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    Old 06-06-2011, 07:25 PM   #1
    WebDozer
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    Cervical Laminoplasty Chronicle

    It seems to me that we could use a centralized and coherent discussion about the reasons for getting - or not getting - cervical laminoplasty. Even more so, with some notable exceptions, there has not been much follow-up from those who have had this procedure done in terms of reporting on how their surgery and recovery went.

    Since I am actually going in for laminoplasty tomorrow, I thought I would start a thread that would, first, detail the stages by which I arrived at my decision, and the factors considered along the way, then second, follow up with descriptions of the surgery/hospital experience, and the (hopefully short) recovery period.

    I am a 59-year-old male, in good physical condition, and accustomed to a great deal of exercise. Except for my spinal problems, my health is excellent.

    15 years ago, symptoms that included a sore shoulder and some loss of dexterity in my right hand ended up in a near-emergency C3-4 ACDF. My C3-4 disk had slipped so badly out of place that it had compressed my spinal cord 50%. The recovery period for this ACDF was easy and short. Some symptoms disappeared immediately, others slowly got better over a couple of years, and some never left, although they were not very bothersome or limiting.

    7 years ago, I experienced a sudden loss of maybe 70% of the strength on my left deltoid and biceps. This was an easy call, as osteophytes were shutting down my C5 foraminal opening. A C5 lateral foraminotomy (outpatient procedure) took care of that problem.

    Several months ago, I noticed that some of the lingering symptoms from 15 years ago seemed to be a little stronger and a little more frequent. Then, I began to notice soreness in one shoulder, then a "cramped" feeling in both hands, followed by soreness in the other shoulder, then a kind of sick, "damaged nerve" feeling in one arm and then the other. Finally, a rather disturbing soreness started on one side of my cervical spine and spread from there. Oddly, these symptoms always came one at a time, never multiply.

    I got a cervical MRI done, and it showed severe congenital canal stenosis from C4 to C6. My spinal canal, which should be about 18mm, is more like 10mm. At C4-5, an osteophyte growing from in front, plus a hypertrophied ligamentum flavum coming in from behind, has compressed my spinal cord by 50%. This time, the cord compression has apparently occurred over so many years that the nerves have had time to adjust, so symptoms are not as bad as 50% compression would normally warrant. Still, it is a situation that needs to be addressed.

    I talked to three spinal surgeons about this (two of them twice):

    #1 said he would do a bi-level ACDF at C4-5 and C5-6

    #2 said that he'd do a 4-level C3-6 laminoplasty

    #1 then said that a laminoplasty was a "reasonable alternative" but that he would still prefer the ACDF (I got the impression that he had not done laminoplasties)

    #3 (my surgeon from 7 years ago) said the he used to do laminoplasties, but that he had stopped because of "problems with neck pain". He recommended an ACDF at C4-5 and maybe also at C5-6. He said he would follow that up two weeks later with an outpatient laminotomy, coming in from behind and taking off parts of the C4 and C5 lamina and removing the intervening ligamentum flavum. Thus, he would directly address the intrusions into the canal and do a little bit to address the stenosis. He said that I'd suffer a 16% loss of range-of-motion from a bi-level ACDF, but my spine would be vertically decompressed by replacing collapsed disks with bone grafts. He was not concerned about "adjacent disk syndrome". I know and respect this surgeon from earlier, so this approach seemed quite appealing.

    #2 again said that he preferred a 4-level laminoplasty, coupled with bilateral foraminotomies at C4-5 and C5-6.


    I decided on the laminoplasty because:

    1) it would address the underlying problem - congenital canal stenosis

    2) it would avoid the loss of r-o-m from having 3 consecutive levels fused

    3) it would not increase the chance of adjacent disk syndrome (even though I rather doubt there is such a thing

    (continued)

    Last edited by WebDozer; 06-23-2011 at 04:50 PM.

     
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    Old 06-06-2011, 08:33 PM   #2
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    Re: Cervical Laminoplasty Chronicle

    (continued)

    My main concerns - regarding laminoplasty - were:

    1) progressive kyphosis - A kyphotic (forward-bending) cervical spine is a strong counterindication for laminoplasty, as the kyphosis may become significantly worse, and may then require fusions to be done. Apparently, though, patients with straight to lordotic (backward-bending) cervical spines seem to maintain or even increase their level of lordosis after laminoplasty. My cervical spine has been described as straight to slightly lordotic, so progressive kyphosis should not be a problem.

