Case Study: Cervical Laminoplasty

History

The patient is a 54-year-old left-hand dominant male. He is a plumber and presented to Dr. Stieber with complaints of left arm weakness and numbness. The patient reported difficulty walking with balance problems and a loss of manual dexterity (eg, difficulty writing).

Examination

On physical examination, he was found to have an unsteady gait, hyper-brisk reflexes (reflexes are increased), as well as significant left arm weakness and numbness.

Pre-treatment images

Figures 1 and 2 are side (lateral) x-rays of the cervical spine in extension, neutral, and flexion.

Figure 1. Extension Figure 2. Neutral

The patient’s MRI findings revealed multi-level cervical spinal stenosis with pinching (compression) of the spinal cord (Figure 4).

Figure 4. MRI; arrow points to a level of spinal cord compression

Figures 5A-5D are axial or overhead views of specific levels of the spine.

Figure 5A. C3-C4 Figure 5B. C4-C5
Figure 5C. C6-C7 Figure 5D. C6-C7

Diagnosis

Cervical spondylotic myelopathy; compression of the spinal cord at multiple levels resulting in spinal cord dysfunction

Selected Treatment

The patient was treated with a C3-C7 cervical laminoplasty. The roof of the spinal canal was split and hinged open at each level (eg, C3-C4, C5-C6, C6-C7). The patient’s own bone was affixed to create an expanded arch, increasing space for the spinal cord and nerves while maintaining motion.

Post-operatively, the patient was placed in a soft cervical collar for two weeks.

 

 

Figure 6. Post-operative anteroposterior (front to back, AP) x-ray

Figures 7 and 8 demonstrate that surgery maintained cervical (neck) motion.

Figure 7. Extension Figure 8. Flexion

 

Figure 9. Neutral Figure 10. Extension

 

Outcome

The patient experienced near complete resolution of his symptoms two weeks following the procedure. Strength in his left arm was completely restored. Walking and writing substantially improved. At one-year after surgery, the patient’s cervical range of motion was maintained. He returned to his demanding work as a plumber.

 

 
 
 
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