Spine lecture posterior cervical laminoplasty for stenosis

2. POSTERIOR CERVICAL
LAMINOPLASTY FOR STENOSIS
Spine Conference
Union Memorial Hospital
September 11, 2018

3. 56 year old man cc: severe! Pain R trapezial that radiates to his lateral arm, wrist and thumb HPI:
acute onsent 6/3/18. numb/tingling, paresthesia; Rx with oxycodone, gabapentin,
PMH: R hemicolectomy, polyps, CAD, CABG, HTN, cig smoking SH: urgent care physician

4. Increased T1 slope
can be associated
with postoperative
loss of cervical
lordosis

9. C2C3

10. C3C4

11. 4

12. C4C5

13. 5

14. C5C6

16. Kidney bean shape

17. C2C3

18. c5c6

19. Compression Ratio < 0.4

20. Mid-sagittal diameter: width
1:5 ratio leads to necrosis of gray
matter
• Ogino H: Canal diameter, anteroposterior compression ratio
and spondylotic myelopathy of the cervical spine. Spine 1983;
8:1-15
• Cord compression causes ischemia and direct mechanical
trauma

21. 6

22. C6C7

24. c4

27. Problem list:
• 1. pain and
radiculopathy R UE
into forearm and
thumb
• 2. smoker
• 3. cervical stenosis
multiple levels
• 4. OPLL?
• 5. lordosis

28. Motion sparing, no risk of nonunion,
postop kyphosis, stiffness, indirect
decompression safer, dome of bone
over the spinal cord for revisions
No future degeneration, no postop kyphosis,
No instability, no axial neck pain,
Recovery easier initially, dysphagia,
nonunion, direct decompression, foraminal
decompression, dysphonia, pseudarthrosis,

31. 17?

33. Inverted supinator reflex

34. Lhermitte (flexion)
and compression
test

35. finger escape sign: involuntary flexion/abduction within 1 minute of extended and adducted fingers held statically
Grip and release test” inability to grip and release fist rapidly
Dysdiadochokinesia, or grip and release sign
Finger escape sign: interossei 5th/4th digit

36. typical
cervical
stenosis

37. A: localized B: segmental C: continuous D: mixed

47. C4 PREOP

48. Greenstick
fracture of
childhood

50. Muscle reattached avoid postop kyphosis, motion retained, dura covered
To avoid postlaminectomy membrane and allow earier posterior revision

52. General concepts:
1. preserve dorsal elements
2. preserve motion
3. expand the spinal canal
via laminar manipulation

54. 1) Oyama M, Hattori S, Moriwaki N,
Nitta S.: [A new method of cervical
laminectomy]. Chuubu Nippon
Seikeigeka Gakkai Zasshi 16: 792– 794,
1973 (z shape)

55. Globus stryker
seaspine

57. The K-line is a straight line from the midpoints of the spinal canal at C2 and C7
K-LIne
Occupying ratio
=a/b x100

58. Local kyphosis >13 degrees a/w highest risk of poor recover
Suda K: Local kyphosis reduces surgical outcomes of expansive open door laminoplasty
for cervical spondylotic myelopathy. Spine 2003; 28 (12) 1258-1262

60. Negative k line

61. K-line

64. • OPLL categories:
• Continuous, segmental, mixed, localized
• Sessile and pedunculated
TYPES OF CERVICAL STENOSIS MECHANISMS

66. 5 5
C5 palsy: posterior migration of the spinal cord, 50% motor 50% sensory radiculopathy, un
And usually last one week, may present 2-4 weeks postop, 5% complication rate, decompr
Foramen if stenosis and symptomatic?, c5 root is short, deltoid has a single innervation by

68. Preserve muscular attachments
To C2

72. ISOLATED 2 DOUBLE LAYER TYPE 7
EN BLOC WITH MENINGEAL TAIL SIGN 1

76. Double layer sign

79. anterior floating decompression
method: 20mm transverse corpectomy , 5mm thin, 2-3 mm margin to borders

82. Postop xray 6 weeks out

83. thanks