Cervical Laminoplasty

Anesthesia

1. General anesthesia is given in the operating room

Positioning

2. Patient is placed in the prone position
3. Surgeons ensure that all bony prominences are padded
4. If indicated, neuromonitoring is set up
5. Patient is prepped and draped

Surgical Exposure

6. Landmarks (base of skull, spinous processes C2-C7) are identified by palpation and marked
7. Midline skin incision is made
8. Midline dissection is made through subcutaneous fat with electrocautery
9. Ligamentum nuchae is identified and divided in the midline to bone
10. Subperiosteal dissection of paraspinal musculature off of bilateral spinous processes, laminate, and lateral masses from C2-C7 using Bovie electrocautery
11. X-ray confirmation of the appropriate levels of dissection using a Kocher clamp on a spinous process and dental probe in a facet joint
12. Facet joint capsules are preserved as much as possible during dissection

Osteotomies

13. Left-sided bi-cortical osteotomies are made through the C2-C7 junctions of the laminate and lateral masses using a high-speed burr
14. Underlying ligamentum flavum is palpated, but not violated at this point
15. Bleeding by epidural vessels is tamponed with bone wax, FLOSEAL hemostatic matrix, and surgical sponges
16. Right-sided uni-cortical osteotomies are made through the C2-C7 junctions of the laminate and lateral masses using a high-speed burr
17. Cobb elevator, retractor, and fingers are used to open the left-sided osteotomy site through hinging on the right-sided uni-cortical osteotomy site
18. Springiness/motion of the posterior elements is frequently checked, with further osteotomy of the hinge side as needed
19. Partial release of the underlying ligamentum flavum with a curette is also performed as needed to further open the left-sided osteotomy location. The goal is an opening of 8mm

Fixation

20. Laminoplasty plates are inserted in the left-sided osteotomy location at C2-C6
21. Through each plate, 1 screw is placed into the lamina and 2 screws into the lateral mass
22. A starting awl is used to start each hole and screws are self-drilling and self-tapping. They are 6-8mm in length

Inspect Repair/Supplement with Bone Graft

23. Inspect repair at each level
24. Morselized bone graft from the removed spinous processes (below) is applied to the right-sided uni-cortical osteotomies to assist bony healing

Closure

25. Spinous processes are partially removed from C2-C7 in order to facilitate a tension-free closure
26. Interrupted sutures are used to close the paraspinal muscle fascia
27. Running, subcuticular dermal closure with a Monocryl stitch