Cervical vertebra single-door cervical laminoplasty

The laminectomy operation, that is, laminectomy, surgically cuts one or both sides of the lamina, and the lamina is displaced to the posterolateral side to enlarge the spinal canal. It was first reported by Pinglin and Nakano of Japan, and later improved by many scholars in practice, and improved surgical methods were proposed. Treatment of diseases: cervical spondylotic myelopathy Indication Cervical single-door cervical spinal canalplasty is suitable for: 1. Severe cervical spinal stenosis, stenosis in the range of more than 3 segments, and even patients with extensive cervical degeneration and hyperplasia and spinal cord compression. In patients with primary spinal stenosis, the ratio of the sagittal diameter of the spinal canal/vertebral body is less than 0.75, or the absolute value of the spinal canal is less than 12 mm. Among them, one with a symptom on one side and the other on the other side is more suitable for this method. 2. The ossification of the posterior longitudinal ligament of the cervical spine is continuous, mixed or intermittent, involving a wide range. In addition, if the diameter of the fossa-shaped bone exceeds 50% of the diameter of the spinal canal, the risk of anterior surgery should be considered first. 3. Multi-segment cervical spondylotic myelopathy, at least 3 or more vertebral segments are involved. 4. Some patients with cervical spondylosis or cervical spine trauma after anterior cervical decompression and bone graft fusion, combined with spinal stenosis, or spinal ligament ligament or wrinkles on the spinal cord caused compression. In particular, MRI sagittal imaging showed a bead-like change in the spinal cord. 5. Yellow ligament calcification, although rare, can cause a series of symptoms and signs of spinal stenosis, requiring posterior decompression. This procedure is more desirable in order to preserve more of the integrity of the posterior cervical structure. Contraindications 1. The general condition is poor, and the patient cannot be tolerated; the disease course is long, the spinal cord has been degenerated, the muscles of the limbs are atrophy, and the joint function is severely impaired. 2. The cervical vertebra has obvious segmental instability, especially in cases where the anterior structure is damaged or damaged, and has not been healed. Preoperative preparation 1. Inform the patient about the surgical position before surgery, as well as the possible discomfort during the operation, so that the patient can get close cooperation during the operation. 2. The patient was pre-operatively prone for several days to adjust to the prone position during surgery. 3. Prepare the necessary equipment for posterior cervical and open surgery, such as micro drills or pneumatic drills. In the absence of these devices, small impact rongeurs and three-joint needle-nosed rongeurs are available. Surgical procedure 1. Incision and laminar exposure The same as the posterior road. The incision side and the hinge side of the lamina are determined, and the spinous processes of all shaped vertebrae are removed from the base or may not be removed. 2. Preparation of the hinge side lamina The electric cortex was used to remove the cortical bone from the lateral margin of the lamina, leaving only the cancellous bone and the inner cortex. If there is no such equipment, the 2.5 mm wide three-joint rongeur is used to evenly force the outer cortical bone to form a bone groove at the lower edge of the lamina of the medial edge of the facet. 3. Operation of the open side lamina Using a power drill or an air drill, or a thin laminar rongeur, along the medial edge of the facet of the lamina, the entire lamina is completely severed from top to bottom, or from bottom to top, showing a dural sac. The number of vertebrae to open the door depends on the extent of the lesion, usually 4 or 5 segments, ie neck 3 to 6 or neck 3 to 7. 4. Spinal canal enlargement One side of the lamina was completely free, and the other side was partially connected by cortical bone. Each intersegmental ligamentum flavum was excised and separated. The lamina is pulled to the hinge side, causing the cortical bone of the inner side of the hinge side to be broken, but some of the cortex is still continuous, so that the lamina forms a door opening state. The greater the expansion of the laminectomy space, the greater the increase in the sagittal diameter of the spinal canal. For every 1 mm increase, the diameter increases by 0.5 mm. It is generally sufficient to expand 6 to 8 mm. 5. Laminar opening and fixing In order to keep the lamina in a permanent open state, a hole can be drilled in the base of the spinous process before the opening operation to penetrate the wire or thick wire, suture the spinous process to the contralateral muscle layer, and between the medial side of the open side Adipose tissue can be placed to prevent adhesion of the neck muscles to the dural sac. In order to prevent the phenomenon of closing the door after single door opening, a tibia or rib corresponding to the thickness of the lamina can be taken, embedded in the opening door, and fixed with steel wire or small screws to achieve the function of reconstructing one side of the lamina. 6. Incision suture The muscle layer, the skin and the skin were sutured, and the incision was placed with a negative pressure drainage or a half tube drainage. complication Spinal cord injury Mainly due to improper operation during surgery, especially those with severe spinal stenosis. It is important to choose the right equipment and master the surgical skills. 2. Hemorrhage and hematoma formation Mainly related to the hemostasis of the wound before the incision was sutured. Local bleeding can form a hematoma. Hematoma can cause compression if it occurs on the open side of the epidural, which makes the clinical symptoms progressively worse.