The university hospital where I'm going to have a laminoplasty done on my neck using a new plating system. It's supposed to have better results than other ways of holding the bone away from my spinal cord. What kind of success rates have been reported for this procedure so far? My surgeon says she has a 90 per cent (or better) success rate. Is that better than average? I tried to find some information about this on-line but didn't come up with anything.
Plate-only open door laminoplasty (the procedure you just described) is a fairly new approach to expanding the space around the spinal cord and taking pressure off the nerve tissue. The surgeon cuts through the lamina (pillar of bone that forms an arch around the spinal cord) and makes a hinge to move the bone away from the spinal cord without removing the bone.
But to keep the door from swinging shut, it is necessary to hold the gate open so-to-speak. To accomplish this, the surgeon can use a prop or spacer made out of bone or ceramic. The spacer is called a strut and functions like a door stop. The plating system you described connects the open edge of the "door" to the other side of the bone. It also holds the door open, expands the space around the spinal cord, and gives rigid support to the spine where the bone has been cut open.
The plating system is fairly new so there aren't a lot of studies done yet. But one published in 2004 and another that came out in 2010 give it high ratings for success. Using CT scans to evaluate bone healing and remodeling, 93 per cent of the levels operated on were healed and stable at the end of 12 months. The remaining seven per cent were considered "nonunions". The area filled in with fibrous scar tissue rather than bone but the spine was still stable.
The surgeons reported very few complications or problems beyond a couple of screws backing out that were used to hold the plate in place. And even in those cases, no neurologic symptoms were reported. There were no cases where the plates broke, shifted, or failed in any way.
Two additional advantages of a plate-only approach are the cost savings (it's much more expensive to add bone struts) and the shorter time under anesthesia required for a plate-only procedure. A shorter operative time also saves money but even more importantly, reduces the risk of complications for the patient.
Evidently, the plate-only procedure is less technical than some of the ones that use struts. The technique of using the spacers requires advanced surgical skills much like a master carpenter. The high success and low complication rates without the use of supplemental bone grafting suggests this technique to expand the spinal canal may become a standard procedure in the future. Patients have immediate spinal stabilization and can move after surgery right away. The cost savings is an added feature to consider.
John M. Rhee, MD, et al. Plate-Only Open Door Laminoplasty Maintains Stable Spinal Canal Expansion with High Rates of Hinge Union and No Plate Failures. In Spine. January 2011. Vol. 36. No. 1. Pp. 9-14.
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