I'm confused about something. I saw two different surgeons about a neck problem I'm having. The spinal cord is getting crunched because there isn't enough space for it in the spinal canal. One surgeon wants to do an operation called a laminectomy. The other doctor says it's a laminoplasty. Are we talking about the same thing or are these two different things?
Spinal stenosis, a narrowing of the spinal canal where the spinal cord is located can cause spinal cord compression. Headache, neck pain, numbness and tingling down the arms can develop as a result. This condition is called cervical myelopathy. Cervical refers to the neck region. Myelopathy tells us there's a problem at the spinal cord.
A pinched nerve causing neck and/or arm pain is one thing. But when the spinal cord in the neck area gets pinched or compressed, that's more serious. Permanent paralysis can develop if the problem isn't corrected. One of the most popular surgical procedures to decompress the spinal cord is called an open-door laminoplasty.
The lamina is a ring of bone around the spinal cord to protect it. And it works very well in doing so until outside forces create a stenosis or narrowing of the spinal canal. And then suddenly, that protection becomes a problem. Aging and the degenerative changes associated with getting older are the most common reasons for spinal stenosis. For example, disc degeneration brings vertebral bones and spinal joints closer together. Closer proximity of the bone and joint surfaces without a healthy disc to hold them apart can cause bone spurs and other bony changes to develop.
The posterior longitudinal ligament (PLL) along the back of the spine thickens and takes up additional space inside the canal. Disc degeneration and arthritic changes cause the vertebral bones to shift or collapse slightly. Even a minor shift in the vertebral bone alignment can put pressure on the spinal cord.
A laminoplasty involves cutting through the lamina on one side and swinging the bone away from the spinal cord. It's much like swinging a door open, which is why it's called an open-door laminoplasty. The surgeon places a laminoplasty plate on the opposite side to help hold the door open. It's a popular procedure because patients get pain relief without causing harm or injury to any of the soft tissues or spinal structures. And neck motion isn't limited or compromised as occurs with a neck fusion.
A laminectomy actually removes some or all of the lamina (usually on one side of the spine). If a large portion of the lamina is removed, then it may be necessary to fuse the spinal segments together. This limits motion but provides the stability needed without the laminal support.
With different surgical opinions, some patients opt for getting a third opinion before making a decision. When making a decision, you will want to ask your surgeon to describe the recommended procedure and explain why one approach might be better than another for you.
Gabriel Liu, MD, et al. Revision Surgery Following Cervical Laminoplasty. Etiology and Treatment Strategies. In Spine. December 1, 2009. Vol. 34. No. 25. Pp. 2760-2768.
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