18 Posterior Cervical Laminoplasty with Instrumentation

10.1055/b-0039-166427

18 Posterior Cervical Laminoplasty with Instrumentation

Ankur S. Narain, Fady Y. Hijji, Philip K. Louie, Daniel D. Bohl, and Kern Singh

18.1 Case Presentation

A 70-year-old man presents to the clinic complaining of worsening ambulation. He also notes the pain radiates to his left scapula and left arm and is associated with numbness and paresthesia of his left lateral forearm and thumb. He also notes weakness and difficulty with fine motor tasks such as buttoning his shirt. On physical examination, the patient exhibits decreased sensation of his left lateral forearm, thumb, and index finger. He exhibits full strength on shoulder abduction, elbow flexion and extension, and wrist flexion and extension. He has a positive Spurling test, with a positive Hoffman sign. He is unable to perform the grip release test with 20 cycles of grips and releases within 10 seconds. The patient’s radiographs and magnetic resonance imaging (MRI) are provided in Figs. 18.1 and 18.2 . The patient is subsequently scheduled to receive a posterior cervical laminoplasty with instrumentation from C3 to C6.

**Fig. 18.1** Flexion **(a)** and extension **(b)** of cervical radiographs. There is significant cervical spondylosis of C3–T1 with C3–C4 and C7–T1 spondylolisthesis.

**Fig. 18.2** Sagittal **(a)** and axial T2-weighted **(b)** cervical MRI. There is C3–T1 spondylosis with moderate to severe spinal stenosis.

18.2 Indications

Paracentral cervical disk herniations.
Cervical spinal stenosis at multiple levels.
Cervical tumors.

18.3 Positioning

Prone.
Landmarks:
- Spinous processes:
  - C2, C7, and T1 are largest spinous processes in the cervical region.
  - C7 and T1 difficult to differentiate via palpation.

18.4 Approach

18.4.1 Superficial Dissection

The skin incision is made midline over the targeted cervical levels:
- Intraoperative imaging and needle placement is necessary to confirm the correct level of decompression.
- The internervous plane is located between the paraspinal cervical muscles of either side. The dorsal rami of the cervical roots supply this region.
The paracervical muscles are stripped subperiosteally to avoid bleeding:
- Only the medial portion of the lamina/facet junction is exposed.