Laminoplasty, also known as osteoplastic reconstruction of the lamina, is a surgical procedure that involves the replacement of the lamina of the vertebral body following a laminectomy procedure in an attempt to provide better post-operative stabilization.
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Indications
patients in need of laminectomy who are at a high risk of failed back syndrome 3
Procedure
Laminoplasties are commonly performed on the cervical spine, but there is currently limited use in the lumbar spine 2. The procedure involves the removal of the lamina to allow for visualization and removal of compressive structures, followed by reattachment of the lamina to maintain spinal stability 1.
stripping of the paraspinal muscles from the spinous process
dissection of the lamina while preserving the integrity of the underlying dura and nerves
removal/opening of the spinal process (see below)
resection of any stenosing posterior soft tissue, such as the ligamentum flavum, abscess collection, or tumors
reattachment of the lamina using small plates and screws, restoring the anatomical position and ensuring structural stability
Two commonly used techniques for opening of the lamina are the "open-door" and the "French-door" laminoplasty.
Open-door laminoplasty
The open-door technique, also known as "hinge" laminoplasty, involves creating a hinge on one side of the lamina and opening it like a door 4. This technique begins with a unilateral approach, where a trough is created on one side of the spinous processes and laminae. The lamina on the opposite side is then cut entirely, forming a hinge on the first side. The opened laminae are then secured in their expanded position using hardware such as small screws and plates, creating more space within the spinal canal for the spinal cord and nerves.
French-door laminoplasty
The French-door technique, on the other hand, involves a bilateral approach. In this technique, the laminae are split down the middle, and both halves are expanded symmetrically, like opening a pair of double doors or French doors 4. This expansion is typically supported by spacers or grafts, which are placed in the opened laminae to maintain the widened spinal canal. The advantage of this technique is that it provides bilateral decompression and symmetry, which can potentially lead to better biomechanical stability.
Radiographic features
Plain radiograph
Radiographs can provide useful data on changes in bony alignment, implant position, and potential hardware fractures 5. It is difficult, however, to adequately visualize the laminoplasty directly.
CT
CT imaging is a preferred modality for assessing bony detail and evaluating the placement and condition of implants. It can help detect and characterize the location of implants, complications, as well as assess the success of decompression and fusion progression.
MRI
MRI is optimal for evaluating soft tissue structures and potential abnormalities with spinal cord and nerve roots.
It can be used to evaluate the success of decompression and show a fibrous scar at the level of the cut of the supraspinous and interspinous ligaments, signs of epidural fibrosis, and any complications 5.
Radiology report
The postoperative radiological report for laminoplasty should include a description of the following features:
levels of the laminoplasty
condition and placement of implants (if any)
fibrous scar tissue
success of decompression
signs of epidural fibrosis
any complications