Cervical Laminoplasty for treatment of Cervical spondylotic myelopathy
Learn the Cervical Laminoplasty for treatment of Cervical spondylotic myelopathy surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Cervical Laminoplasty for treatment of Cervical spondylotic myelopathy surgical procedure.
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(Tr & Orth)
Institution: The Avon Orthopaedic Centre, Bristol, UK.
0 of 15 questions completed
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading…
You must sign in or sign up to start the quiz.
You must first complete the following:
0 of 15 questions answered correctly
Time has elapsed
Question 1 of 15
Cervical spondylosis most commonly affects which one of the following cervical levels?CorrectIncorrect
Question 2 of 15
Most cases of cervical spondylotic myelopathy progress in a step wise fashion .Which one of the following describes the frequency of more rapid deterioration ?CorrectIncorrect
Question 3 of 15
All of the following features may be seen in cervical myelopathy except which one ?CorrectIncorrect
Question 4 of 15
Which one of the following classification systems is not used in cervical myelopathy ?CorrectIncorrect
Question 5 of 15
Which one of the following has the strongest association with poor clinical outcome in patients who undergo cervical laminoplasty for CSMCorrectIncorrect
Question 6 of 15
Laminoplasty is widely accepted to be contraindicated for management of CSM in which one of the following circumstancesCorrectIncorrect
Question 7 of 15
If using the Mayfield Clamp, which one of the following is the pressure in pounds is generally recommended to secure the head for cervical spine surgery ?CorrectIncorrect
Question 8 of 15
Which one of the following describes the course of the ligamentum nuchae ?CorrectIncorrect
Question 9 of 15
Which one of the following is the nerve supply to the cervical posterior paravertebral vertebral muscles ?CorrectIncorrect
Question 10 of 15
With regards to the the ligamentum flavum, which one statement is not correct ?CorrectIncorrect
Question 11 of 15
Following cervical laminoplasty for CSM, which one of the following routine post operative instructions is correct ?CorrectIncorrect
Question 12 of 15
The following post operative complications are seen after cervical laminoplasty except which one ?CorrectIncorrect
Question 13 of 15
With regard to C5 palsy after surgery for cervical spondylotic myelopathy which one of the following statements is false ?CorrectIncorrect
Question 14 of 15
Which one of these statements is false with regard to outcomes of surgical decompression in patients with very severe degenerative cervical myelopathy ?CorrectIncorrect
Question 15 of 15
Which one of the following statements is incorrect regarding post operative walking ability of non-ambulatory cervical myelopathy patients ?CorrectIncorrect