EXPANSIVE LAMINOPLASTY IN CERVICAL CANAL STENOSISDeepak Agrawal, B S Sharma, V S Mehta Deptt of Neurosurgery, CN Centre, AIIMS, New DelhinSURGICAL OPTIONSnANTERIOR CERVICAL DECOMPRESSION AND SPINAL FUSION (ACDF)nLAMINECTOMY/LAMINOPLASTYExpansive laminoplasty in cervical canal stenosisnACDFnLENGTHY AND COMPLICATEDnIMMOBILIZES SEGMENTSnHIGH MECHANICAL DEMANDS ON ADJACENT SEGMENTSnRADIOLOGICAL & CLINICAL EVIDENCE OF DETERIORATION ON FOLLOW UPExpansive laminoplasty in cervical canal stenosisLAMINECTOMYnKYPHOSISnSPINAL INSTABILTYnLAMINECTOMY MEMBRANEExpansive laminoplasty in cervical canal stenosisExpansive laminoplasty in cervical canal stenosisBEAUTY LIES IN SIMPLICITYExpansive laminoplasty in cervical canal stenosisEXPANSIVE LAMINOPLASTYnQUICK, EFFICACIOUS & DURABLEnMANTAINS CERVIVAL MOBILITYnPREVENTS KYPHOSISnLONG TERM RESULTS SURPASS THAT OF ANTERIOR PROCEDURESINDICATIONS CERVICAL CANAL STENOSISnOPLL-continuous/ mixednMultisegmental cervical spondylotic myelopathy (MSCS)nLigamentum flavum hypertrophyExpansive laminoplasty in cervical canal stenosisCONTRAINDICATIONSnFocal anterior compressionnEstablished, absolute kyphosisnIsolated radiculopathynSpinal instability (Trauma, tumour or infection)Expansive laminoplasty in cervical canal stenosisnRETROSPECTIVE STUDYnPERIOD: Jan 1999- Nov 2002Expansive laminoplasty in cervical canal stenosisDEMOGAPHIC PROFILEn24 patientsnM:F 21:3 (7:1)nMean age: 57 yrs (36-76 yrs)Expansive laminoplasty in cervical canal stenosisMRI FINDINGSnOPLL (Continuous/ Mixed) 12nMSCS (Multisegmental cervical spondylosis)18nLig flavum hypertrophy05nCord changes20(11 pts had more than one pathology)Expansive laminoplasty in cervical canal stenosisExpansive laminoplasty in cervical canal stenosisExpansive laminoplasty in cervical canal stenosisSURGICAL PROCEDURE MODIFIED OPEN-DOOR LAMINOPLASTYNumber of ptsnTitanium miniplates and screws22nHydroxyapatite spacer01nAutologous bone spacer01AVERAGE NUMBER OF LEVELS OPERATED- 5 (4-6)Expansive laminoplasty in cervical canal stenosisExpansive laminoplasty in cervical canal stenosisNEUROLOGICAL ASSESMENTNURICKS SCALE WAS USED PREOPERATIVELY AND AT LAST FOLLOW UPExpansive laminoplasty in cervical canal stenosisnNURICKS GRADEn0- Radiculopathyn1- Myelopathy+, No gait disturbancen2- Mild gait dist/ carry on with daily activityn3- Mod gait dist- works without assistancen4- Severe gait dist-works with assistancen5- BedriddenExpansive laminoplasty in cervical canal stenosisExpansive laminoplasty in cervical canal stenosisNURICKS GRADEPREOPERATIVE (No. of pts)POSTOPERATIVE (No. of pts)GRADE 102GRADE 211GRADE 3214GRADE 494GRADE 5123Expansive laminoplasty in cervical canal stenosisExpansive laminoplasty in cervical canal stenosisNURICKS GRADECORD CHANGES (No. of pts)GRADE 10GRADE 20GRADE 31GRADE 47GRADE 512RESULTSn21 PTS (87%) had improvement n3 pts remained unchanged in their Nuricks grade (All had severe cord changes)Expansive laminoplasty in cervical canal stenosisCOMPLICATIONSnCSF leak1(resolved on conservative Mx)nDeterioration in power1(compression by spacer- Reoperated-improvedExpansive laminoplasty in cervical canal stenosisCONCLUSIONSnLaminoplasty is a valuable procedure in multisegmental anterior compression (results =/ anterior procedures)nFor best results- should be performed before cord changes developExpansive laminoplasty in cervical canal stenosis