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    Old 06-01-2011, 07:47 AM   #1
    digiguy
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    Cervical spine laminoplasty

    Hi, I'm diagnosed with congenital stenosis on cervical spine and the neurosurgeon I'm seeing want to perform laminectomy from c2 to c6. Could someone recommend a good neurosurgeon in Dallas area who is good at laminoplasty so I can get a 2nd opinion? Thanks.

     
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    Old 06-01-2011, 02:36 PM   #2
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    Re: Cervical spine laminoplasty

    Look for both a Neurosurgeon and an Orthopedic Spine Surgeon. If you know anyone who has had any kind of spine surgery ask about their doctors. That's how I found my current Orthopedic Spine Surgeon. Another person at a cocktail party was about to have lumbar spine surgery and I was getting frustrated with my OSS. I contacted the person I met at the party 6 mo after his surgery (he was a large very tall man) and asked how it went. He raved about the surgeon and the care. I went and found the OSS and his medical assistant to be amazing.

    Look around for Spine Centers and check your insurance on line to see what doctors are available to you. Perhaps UT Southwestern spine center is an option. Once I found i was going to have my initial cervical spine surgeon you wouldn't believe how many people around me had some spine issues, physician recommendations (and doctors to avoid), etc
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    Old 06-02-2011, 06:50 PM   #3
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    Re: Cervical spine laminoplasty

    To find someone who does laminoplasties(as opposed to the more traditional laminectomy with fusion), check neurosurgery depts. at major medical schools in the area. Call and ask if the doc does laminoplasties...the staff will know. I'm not sure if ortho spine surgeons do laminoplasties as even at Hospital for Special Surgery in NYC doesn't do it and they are all orthos. I had mine with a neurosurgeon.

    I am seeing my neurosurgeon next week for my annual checkup and will ask if there is a way to find someone who does them such as a website or organization.

    Jenny

     
    Old 06-03-2011, 07:47 AM   #4
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    Re: Cervical spine laminoplasty

    Quote:
    Originally Posted by digiguy View Post
    Hi, I'm diagnosed with congenital stenosis on cervical spine and the neurosurgeon I'm seeing want to perform laminectomy from c2 to c6. Could someone recommend a good neurosurgeon in Dallas area who is good at laminoplasty so I can get a 2nd opinion? Thanks.
    The doctor that did my cervical fusion is a spine specialist ,he is excellent ,a lot of my coworkers when to him ,he specializes in spine and surrounding tissues and muscles, you can barely see my scar, he has an excellent bedside manner ,takes time the answer your questions and is well respected by his peers , he is based in Plano ,I am sure that you know where Plano is, It was a hour and 15 minute drive from my home but well worth it . I hope it's okay to give his name .

    Donald Mckenzie ,he has an office but I can't find the number ,he does his surgeries out of Medical City of Plano which is a great hospital ,you will get other great suggestions ,I am just tossing this into the ring
    would like to know how you come out

     
    Old 06-03-2011, 04:47 PM   #5
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    Re: Cervical spine laminoplasty

    Thanks everyone.

    Hi Capatga, I'm in Plano and about 10 mins from Medical Center of Plano. Do you know if Dr. Donald McKenzie specialize in Laminoplasty?

     
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    Old 06-03-2011, 05:21 PM   #6
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    Re: Cervical spine laminoplasty

    Quote:
    Originally Posted by digiguy View Post
    Thanks everyone.

    Hi Capatga, I'm in Plano and about 10 mins from Medical Center of Plano. Do you know if Dr. Donald McKenzie specialize in Laminoplasty?
    I am not 100% ,I think he does,if not he has collegues that practice in that area ,when I had issues that he didn't specilaize in ,he was always able to refer me to the specialist that could help me and they also turned out to be great .all of my care was done in about a 2 mile radius

    good luck, would like to know what happens

     
    Old 06-04-2011, 06:33 PM   #7
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    Re: Cervical spine laminoplasty

    Digiguy....you will have to call and ask if the doc does laminoplasties. Most don't....it's fairly new. And don't let them tell you he does laminectomies and that is the same thing...it isn't. Laminoplasties are VERY different. And even better.....ask what kind of laminoplasty he/she does. Many have given up the original "open door laminoplasty" in favor of the "French door laminoplasty" as it doesn't leave the spine lopsided.

    Once you go "fusion" that is when the real problems begin. Give the laminoplasty a good try.

