Question:As a young adult, I fell and hurt my neck. Over the years bone spurs have formed in that area. Now there's pressure on the spinal cord causing neck and arm pain. The surgeon has shown me two types of operations I can have to treat this problem. One is a laminaplasty. The other is a laminectomy. Which one is better?
Answer:Laminectomy refers to surgically cutting the lamina and removing it. The lamina is a bridge of bone that helps form a protective arch around the spinal cord. There is a lamina on each side of the vertebra. In between the two laminae is the spinous process. The tip of the spinous process is what you feel as a bump down the back of your spine.
Removing the lamina takes the pressure off the sensitive nerve tissue. But without this bony support, the vertebra can collapse causing spinal deformity. And although the pressure is off the spinal cord, there's no protective covering for it without the lamina.
The laminaplasty does not remove the lamina. Instead, a hinge joint is made by cutting completely through the lamina on one side. A second incision is made through half the lamina on the other side. This allows the back of the vertebral bone to swing away from the body of the vertebra. The pressure is off without removing the protective roof over the cord.
On the down side, laminaplasty is done from the back of the neck. This requires all of the muscles and soft tissues to be stripped away from the bone. Some patients report increased neck pain after surgery. The pain will gradually subside over the next few weeks to months.
With the anterior approach, there are risks for problems swallowing and speaking. A posterior approach avoids damage to the vocal cords and throat. One other advantage of the laminaplasty is the long-term results that have been reported. Many patients maintain the benefits of this operation up to 10 years or more.
Laminaplasty is a good option for some patients who want to avoid cervical fusion. There are some patients who are not eligible for a laminaplasty. Patients with severe neck pain may not want to risk even more pain afterwards.
Patients with increased kyphosis (a forward curve of the neck instead of a backward curve) are poor candidates for laminaplasty. Each procedure has its own pros and cons. Ask your surgeon to help you understand what these are for your particular situation. Once you know what all the factors are, there may be a clear choice for you.Ronald A. Lehman, Jr, MD, MAJ, MC, et al. Surgical Techniques: Cervical Laminaplasty. In Journal of the American Academy of Orthopaedic Surgeons. January 2008. Vol. 16. No. 1. Pp. 47-56.
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