Posterior cervical laminectomy and laminaplasty

Abstract

The most commonly performed posterior cervical procedures for radiculopathy and myelopathy are laminotomy with foraminotomy, laminectomy, and laminaplasty. These procedures vary in the amount of neural element decompression that is achieved as well as the potential for postoperative kyphotic deformity. Laminotomy with foraminotomy requires only a minimal resection of bone to visualize the nerve root. This procedure does not decompress the spinal cord and has minimal effect on cervical spine stability. The indications for laminectomy are limited, but this procedure may be performed in a patient with myelopathy caused by multiple level cervical spondylitic changes. Laminectomy may be combined with foraminotomies for the patient with myeloradiculopathy; however, this procedure increases the risk of postoperative kyphosis. Cervical laminaplasty was developed by the Japanese in response to the high incidence of postlaminectomy deformity seen after extensive cervical laminectomy. The indications for open-door laminaplasty include the patient with preoperative cervical lordosis and either three or more levels of cervical radiculopathy, or cervical myelopathy caused by disease at three or more levels. Any patient with a loss of normal cervical lordosis should be treated with anterior cervical surgery.