    Jenny(C3-6 laminoplasty)

     
    Old 06-04-2011, 07:11 PM   #8
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    Re: Cervical spine laminoplasty

    Quote:
    Originally Posted by jennybyc View Post
    Digiguy....you will have to call and ask if the doc does laminoplasties. Most don't....it's fairly new. And don't let them tell you he does laminectomies and that is the same thing...it isn't. Laminoplasties are VERY different. And even better.....ask what kind of laminoplasty he/she does. Many have given up the original "open door laminoplasty" in favor of the "French door laminoplasty" as it doesn't leave the spine lopsided.

    Once you go "fusion" that is when the real problems begin. Give the laminoplasty a good try.

    Jenny(C3-6 laminoplasty)
    Thanks Jennybyc. One of the neurosurgeons I visited did try to persuade me that Laminoplasties doesn't provide better benefit than Laminectomy. They sent me this document to prove their point: http://www.ncbi.nlm.nih.gov/pubmed/12691377

    What are the differences between "open door" and "french door" Laminoplasties? Which one is better and why? Do you know any document/video can demonstrate?

     
    Old 06-04-2011, 10:14 PM   #9
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    Re: Cervical spine laminoplasty

    I'd imagine the "open door" is "hinged " on one side whereas "French door" opens like French doors based on two "hinges". Fascinating. I'll have to see if this is ever an option for me after my next ACDF revision to add in C4.
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    Old 06-05-2011, 04:45 PM   #10
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    Re: Cervical spine laminoplasty

    The difference between laminectomy and laminoplasty is that the laminectomy leaves your spinal cord uncovered and liable to injury. The laminoplasty restores bone coverage over the cord with the spinal canal doubled in size. I can see that as a distinct advantage when you are younger and still quite active.

    The "open door" laminoplasty is as follows: the surgeon removes the spinous process off the back of the vertebra(the stegasaurus thing on the back of the spine). This leaves him with the lamina bones that are on either side and they form the back of the spinal canal. They emerge from the sides of the vertebra at 30* angles. The surgeon then cuts through the area in between the lamina and then enters the canal and breaks the lamina on one side(I'll use the left side to explain). The lamina bone is then reset from a 30* angle to a 90* or straight up and held in place with bone sutures. A bone graft is then used to bridge the area between the upright lamina and the still 30* lamina, in effect, making it look like a door held open at 30*. The big problem with that, is that it makes the back of the spine lopsided and the attached ligaments then get pulled to one side.

    In the French door type, the surgeon starts the same with removing the spinous process and then makes a thin cut into the canal to access the lamina bones. Both lamina are then broken off and reset with bone sutures to 60*. Then a bone graft is used to close the back of the canal so it looks like French doors propped open. It also doubles the size of the canal but does not leave the back of the spine lopsided and the ligaments are only slightly elevated.

    I had the French door type done on C3 to C6.

    In full disclosure, I had major complications 3 months after surgery, after everything was healed. I tore a ligament on the left side of my neck from an old injury, and that in turn caused the lamina bones on the left side to break at C 5and 6 and subsequently, breaking the grafts at C4,5 and 6. My doc had to fused the entire area, from C3 to T1 but he also restored the grafts and lamina so that my cord is covered, safely. This complication is unheard of in laminoplasties according to my neurologist(not the neurosurgeon) who did a full literature search for me, trying to see if this was a complication that had been seen. I am an abuse survivor with other spine injuries and the neurosurgeon said the ligaments were like tissue paper when he repaired it the 2nd time. I had the same thing happen with my lumbar spine as well.

    Would I do it all over again....YES. The 3 months that I did have it were great. Since the fusion, it's been one headache after another. Once you make something solid where everything else moves, you create problems. In the rest of the world, this surgery is pretty routine on the neck and even now on the lumbar spine. Only the US is dragging it's feet on the procedure as it means a lot of going back to school for a lot of spine surgeons. It's harder to do then a quick ACDF but much better for the patient in the long run. No fusion.

    Jenny

     
    Old 06-06-2011, 08:25 AM   #11
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    Re: Cervical spine laminoplasty

    Let me add a couple of things to consider.

    Unless NECESSARY, do NOT do laminoplasty of C2 or C7. Those spinous processes are important anchors for neck musculature, and removing them results in much higher incidence of post-operative axial pain. See studies from Japan and Korea (I don't have links right now). Doing C3-C6 should give the cord plenty of room. Even C4-6 might be good enough.

    If you have laminoplasty done, consider foraminotomies during the procedure, especially at C5. Giving the spinal cord room to move can actually CAUSE a problem if the peripheral nerves are "tethered" by osteophyte growth in the foraminal openings. Another study (don't have the link at the moment) showed that the incidence of C5 Palsy (paralysis - nearly always short-term - of the biceps and deltoid) is much lower if laminoplasty is accompanied by foraminotomy.

