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EXPANSIVE LAMINOPLASTY IN CERVICAL CANAL STENOSIS

EXPANSIVE LAMINOPLASTY IN CERVICAL CANAL STENOSIS. Deepak Agrawal , B S Sharma, V S Mehta Deptt of Neurosurgery, CN Centre, AIIMS, New Delhi. Expansive laminoplasty in cervical canal stenosis. SURGICAL OPTIONS ANTERIOR CERVICAL DECOMPRESSION AND SPINAL FUSION (ACDF)

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EXPANSIVE LAMINOPLASTY IN CERVICAL CANAL STENOSIS

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  1. EXPANSIVE LAMINOPLASTY IN CERVICAL CANAL STENOSIS Deepak Agrawal, B S Sharma, V S Mehta Deptt of Neurosurgery, CN Centre, AIIMS, New Delhi

  2. Expansive laminoplasty in cervical canal stenosis • SURGICAL OPTIONS • ANTERIOR CERVICAL DECOMPRESSION AND SPINAL FUSION (ACDF) • LAMINECTOMY/LAMINOPLASTY

  3. Expansive laminoplasty in cervical canal stenosis • ACDF • LENGTHY AND COMPLICATED • IMMOBILIZES SEGMENTS • HIGH MECHANICAL DEMANDS ON ADJACENT SEGMENTS • RADIOLOGICAL & CLINICAL EVIDENCE OF DETERIORATION ON FOLLOW UP

  4. Expansive laminoplasty in cervical canal stenosis LAMINECTOMY • KYPHOSIS • SPINAL INSTABILTY • LAMINECTOMY MEMBRANE

  5. Expansive laminoplasty in cervical canal stenosis BEAUTY LIES IN SIMPLICITY

  6. Expansive laminoplasty in cervical canal stenosis EXPANSIVE LAMINOPLASTY • QUICK, EFFICACIOUS & DURABLE • MANTAINS CERVIVAL MOBILITY • PREVENTS KYPHOSIS • LONG TERM RESULTS SURPASS THAT OF ANTERIOR PROCEDURES

  7. Expansive laminoplasty in cervical canal stenosis INDICATIONS CERVICAL CANAL STENOSIS • OPLL-continuous/ mixed • Multisegmental cervical spondylotic myelopathy (MSCS) • Ligamentum flavum hypertrophy

  8. Expansive laminoplasty in cervical canal stenosis CONTRAINDICATIONS • Focal anterior compression • Established, absolute kyphosis • Isolated radiculopathy • Spinal instability (Trauma, tumour or infection)

  9. Expansive laminoplasty in cervical canal stenosis • RETROSPECTIVE STUDY • PERIOD: Jan 1999- Nov 2002

  10. Expansive laminoplasty in cervical canal stenosis DEMOGAPHIC PROFILE • 24 patients • M:F 21:3 (7:1) • Mean age: 57 yrs (36-76 yrs)

  11. Expansive laminoplasty in cervical canal stenosis MRI FINDINGS • OPLL (Continuous/ Mixed) 12 • MSCS (Multisegmental cervical spondylosis) 18 • Lig flavum hypertrophy 05 • Cord changes 20 (11 pts had more than one pathology)

  12. Expansive laminoplasty in cervical canal stenosis

  13. Expansive laminoplasty in cervical canal stenosis

  14. Expansive laminoplasty in cervical canal stenosis SURGICAL PROCEDURE MODIFIED OPEN-DOOR LAMINOPLASTY Number of pts • Titanium miniplates and screws 22 • Hydroxyapatite spacer 01 • Autologous bone spacer 01 AVERAGE NUMBER OF LEVELS OPERATED- 5 (4-6)

  15. Expansive laminoplasty in cervical canal stenosis

  16. Expansive laminoplasty in cervical canal stenosis NEUROLOGICAL ASSESMENT NURICKS SCALE WAS USED PREOPERATIVELY AND AT LAST FOLLOW UP

  17. Expansive laminoplasty in cervical canal stenosis • NURICKS GRADE • 0- Radiculopathy • 1- Myelopathy+, No gait disturbance • 2- Mild gait dist/ carry on with daily activity • 3- Mod gait dist- works without assistance • 4- Severe gait dist-works with assistance • 5- Bedridden

  18. Expansive laminoplasty in cervical canal stenosis

  19. Expansive laminoplasty in cervical canal stenosis

  20. Expansive laminoplasty in cervical canal stenosis

  21. Expansive laminoplasty in cervical canal stenosis RESULTS • 21 PTS (87%) had improvement • 3 pts remained unchanged in their Nuricks grade (All had severe cord changes)

  22. Expansive laminoplasty in cervical canal stenosis COMPLICATIONS • CSF leak 1 (resolved on conservative Mx) • Deterioration in power 1 (compression by spacer- Reoperated-improved

  23. Expansive laminoplasty in cervical canal stenosis CONCLUSIONS • Laminoplasty is a valuable procedure in multisegmental anterior compression (results =/> anterior procedures) • For best results- should be performed before cord changes develop

  24. THANK YOU

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