Discuss the indications for and results of cervical laminoplasty

Laminoplasty increases the midsagittal diameter and cross-sectional area of the spinal canal. This procedure directly decompresses dorsal aspect of the spinal cord. It also allows posterior displacement of the cord, which indirectly decompresses its ventral surface. Accepted indications for laminoplasty are a straight or lordotic cervical spine, a stable spine, and multilevel cord compression. It is the preferred technique when only dorsal cord compression is present. Long-term improvement is seen in 60% to 75% of patients (Fig. 46-5).

Figure 46-5. A 55-year-old man with cervical myelopathy. A, Sagittal magnetic resonance imaging shows severe multilevel stenosis due to congenital spinal canal narrowing and superimposed multilevel disc hernia-tions. B, Lateral radiograph following C4 to C7 laminoplasty. C, Model demonstrates use of laminoplasty miniplates and allograft spacers that are used to hold open the hinge and maintain expansion of the spinal canal. D, Postoperative computed tomography myelo-gram demonstrates expansion of the spinal canal via allograft bone spacers and miniplate fixation. (C and D from Feigenbaum F, Henderson FC. A decade of experience with expansile lamino-plasty: Lessons learned. Semin Spine Surg 2006;18(4):207-10.)

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