    2) C5 Palsy - a condition where a problem with the C5 nerve root causes paralysis of the deltoid and biceps muscle on one side. This is believed to be caused by the C5 root being "tethered" by osteophytes growing into the foraminal opening. When the laminoplasty releases the spinal cord to move backward, the cord tries to pull the nerve root with it but, since the root is tethered by osteophytes, it is instead aggravated, or even slightly damaged. One study has been done which indicates that, if the laminoplasty is coupled with foraminotomies of those foraminal openings that have been made stenotic by osteophytes, the C5 palsy problem is mostly avoided. I am thus having four foraminotomies done during the surgery... both sides at two levels.

    3) Neck Pain - this is THE major concern with laminoplasty. You only have to see the online movie of a laminoplasty perfomed at Cleveland Case to see why. A LOT of muscle has to be cut or moved. In addition, the spinous processes of the affected lamina are removed, thus causing permanent displacement of some muscle and perhaps removing the anchor for some muscle as well. Watching the Cleveland Case movie, I frankly had a hard time seeing how the neck muscles EVER recover, let alone get more or less back to normal in six weeks.

    Nevertheless, it seems that - for the most part - the neck muscles DO recover, and more rapidly than would seem possible. Two studies on neck pain - one Japanese and one Korean - are worth noting. They both posited that a major cause of neck pain is including the C7 lamina in the procedure. The C7 has the largest spinous process of the cervical laminas, and that spinous process seems to serve as an important muscle anchor. The studies were to determine the difference in post-op neck pain between those who had had C3-C7 done as opposed to those who only had C3-C6 done. It turned out that NOT doing C7 resulted in a major decrease in the number of patients reporting neck pain, both post-op and after one year. Recovery from symptoms was as good with the C3-6 group as with the C3-7's. For me, fortunately, there is no problem at the C6-7 level, so including the C7 in my laminoplasty will not be necessary.

    Tomorrow, I am anticipating a rather lousy day. Surgery doesn't scare me, and I know that I'll just wake up afterward without even remembering being put under anesthesia. It's the 24 hours after I wake up that I'm not looking forward to. I expect to be in the hospital no more than two nights, and possibly only one. I think I'm somewhat stronger and healthier than the average laminoplasty patient, so that may help.

    I'm told that I cannot drive for two weeks, that I "won't feel like it". That sounds ominous. I'm told that I'll get a soft collar "for my comfort". I get the impression that moving my neck may do no harm (and may even be desirable to start healing), but that it will hurt LIKE HELL.

    Anyway, in a few days, when I'm back at my computer, I will describe the hospital experience.

    Last edited by WebDozer; 06-13-2011 at 07:45 PM.

     
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    Old 06-07-2011, 05:47 AM   #3
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    Re: Cervical Laminoplasty Chronicle

    Thanks WebDozer for starting this thread and good luck with your surgery. Keep us posted of how it turns out.
    Are you getting "open door" or "french door" laminoplasty?

    My surgery is scheduled later this month. So far I visited 5 surgeons. The doctor I visited yesterday said MRI alone may not be correct and asked me to get a myelogram done. Did you all have myelogram test?

    This doctor also said there's no difference between "open door" and "french door". He has done "french door" before but still nervous of damaging spinal cord when making the cut in the middle of verterbre. He's preferring the "open door" laminoplasty.

     
    Old 06-07-2011, 11:58 AM   #4
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    Re: Cervical Laminoplasty Chronicle

    I go for my 4 1/2 year check-up with my neurosurgeon tomorrow to see how my neck is. I still have my laminoplasty as well as the subsequent fusion. I only had the laminoplasty from C3 to C6 with foraminotmies (forgot which levels) and a decompression of C7.

    As I understand it, kyphosis after surgery is more likely with laminectomies. But I got it instantaneously when I tore the ligaments.

    One problem I have developed and has become a big concern, is that I am growing osteophytes inside the fusion. Would have done the same with the laminoplasty. Supposedly, the fusion should stop that as it stops all movement but I have them. My left shoulder has now lost significant strength and within the past 3 weeks, left arm numbness and weakness. How they fix this I have no idea.

    Webdozer, good luck with the surgery. Thought you had decided against laminoplasty but as I see it, it is the least intervention they can do. If you need more, they can do more. But once fused, you can never go back.

    Jenny

     
    Old 06-09-2011, 04:09 PM   #5
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    Re: Cervical Laminoplasty Chronicle

    OK, I am out of the hospital, so I'll try to get something down. Unfortunately, the whole situation is pretty "uncomfortable", so I may have to do it in bits and pieces.

    Day 0 - I went into surgery at 7 AM, and woke up in the recovery room, but I don't know when. Woke up again in my overnight room, with no memory of having been moved. I guess this gives some idea of the level of anesthetic.

    The surgeon performed a right-side open-door laminoplasty at C4-C5-C6. Allografts (bone) were used. We had left C3 to his discretion, and he decided on a laminotomy at that level. That is, he cut off some of the INSIDE of that lamina, but didn't move it. He also did four foraminotomies, both sides at C4-5 and C5-6.

