Cervical Laminoplasty

Laminoplasty addresses the same problem as other decompression operations: a narrowed spinal canal in the neck compressing the spinal cord and causing myelopathy, with effects on the hands, balance and walking. It is particularly suited to situations where several levels are compressed and the neck alignment is reasonably well preserved. In these cases, opening the canal without fusing the spine can relieve the cord while keeping the neck mobile.

In a laminoplasty, carried out from the back of the neck, the bony arch (lamina) at each affected level is cut on one side and hinged open on the other, enlarging the canal and lifting pressure off the cord. Small plates or spacers hold the arches in their new, more open position. Because the bone is repositioned rather than removed and the spine is not fused, the segments retain much of their movement, and the reconstructed arches continue to protect the cord. The number of levels treated is tailored to the pattern of compression.

Laminoplasty can be considered for multilevel cervical myelopathy, including that caused by ossification of the posterior longitudinal ligament, particularly where the neck alignment is satisfactory and preserving motion is valued. It is less suitable where the neck is already kyphotic (bent forward), where there is significant instability, or where axial neck pain is a dominant problem, in which case a fusion-based approach may serve better. The choice between laminoplasty, laminectomy with fusion, and anterior surgery is individualised.

The evidence supports laminoplasty as an effective, motion-preserving option for suitable multilevel myelopathy. Meta-analyses comparing laminoplasty with laminectomy and fusion find broadly similar neurological improvement, with each approach having particular advantages — laminoplasty preserving more motion and avoiding fusion-related issues, and fusion offering advantages where alignment or stability is a concern. Studies in ossification of the posterior longitudinal ligament also examine where laminoplasty fits best. The balanced view is that laminoplasty is a well-evidenced technique for the right pattern of compression and alignment, chosen as part of an individualised plan.

The operation is performed under general anaesthetic, usually with a hospital stay of a few days. The aim is to relieve pressure on the cord and allow neurological recovery, which typically occurs gradually over months. Because the spine is not fused, movement is generally encouraged, though some stiffness can occur, and rehabilitation supports recovery. As with any operation there are risks, which are discussed fully beforehand. Whether laminoplasty is the best choice for a given person is decided together.

• —Avetisian H, et al. Laminoplasty versus laminectomy and posterior fusion for cervical myelopathy: meta-analysis of radiographic and clinical outcomes. Global Spine J 2024. (PMID 38764362)
• —Lee CH, et al. Comparison of laminoplasty versus laminectomy and fusion in multilevel cervical OPLL: systematic review and meta-analysis. World Neurosurg 2018. (PMID 30024545)
• —Yuan W, et al. Laminectomy and fusion versus laminoplasty for multilevel cervical myelopathy: systematic review and meta-analysis. Eur Spine J 2017. (PMID 27342611)
• —Lao L, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical compressive myelopathy: a meta-analysis. Int Orthop 2013. (PMID 27281067)