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Laminectomy vs. Laminoplasty for Cervical Myelopathy w/OPLL
I have been diagnosed with severe cervical stenosis from C-3 to C-7 and OPLL (Ossification of the Posterior Longitudinal Ligament). I understand that OPLL affects only about 0.2% of the caucasion population and I'm not really clear on its cause. Canal size on MRI is 4.9 in some areas, so compression is beginning to cause symptoms such as numbness of hands, difficulty w/motor skills in hands, leg weakness on left side, etc. I have received four surgical opinions, ranging from laminectomy to laminoplasty to anterior vertebrectomy to posterior fusion. To say the least, I am more confused than ever. After careful consideration, I think I am ready to commit to the laminoplasty as my best option - but I am curious as to why there are so few surgeons who seem to know and perform this surgical technique. Is it simply a matter of preference on the part of the surgeon or is there a better explanation? I've done substantial research, but just don't see a lot of information that is truly current and up to date. Apparently, none of the surgeons want to touch the OPLL and the consensus (except for one) is to do a posterior approach and simply relieve the pressure. I am just curious as to some of the disadvantages of the laminoplasty and why it is not as widely accepted as laminectomy, when it appears to offer a safer alternative?
I cannot give you a specific opinion for your case without seeing your films and knowing your neurological examination
Its true that ossiffication of the OPLL is rare in caucasions but is common in asian poulations, particularly Japan. Laminoplast has been more commonly used for ossification of the OPLL when this is the only abnormality. Laminectomy is more commonly favoured over here, and probably the experience is less for laminoplasty given its rarity here. Both have their advantiages and disadvantages,laminecotmy may have an overall better chance of releiving the pressure on the cervical canal, although if laminectomy would be sufficient in your case (due to it being due to OPLL ossification) this may give the same result with less chance of complications.
The trouble is, there is a limited amount of good scientific trials comparing these techniques. Perhaps an opinion at a large academic spine center would give you the most 'evidence-based' opinion - once the surgery is done, there is no going back!
Its true that ossiffication of the OPLL is rare in caucasions but is common in asian poulations, particularly Japan. Laminoplast has been more commonly used for ossification of the OPLL when this is the only abnormality. Laminectomy is more commonly favoured over here, and probably the experience is less for laminoplasty given its rarity here. Both have their advantiages and disadvantages,laminecotmy may have an overall better chance of releiving the pressure on the cervical canal, although if laminectomy would be sufficient in your case (due to it being due to OPLL ossification) this may give the same result with less chance of complications.
The trouble is, there is a limited amount of good scientific trials comparing these techniques. Perhaps an opinion at a large academic spine center would give you the most 'evidence-based' opinion - once the surgery is done, there is no going back!
Please keep you status, thoughts and decisions posted. I'm in the initial stages of diagnosis. I'll let you know the same.
Well, I am just home from surgery - I ended up having the laminoplasty on C-3 through C-7. I interviewed four surgeons - even went to Mayo Clinic. In the end, I went with the laminoplasty for two reasons - the confidence I had in the particular surgeon's recommendation and the fact that in my case, I felt it was the "safest" procedure. First of all, she didn't "remove" anything, preserving the stability of my spine. Secondly, I wanted to try and avoid an anterior surgery, which might have caused a speech/swallowing problem (been there, done that with my thyroid goiter and it was no picnic.) I was in surgery for about 5 hours, in the hospital for 4 days and then went to Sister Kenny Rehabilitation for physical/occupational therapy as an inpatient for a week. I have already noticed some improvement in the numbness and tingling I had prior to surgery. I have a cervical collar on 24/7, which I have to wear for 6 weeks - and the surgeon said I would be in "a lot of pain". She was right - I am now at home and taking several drugs to manage the pain I have....I have a PT coming to my home and a home health aide comes in to give me showers 3 times a week. I had surgery May 31 and it is now June 15 - the most difficult part of the whole thing is keeping this collar on all the time! (I have a separate one to use for the shower.) I'm sleeping in a recliner - and have appointments to see both my surgeon in 4 weeks and the rehabilitation physician at Sister Kenny Rehab in 6 weeks. Will keep you posted on my progress. What is your particular situation? Do you also have OPLL? MJE
A related discussion, How to care for mild spinal stenosis was started.
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