Cervical Laminoplasty for treatment of Cervical spondylotic myelopathy surgical technique
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Cervical spondylosis is a common age related degenerative process which may lead to development of axial neck pain, cervical radicular symptoms or cervical myelopathy. Most common levels are C5/6 followed by C6/7 because they are associated with the most flexion and extension in the subaxial spine.
Degenerative cervical spondylosis is the most common cause of cervical myelopathy. It is a slowly progressive disorder usually caused by spinal cord compression and ischaemia due to age related changes in the spine.
Although asymptomatic degeneration of the cervical spine is common in the elderly, when these changes lead to myelopathy, patients are at risk of motor, sensory and autonomic dysfunction, as well as a reduction in quality of life. Cervical myelopathy is generally considered a surgical disorder due to its natural history. Surgery may arrest progression and can improve neurological outcomes.
The decision to use either an anterior, posterior or combined anterior-posterior surgical approach depends on many factors. The cervical spinal cord may be compressed from a single, or by multi level, anterior based, posterior based or circumferentially from combined anterior and posterior based pathologies. The contribution each of the aforementioned pathologies make to overall cervical cord compression will also vary.
Here I perform a C4 split cervical laminoplasty to decompress the spinal cord at C3/4.
The technique described is in a patient with a C1 (Jefferson) fracture and C2 Type II peg fracture treated conservatively due to a life threatening cardiac event immediately post injury. An MRI at that admission did not demonstrate any cervical stenosis.
Follow-up Computer Tomography (CT) imaging demonstrated union of the C1 fracture, but the C2 peg fracture did not radiologically unite.
At 12-month review he had clinical features suggestive of cervical myelopathy and imaging showed a new C3/4 stenosis compressing the spinal cord rather than C1/C2 instability. The patients past medical history included oropharangeal carcinoma treated with surgery and radiotherapy that had already resulted in difficulties with swallowing and speech. I therefore opted to manage his Cervical spondylotic Myelopathy (CSM) with posterior decompression of the cord, via a split cervical laminoplasty technique. This technique for decompressing the spinal cord posteriorly is both discussed and demonstrated in the technique.
Author: Neil Upadhyay FRCS
Institution : The Avon Orthopaedic Centre , Bristol ,UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
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The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
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