    I spent the rest of the day in bed, on my back. I felt pretty comfortable, but I wasn't moving. About 6 PM the surgeon came by and removed the soft collar that I had been wearing. I believe it is his philosophy that not wearing the collar gets the healing process started sooner.

    I really FELT like I could go home right away, although whatever drugs I was on were probably fooling me. Besides, I had a blood drain in my neck, and they have to wait for the draining to drop to a certain level before they can let you go. I also had in a urinary catheter, which was a BIG improvement on my first surgery 15 years ago.

    That night I slept very little... not from pain but I guess from some drug effect. Read 250 pages of a book, which I was glad I brought.

     
    Old 06-09-2011, 05:06 PM   #6
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    Re: Cervical Laminoplasty Chronicle

    Day 1 - I finally got out of bed and took a walk around the floor with a PT. She wanted to see if I could walk OK, and if I could get up and down stairs that had a railing. From that point it was just a matter of waiting to make sure the blood drainage was down far enough for the tube to be disconnected.

    About noon, the tube was disconnected, and I was sent home with a prescription for Norco (hydrocodone/acetaminophen). I spent the rest of the day napping or at my computer.

    Day 2 - Things are somewhat more difficult today. If I DON'T MOVE, and I can support my head on something, I am fine. Moving around causes considerable neck pain (oddly, though, only on the right side). Really very uncomfortable. I have not filled the Norco prescription, so I am only taking Tylenol.

    I have been for a couple of "walks", totalling four and six blocks. I'm fixing to try for eight in a few minutes.

    Somewhat worrying is that my symptoms have come back. They perversely disappeared the week before the surgery, but now they are definitely back... both arms and one leg. Hopefully, that's just because everything in my neck is temporarily disturbed.

    Also, the tip of my tongue is swollen and rather numb. They tell me that's probably from the breathing tube used during surgery.

    Last edited by WebDozer; 06-09-2011 at 07:59 PM.

     
    Old 06-09-2011, 06:09 PM   #7
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    Re: Cervical Laminoplasty Chronicle

    Sounds like you are doing great Webdozer. Any fever? I had a 102* for a couple of days as a reaction to the BMP they use with the bone grafts. That kept me in longer.

    Glad to hear you are up and about and not in too much pain.

    gentle hugs...........Jenny

     
    Old 06-13-2011, 03:14 PM   #8
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    Re: Cervical Laminoplasty Chronicle

    Webdozer, how goes the recovery? Don't make us worry by not replying!!!!!!!!!

    Jenny

     
    Old 06-13-2011, 04:24 PM   #9
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    Re: Cervical Laminoplasty Chronicle

    Sorry... I have every intention of creating a good record, but I didn't want to clutter things up by posting every day. Let me just add...

    Day 4 - Have to spend all night and nearly all day on my back,
    because muscles in neck cannot support forward-bending head
    without pain. Pre-op symptoms have all returned, even more
    intense than before.

    Day 5 - Pre-op symptoms even worse. I really don't understand why I would have exactly the same symptoms now, albeit somewhat more intense than before.

    Day 6 - Today seems to be better, both for neck pain and pre-op symptoms. It doesn't SEEM better, but I realize I'm doing some things I wasn't doing several days ago. Walking about a mile at a time There's never been a problem with walking, per se, only that the walking posture requires the neck muscles to hold the head upright, and my neck muscles don't feel like doing that for long.

     
    Old 06-13-2011, 06:59 PM   #10
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    Re: Cervical Laminoplasty Chronicle

    Glad you're okay. Yes, the symptoms do worsen in the days after surgery due to swelling around the nerves where you had the surgery. It will subside as you heal.

    Takes a long time for those back muscles to heal and you can hold your head up for any length of time without pain. But you sound great to me!

    hugs...........Jen

     
    Old 06-13-2011, 07:54 PM   #11
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    Re: Cervical Laminoplasty Chronicle

    I want to interject a note about neck pain. Anyone who has seen the online video of the Cleveland Case laminoplasty will wonder how neck muscles EVER recover, let alone recover in a matter of weeks (or several months). I asked my surgeon's PA about this. Unfortunately, the conversation was entirely verbal, and I need to SEE things like this. I will nevertheless attempt to convey my understanding:

    The cervical muscles run mostly longitudinally (up/down) and can thus to some extent be "parted" above the spine rather than cut. Also, while the tips of the spinous processes are removed, enough is left at the base to preserve the muscle attachments there. This part I could not reconcile with the CC video, as it shows ALL the muscle pulled completely away from the spinous processes. Maybe I can clear this up in the future.

    The PA said that when the laminoplasty is done, the muscles are "layered" back in, using [aargh... I forgot the word, was it "sutures"?] which dissolve over time.

