ul><ul><li>OPLL-continuous/ mixed </li></ul><ul><li>Multisegmental cervical spondylotic myelopathy (MSCS) </li></ul><ul><li>Ligamentum flavum hypertrophy </li></ul>Expansive laminoplasty in cervical canal stenosis
  8. 8. <ul><li>CONTRAINDICATIONS </li></ul><ul><li>Focal anterior compression </li></ul><ul><li>Established, absolute kyphosis </li></ul><ul><li>Isolated radiculopathy </li></ul><ul><li>Spinal instability (Trauma, tumour or infection) </li></ul>Expansive laminoplasty in cervical canal stenosis
  9. 9. <ul><li>RETROSPECTIVE STUDY </li></ul><ul><li>PERIOD: Jan 1999- Nov 2002 </li></ul>Expansive laminoplasty in cervical canal stenosis
  10. 10. <ul><li>DEMOGAPHIC PROFILE </li></ul><ul><li>24 patients </li></ul><ul><li>M:F 21:3 (7:1) </li></ul><ul><li>Mean age: 57 yrs (36-76 yrs) </li></ul>Expansive laminoplasty in cervical canal stenosis
  11. 11. <ul><li>MRI FINDINGS </li></ul><ul><li>OPLL (Continuous/ Mixed) 12 </li></ul><ul><li>MSCS (Multisegmental cervical spondylosis) 18 </li></ul><ul><li>Lig flavum hypertrophy 05 </li></ul><ul><li>Cord changes 20 </li></ul><ul><li>(11 pts had more than one pathology) </li></ul>Expansive laminoplasty in cervical canal stenosis
  12. 12. Expansive laminoplasty in cervical canal stenosis
  13. 13. Expansive laminoplasty in cervical canal stenosis
  14. 14. <ul><li>SURGICAL PROCEDURE </li></ul><ul><li>MODIFIED OPEN-DOOR LAMINOPLASTY </li></ul><ul><li> Number of pts </li></ul><ul><li>Titanium miniplates and screws 22 </li></ul><ul><li>Hydroxyapatite spacer 01 </li></ul><ul><li>Autologous bone spacer 01 </li></ul><ul><li>AVERAGE NUMBER OF LEVELS OPERATED- 5 (4-6) </li></ul>Expansive laminoplasty in cervical canal stenosis
  15. 15. Expansive laminoplasty in cervical canal stenosis
  16. 16. <ul><li>NEUROLOGICAL ASSESMENT </li></ul><ul><li>NURICKS SCALE WAS USED PREOPERATIVELY AND AT LAST FOLLOW UP </li></ul>Expansive laminoplasty in cervical canal stenosis
  17. 17. <ul><li>NURICKS GRADE </li></ul><ul><li>0- Radiculopathy </li></ul><ul><li>1- Myelopathy+, No gait disturbance </li></ul><ul><li>2- Mild gait dist/ carry on with daily activity </li></ul><ul><li>3- Mod gait dist- works without assistance </li></ul><ul><li>4- Severe gait dist-works with assistance </li></ul><ul><li>5- Bedridden </li></ul>Expansive laminoplasty in cervical canal stenosis
  18. 18. Expansive laminoplasty in cervical canal stenosis 4 9 GRADE 4 3 12 GRADE 5 14 2 GRADE 3 1 1 GRADE 2 2 0 GRADE 1 POSTOPERATIVE (No. of pts) PREOPERATIVE (No. of pts) NURICKS GRADE
  19. 19. Expansive laminoplasty in cervical canal stenosis
  20. 20. Expansive laminoplasty in cervical canal stenosis 7 GRADE 4 12 GRADE 5 1 GRADE 3 0 GRADE 2 0 GRADE 1 CORD CHANGES (No. of pts) NURICKS GRADE
  21. 21. <ul><li>RESULTS </li></ul><ul><li>21 PTS ( 87% ) had improvement </li></ul><ul><li>3 pts remained unchanged in their Nuricks grade ( All had severe cord changes ) </li></ul>Expansive laminoplasty in cervical canal stenosis
  22. 22. <ul><li>COMPLICATIONS </li></ul><ul><li>CSF leak 1 </li></ul><ul><li>(resolved on conservative Mx) </li></ul><ul><li>Deterioration in power 1 </li></ul><ul><li> (compression by spacer- Reoperated-improved </li></ul>Expansive laminoplasty in cervical canal stenosis
  23. 23. <ul><li>CONCLUSIONS </li></ul><ul><li>Laminoplasty is a valuable procedure in multisegmental anterior compression (results =/> anterior procedures) </li></ul><ul><li>For best results- should be performed before cord changes develop </li></ul>Expansive laminoplasty in cervical canal stenosis
  24. 24. THANK YOU

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