    One more thing..... I am going in for laminoplasty surgery tomorrow. I intend to start a thread here called Laminoplasty Chronicle starting with my reasons for doing the surgery, then following up with post-op updates. Stay tuned...

     
    Old 06-06-2011, 01:16 PM   #12
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    Re: Cervical spine laminoplasty

    Quote:
    Originally Posted by jennybyc View Post
    The difference between laminectomy and laminoplasty is that the laminectomy leaves your spinal cord uncovered and liable to injury. The laminoplasty restores bone coverage over the cord with the spinal canal doubled in size. I can see that as a distinct advantage when you are younger and still quite active.

    The "open door" laminoplasty is as follows: the surgeon removes the spinous process off the back of the vertebra(the stegasaurus thing on the back of the spine). This leaves him with the lamina bones that are on either side and they form the back of the spinal canal. They emerge from the sides of the vertebra at 30* angles. The surgeon then cuts through the area in between the lamina and then enters the canal and breaks the lamina on one side(I'll use the left side to explain). The lamina bone is then reset from a 30* angle to a 90* or straight up and held in place with bone sutures. A bone graft is then used to bridge the area between the upright lamina and the still 30* lamina, in effect, making it look like a door held open at 30*. The big problem with that, is that it makes the back of the spine lopsided and the attached ligaments then get pulled to one side.

    In the French door type, the surgeon starts the same with removing the spinous process and then makes a thin cut into the canal to access the lamina bones. Both lamina are then broken off and reset with bone sutures to 60*. Then a bone graft is used to close the back of the canal so it looks like French doors propped open. It also doubles the size of the canal but does not leave the back of the spine lopsided and the ligaments are only slightly elevated.

    I had the French door type done on C3 to C6.

    In full disclosure, I had major complications 3 months after surgery, after everything was healed. I tore a ligament on the left side of my neck from an old injury, and that in turn caused the lamina bones on the left side to break at C 5and 6 and subsequently, breaking the grafts at C4,5 and 6. My doc had to fused the entire area, from C3 to T1 but he also restored the grafts and lamina so that my cord is covered, safely. This complication is unheard of in laminoplasties according to my neurologist(not the neurosurgeon) who did a full literature search for me, trying to see if this was a complication that had been seen. I am an abuse survivor with other spine injuries and the neurosurgeon said the ligaments were like tissue paper when he repaired it the 2nd time. I had the same thing happen with my lumbar spine as well.

    Would I do it all over again....YES. The 3 months that I did have it were great. Since the fusion, it's been one headache after another. Once you make something solid where everything else moves, you create problems. In the rest of the world, this surgery is pretty routine on the neck and even now on the lumbar spine. Only the US is dragging it's feet on the procedure as it means a lot of going back to school for a lot of spine surgeons. It's harder to do then a quick ACDF but much better for the patient in the long run. No fusion.

    Jenny


    One point to be considered is that a laminoplasty is not right for every patient. So it isn't hands down better in the long run. Two key drawbacks in a laminoplasty are the inability to restore disc height, and the inability to restore sagittal balance.

    It is a great operation, and it is definitely being underutilized in the U.S, but it isn't a solution for every patient unfortunately.

     
    Old 06-06-2011, 02:18 PM   #13
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    Re: Cervical spine laminoplasty

    Just wondering which is most beneficial ,the laminoplasty or the cervical fusion, and how do they decide which is better, I had a 2 level cervical fusion in 2002 with bone graft and hardware, my surgeon told me at the time , in a couple of years later that he would need to go back in and do the one above it and the one below it because they tend to deteriorate faster because of it, now I have severe lumbar spinal stenosis with nerve root contact ,I am wondering which I should have done, the neck or the back because they are both bad, but the lumbar is worse, I now have some mild buldging in the thoracic area, I can't replace my entire spinal column, I am screwed from neck to tail bone, anybody out there going thru this

     
    Old 06-06-2011, 02:28 PM   #14
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    Re: Cervical spine laminoplasty

    bskryz... what do you mean by "sagittal balance"? TIA

     
    Old 06-06-2011, 02:33 PM   #15
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    Re: Cervical spine laminoplasty

    CAPATGA - I think that it's a myth that adjacent levels are more likely to deteriorate once fusion has been done. The one study on this showed 3%/year likelihood of failure at an adjacent level, with a compounded 25% over ten years. This looks much more like a correlative effect to me than a causative one.

    Many surgeons just don't know how to do laminoplasties.

    Also, a kyphotic (forward-bending) cervical spine is a strong counterindication. I would also consider problems at C6-7 a counterindication, because of studies that show laminoplasties involving C7 result in more axial pain.

     
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