    Last edited by WebDozer; 06-13-2011 at 07:56 PM.

     
    Old 06-23-2011, 05:15 PM   #12
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    Re: Cervical Laminoplasty Chronicle

    Day 9 - I drove my pickup 1.5 miles to the dealer for a repair. I'm not "supposed" to, but it was pretty easy. Of course, once a surgeon tells you not to drive for two weeks after surgery, it's probably a good idea not to, as liability insurance would not be honored if the insurer found out about the surgeon's warning.

    Day 14 - Two weeks out. For about twelve days, I would say that pain level and disability steadily improved. Then, pretty much overnight, things got a lot worse. Pain is much stronger and it takes very little to set if off. Appears to be entirely muscular, like a torn or very badly pulled muscle that doesn't want to get better. Seems pretty certain to be the scalene muscles. I'm not sure why they would be a problem, because while they do originate from the cervical spine, the point of attachment is the transverse process, which is in front of any of the engineering involved in a laminoplasty.

    Day 16 - Neck muscles not improved today. I went for a three-mile walk, which is doable as long as I stay upright and don't force those neck muscles (scalenes?) to work to hold my head up. Took a couple of breaks to sit and let my neck recover a little bit.

    Last edited by WebDozer; 06-23-2011 at 05:18 PM.

     
    Old 06-23-2011, 05:31 PM   #13
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    Re: Cervical Laminoplasty Chronicle

    You are doing great Web. I went back to work at Day 16, only part time but I was off all pain meds at 6 days so I could drive. And my staples came out at day 15 so back to work.

    I remember those scalenes hurting too. Why? don't know.

    take care..........Jenny

     
    Old 06-26-2011, 07:39 AM   #14
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    Re: Cervical Laminoplasty Chronicle

    Day 17 - Seems like a big step down today. Severe pain that started four days ago roughly doubled in intensity. No idea what might have caused. Went to talk to surgeon's PA for first scheduled follow-up and she thought I'd "overdone it" somehow. I'd sure like to know how, because I'm barely doing anything, let alone overdoing. The PA told me to try double doses of Aleve, but also gave me prescriptions for methylprednisolone (anti-inflammatory) and a muscle relaxant. She also said that my condition was "not unheard of" but definitely was out of the ordinary, which is a steady improvement.

    Day 19 - Anti-inflammatory not working at all. At least, I HOPE it isn't, as I'd hate to think things could be much worse. I find it very difficult to find any position where neck won't hurt, except lying on my back.

    I'm starting to be concerned that I may be experiencing the possible downside of laminoplasty, which is that neck muscles are not only damaged by the surgery, but are permanently displaced by the outswinging lamina and the loss of the spinous processes. Of course, maybe things'll just starting getting better as soon as I finish this sentence....

    Last edited by WebDozer; 06-26-2011 at 07:41 AM.

     
    Old 07-10-2011, 01:04 PM   #15
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    Re: Cervical Laminoplasty Chronicle

    Day 22 - I gave up on the steroid I was prescribed for inflammation and went back to double doses of Aleve (naproxon sodium). Things got better right away. Maybe Aleve works better and maybe it was because some of the steroid was still in my system and I was effectively getting redundant antiinflammatory doses.

    Day 29 - Things seem to be somewhat better in terms of range of motion. Also, the extremely sharp pain - don't-DO-this kind of pain - that I was getting on the right side of the spine when I reached at all with my left hand has mostly abated. The last several days, a dullish-but-intense pain running from the spine toward the right shoulder has been growing. This morning, no position other than lying flat on my back was OK.

    It just happened, though, that today was my final follow-up with the surgeon. He took an x-ray and pronounced that everything was perfect. (let it be said that he has a remarkably sunny disposition). He said the latest pain I was feeling was only caused by spasming muscles (splenius cervicus?) irritated by my beginning to exercise a full range of motion. A good thing, IOW. He also said that the pain was only pain, that it was NOT a warning that I was about to damage anything. That, in fact, that there's nothing in jeopardy of being damaged. Exactly what I wanted to hear.

    Day 33 - I'm starting to think it's all about the drugs. After the surgeon told me the pain was caused by spasming muscles, I started adding night-time muscle relaxants to the Aleve. I had a root canal the other day and was told to take Tylenol, so I added that. Maybe I can have some other operation and get morphine prescribed, too?
    Anyway, MUCH less pain and pretty good range of motion. More stiffness and soreness than anything else.

    Lest all this sound too positive, I have to add that nearly ALL the pre-op symptoms have returned. Both shoulders, both arms, right leg. Just a frequent as before, if not more so. Also, some minor symptoms that are completely new. I guess I will just have to wait and see if they get better. Not much else to do...

    Last edited by WebDozer; 07-10-2011 at 01:11 PM.

     
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