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Bilateral spinal canal decompression via hemilaminectomy in cervical spondylotic myelopathy

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Acta Neurochirurgica Aims and scope

Abstract

Background

In cervical spondylotic myelopathy (CSM), laminoplasty (LP) or laminectomy plus fusion (LF) are accepted operative options and alternatives to anterior approaches. Both LP and LF have distinctive disadvantages, which might be avoided by unilateral hemilaminectomy and bilateral decompression of the spinal cord.

Methods

Description of the surgical technique, indications, and limitations. The potential advantages in comparison to LP and LF are discussed.

Conclusions

Unilateral hemilaminectomy allows bilateral decompression of the whole dorsal circumference of spinal cord from nerve root to nerve root. The potential major advantages are a reduction of invasiveness by only unilateral muscle detachment, avoidance of implants, and shorter operation times.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Correspondence to Dorothee Mielke.

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ESM 1

The approach in this case is from the right side. After muscle detachment from the hemilaminae, primarily a hemilaminectomy is performed. Care is taken to preserve the integrity of the facet joint. The next step is removal of the base of the spinous process(es) with the drill and Kerrison rongeur, beginning at the medial edge of the hemilaminectomy and ending near the contralateral medial part of the facet joint(s), thereby thinning the inner contralateral hemilaminae. The hypertrophied ligament is further being removed. Bleeding from the epidural veins can easily be managed by coagulation and GELFOAM (MP4 87643 kb)

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Mielke, D., Rohde, V. Bilateral spinal canal decompression via hemilaminectomy in cervical spondylotic myelopathy. Acta Neurochir 157, 1813–1817 (2015). https://doi.org/10.1007/s00701-015-2549-7

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  • DOI: https://doi.org/10.1007/s00701-015-2549-7

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