Introduction We describe the surgical technique and the pitfalls of French-door laminoplasty.
Step 1: Patient Positioning Position the patient to keep the cervical spine “parallel to the floor” or in the “reverse Trendelenburg position” with only a slight incline and place intraoperative neurological monitors to prevent intraoperative neurological deterioration.
Step 2: Surgical Approach Use the common cervical posterior approach to expose the lamina and ligamentum flavum.
Step 3: Create Grooves Cut the center of each lamina and create bilateral grooves using a high-speed burr.
Step 4: Open the Lamina Open the lamina bilaterally and create a small hole in each one using a high-speed burr.
Step 5: Create Bone Struts Create bone struts from the spinous processes and tie them to each lamina.
Step 6: Wound Closure Perform meticulous closure of the wound to avoid wound-healing complications.
Results In our original study12, we treated forty-six patients with French-door laminoplasty and compared the surgical results of this procedure with those of open-door laminoplasty in a prospective, randomized controlled manner.
Pitfalls & Challenges
We describe the surgical technique and the pitfalls of French-door laminoplasty.
Cervical laminoplasty was developed in the 1970s as an alternative to laminectomy for treating multilevel cervical compressive myelopathy1. The proposed advantages of laminoplasty are that it achieves expansion of the spinal canal and preserves spinal stability2. Posterior laminectomy with fusion with use of instrumentation is also an effective alternative, especially for patients with kyphosis or instability. However, it is less cost-effective and a variety of complications have been reported3. Anterior discectomy and fusion could provide better surgical outcomes than posterior decompression, but the complications at an early stage after the surgery are more common in patients with multilevel cervical myelopathy4.
Various modified methods of laminoplasty have …
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