EXPANSIVE LAMINOPLASTY IN CERVICAL CANAL STENOSIS Deepak Agrawal, B S Sharma, V S Mehta Deptt of Neurosurgery, CN Centre, AIIMS, New Delhi.

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Presentation transcript:

EXPANSIVE LAMINOPLASTY IN CERVICAL CANAL STENOSIS Deepak Agrawal, B S Sharma, V S Mehta Deptt of Neurosurgery, CN Centre, AIIMS, New Delhi

SURGICAL OPTIONS ANTERIOR CERVICAL DECOMPRESSION AND SPINAL FUSION (ACDF) LAMINECTOMY/LAMINOPLASTY Expansive laminoplasty in cervical canal stenosis

ACDF LENGTHY AND COMPLICATED IMMOBILIZES SEGMENTS HIGH MECHANICAL DEMANDS ON ADJACENT SEGMENTS RADIOLOGICAL & CLINICAL EVIDENCE OF DETERIORATION ON FOLLOW UP Expansive laminoplasty in cervical canal stenosis

LAMINECTOMY KYPHOSIS SPINAL INSTABILTY LAMINECTOMY MEMBRANE Expansive laminoplasty in cervical canal stenosis

BEAUTY LIES IN SIMPLICITY

Expansive laminoplasty in cervical canal stenosis EXPANSIVE LAMINOPLASTY QUICK, EFFICACIOUS & DURABLE MANTAINS CERVIVAL MOBILITY PREVENTS KYPHOSIS LONG TERM RESULTS SURPASS THAT OF ANTERIOR PROCEDURES

INDICATIONS CERVICAL CANAL STENOSIS OPLL-continuous/ mixed Multisegmental cervical spondylotic myelopathy (MSCS) Ligamentum flavum hypertrophy Expansive laminoplasty in cervical canal stenosis

CONTRAINDICATIONS Focal anterior compression Established, absolute kyphosis Isolated radiculopathy Spinal instability (Trauma, tumour or infection) Expansive laminoplasty in cervical canal stenosis

RETROSPECTIVE STUDY PERIOD: Jan Nov 2002 Expansive laminoplasty in cervical canal stenosis

DEMOGAPHIC PROFILE 24 patients M:F 21:3 (7:1) Mean age: 57 yrs (36-76 yrs) Expansive laminoplasty in cervical canal stenosis

MRI FINDINGS OPLL (Continuous/ Mixed) 12 MSCS (Multisegmental cervical spondylosis) 18 Lig flavum hypertrophy05 Cord changes20 (11 pts had more than one pathology) Expansive laminoplasty in cervical canal stenosis

SURGICAL PROCEDURE MODIFIED OPEN-DOOR LAMINOPLASTY Number of pts Titanium miniplates and screws22 Hydroxyapatite spacer01 Autologous bone spacer01 AVERAGE NUMBER OF LEVELS OPERATED- 5 (4-6) Expansive laminoplasty in cervical canal stenosis

NEUROLOGICAL ASSESMENT NURICKS SCALE WAS USED PREOPERATIVELY AND AT LAST FOLLOW UP Expansive laminoplasty in cervical canal stenosis

NURICKS GRADE 0- Radiculopathy 1- Myelopathy+, No gait disturbance 2- Mild gait dist/ carry on with daily activity 3- Mod gait dist- works without assistance 4- Severe gait dist-works with assistance 5- Bedridden Expansive laminoplasty in cervical canal stenosis

NURICKS GRADE PREOPERATIVE (No. of pts) POSTOPERATIVE (No. of pts) GRADE 102 GRADE 211 GRADE 3214 GRADE 494 GRADE 5123

Expansive laminoplasty in cervical canal stenosis

NURICKS GRADE CORD CHANGES (No. of pts) GRADE 10 GRADE 20 GRADE 31 GRADE 47 GRADE 512

RESULTS 21 PTS (87%) had improvement 3 pts remained unchanged in their Nuricks grade (All had severe cord changes) Expansive laminoplasty in cervical canal stenosis

COMPLICATIONS CSF leak1 (resolved on conservative Mx) Deterioration in power1 (compression by spacer- Reoperated-improved Expansive laminoplasty in cervical canal stenosis

CONCLUSIONS Laminoplasty is a valuable procedure in multisegmental anterior compression (results =/> anterior procedures) For best results- should be performed before cord changes develop Expansive laminoplasty in cervical canal stenosis