What Is Laminoplasty?

Due to joint trauma, inflammation, degenerative changes and other reasons, the corresponding articular surface is disproportionate, causing severe joint dysfunction, or stubborn joint pain, which affects work and life. It is not effective after non-surgical treatment, and it is not suitable to be retained by other surgery. For those with joint mobility, joint fusion should be performed.

Laminar fusion

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Due to joint trauma, inflammation, degenerative changes and other reasons, the corresponding articular surface is disproportionate, causing severe joint dysfunction, or stubborn joint pain, which affects work and life. It is not effective after non-surgical treatment, and it is not suitable to be retained by other surgery. For those with joint mobility, joint fusion should be performed.

Chinese name

Laminar fusion

Subject

medicine

Nature

surgery

Used for

Laminar fusion

1. Due to joint trauma, inflammation, degenerative changes, etc., the corresponding articular surface is disproportionate, causing severe joint dysfunction, or stubborn joint pain, which affects work and life. It is not effective after non-surgical treatment, and it is not suitable for other operations. To preserve joint mobility, joint fusion should be performed. Such as severely traumatic arthritis caused by fractures of the joints of the lower extremities,

In addition to the contraindications for general elective surgery, fusion should be contraindicated in the following cases:

1. Adjacent joints have bone rigidity, it is not suitable for joint fusion. For example, after hip joint fusion, its activities can be compensated by normal lumbar and knee joints to meet the needs of work and life activities. If the lower lumbar spine or knee joint is already stiff, hip fusion will cause great difficulty for the patient.

2. Of the same joints on both sides of the limbs, those who have ankylosing on one side should not perform joint fusion on the opposite side. If both sides of the hip joint are fused, it will be very difficult to get up, lie, walk, and sit.

3. Children's articular cartilage is rich, joint fusion is not prone to osseointegration, and it is easy to damage the epiphysis, and affect growth and development. At the same time, under the continuous development of limbs and children, the fused joints can deform again. Therefore, children under the age of 12 should not perform joint fusion surgery.

Brachial plexus anesthesia or general anesthesia can be used for upper limb joint fusion; spinal or epidural anesthesia for lower limbs; spinal fusion can be epidural or local anesthesia, and general anesthesia is used when needed.

1. Posture, prone position, head turned to one side, with pillows on both sides of the trunk to facilitate breathing. Patients with poor breathing can also use the lateral position.

2. Incision and exposure see the anterior approach of cervical spine.

3. Positioning the vertebral body of the diseased vertebral body as the fusion center requires precise positioning. Common positioning methods are:

For example, if the spine has a kyphotic deformity, the most prominent vertebral body of the spinous process is the diseased vertebra. Compare the X-rays to count the laminae to be fused.

If the iliac deformity is not obvious, the diseased vertebrae can be determined by melanin injection on the body's surface on the day of surgery. That is, after disinfecting the local skin, insert a common needle into the spinous process or lamina of the diseased area, take an X-ray lateral film, determine which vertebral body of the spinous process or lamina where the needle is located, and then inject 0.2ml Meilan. When the surgery is revealed, the spinous process or lamina with Methylene blue staining can be used, and the X-ray film can be used for positioning.

4. The chiropractic lamina is first cut from the root of the spinous process that is scheduled to fuse, and the bone slice is reserved for bone grafting. Start with a bone chisel under the cortical bone at the root of the spinous process, and split the cortical bone on both sides of the lamina to the sides. Turn the bone flap to the sides to form a bone groove. When using a chisel, the inclined side is facing down and the straight side is facing up, and tapping gently to avoid deep injury to the spinal cord. You can also use the Emei chisel to open the fish scale-like bone pieces and overlap them.

5. Bone grafting The bone fragments and spinous processes cut from the sacrum are used to remove soft tissue and cut into small strips of bone, which are evenly spread on the rough surface of the lamina. The amount of bone graft should not be too small, so as not to break in the future. Especially in the cervical spine, lumbar spine, cervical and thoracolumbar and thoracolumbar, which have many activities and large tensile stress, the amount of bone graft is even larger. Then cover it with gauze, gently tighten the bone graft with a chisel handle to bring it into close contact, and then remove the gauze and stitch it in layers.

1. If there is a spina bifida, laminar defect or fracture, it is best to expose the normal laminae first, and then sharply peel the diseased lamina under direct vision, so as not to mistakenly enter the spinal canal and damage the spinal cord.

2. Too many and too few spine segments are inappropriate. The fusion range is insufficient to achieve the expected fixation effect; too much is prone to fractures and false joints, and the spinal movement function is also limited (especially the neck and lumbar spine), which will have a serious impact on work and life. Therefore, the fusion range of lumbar spinal tuberculosis should only include the diseased vertebra and the lamina of the upper and lower normal vertebrae. Other diseases only need to fuse the lamina of the diseased vertebra.

3. For those with lamina defects, the entire patella outer plate can be trimmed into an H shape, and the two ends of the gap can be embedded between the upper and lower spinous processes. .

Lying on a hard bed after operation, avoid twisting or flexing the spine when turning over; if it is a child, make an anterior and posterior plaster bed before surgery, and then fix it until bone healing. After 2 weeks of operation, the suture was removed, and the patient stayed in bed for 2 to 3 months. After taking X-rays to show bone healing, he could exercise the back muscles and gradually get out of bed. If there is a pseudo joint, the patient often feels pain in the fusion section, and a lateral X-ray film of the spine extension and flexion can be taken to confirm the diagnosis. It can be seen that there is a crack in the fusion bone. During treatment, first try bed rest or fix it with thoracolumbar plaster vest. After 1 to 3 months of observation, those who still do not heal need a second stage bone graft surgery.