Open Door Posterior Cervical Laminoplasty: A Step-by-Step Surgical Technique Guide by the Cervical Spine Research Society.

Study design: Surgical technique video alongside a detailed technical report.

Objective: To present an open door posterior cervical laminoplasty step-by-step surgical technique guide.

Summary of background data: Cervical laminoplasty is a motion-sparing surgical technique that addresses cervical myelopathy resulting from spinal cord compression, largely in a degenerative setting. This procedure decompresses the spinal cord while maintaining the integrity of posterior stabilizing structures, minimizing postoperative kyphosis, and eliminating pseudoarthrosis risk. Laminoplasty has also demonstrated superior improvement in neck disability compared with fusion, while achieving comparable long-term outcomes for functional status, pain, quality of life, and satisfaction.

Materials and methods: We present an open door posterior cervical laminoplasty step-by-step guide, both video and written format, illustrating clinical scenarios where this technique may be applicable, complications, pearls and pitfalls. The full video of the surgical technique can be found at: https://www.youtube.com/watch?v=q2WVlSFcjjA.

Results: Laminoplasty can be performed for cervical myelopathy secondary to cervical spondylosis, multilevel disc herniation, congenital stenosis, and ossification of the posterior longitudinal ligament. Careful preoperative evaluation of the cervical alignment is essential. The surgical technique involves a posterior midline approach, C3 laminectomy, C7 dome laminectomy, and preparation of opening and hinge troughs. Laminoplasty opening is performed, and plate reconstruction is recommended for stability. Complications reported include: C5 palsy, axial neck pain (minimized by preserving Semispinalis cervicis insertions), loss of cervical motion, and dural tear.

Conclusions: Cervical laminoplasty provides effective spinal cord decompression for cervical myelopathy, yielding outstanding outcomes when performed with meticulous surgical technique. Preservation of posterior structures avoids postoperative immobilization and graft-related complications. Careful attention to each surgical step is essential for maximizing patient benefit and minimizing potential complications.