What kind of surgery can be done to take pressure off the spinal cord? I have a condition called cervical spondylotic myelopathy (CSM). I was born with this problem, but the symptoms are getting worse. Surgery may be my next step.
Cervical spondylotic myelopathy (CMS) affects the neck and can cause disabling pain and loss of function. Cervical refers to the cervical spine or neck. Spondylotic means the vertebral bones are involved. In the case of CSM, the opening of the vertebral bones that form the spinal canal (where the spinal cord goes) is too narrow. Myelopathy tells us the spinal cord is pinched or compressed by the narrowing of the canal.
One cause of CSM is a congenital decrease in the size of the spinal canal. This occurs without an equal decrease in the size of the spinal cord going through the canal. The condition is referred to as developmental stenosis since it is present at birth.
There are different ways to approach this problem. One of the more common surgical procedures performed is a bilateral open-door laminoplasty. An open-door laminoplasty refers to a single incision along the lamina bone of the vertebra with a partial incision on the other side.
The lamina is the bridge of bone that connects the spinous process (bony projection out from the vertebra felt as a bump along the back of your spine) to the main body of the vertebra. The lamina is present on both sides of the spinous process. The surgeon then swings one side of the bone open like a door and away from the spinal cord. Bilateral means the procedure is done on both sides of the vertebra.
The surgeon may use a modification of the open-door laminoplasty called the double-door laminoplasty. The spinous process is removed at the level of the problem. The center of the lamina is split and opened like double doors. This technique enlarges the spinal canal more than a single open-door procedure.
Once the surgeon assesses the location and severity of your problem, then the specific type of procedure can be planned. X-rays and MRIs are usually taken during the evaluation process. The size of the diameter of the spinal canal is measured.
The smaller the diameter, the more complicated the procedure may be. That's why MRIs are needed to document the actual size of the canal. The surgeon uses this information to determine how much the nearby soft tissues are compressed and how to proceed with the surgical treatment.
Hideki Shigematsu, MD, et al. Does Developmental Canal Stenosis Influence Surgical Results of Bilateral Open-Door Laminoplasty For Cervical Spondylotic Myelopathy? In Journal of Neurosurgery. October 2008. Vol. 9. No. 4. Pp. 358-362.
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