Laminoplasty
Motion-preserving surgery that expands the cervical spinal canal without fusion
Laminoplasty is a surgical procedure that widens the cervical spinal canal by restructuring — rather than removing — the lamina (the back portion of the vertebrae). Instead of removing the bone as in laminectomy, the surgeon "hinges" the lamina open like a door, creating permanent space for the spinal cord. Because no fusion is required, cervical motion is largely preserved. Laminoplasty is most commonly used for multilevel cervical stenosis causing myelopathy (spinal cord compression) in patients with a naturally straight or slightly curved cervical spine.
Who Is a Candidate?
- Multilevel cervical stenosis (3 or more levels) causing myelopathy
- Cervical myelopathy with preservation of normal cervical curvature (lordosis)
- OPLL (Ossification of the Posterior Longitudinal Ligament) — a common indication
- Patients who prefer to avoid cervical fusion and maintain more neck motion
- Cases where multilevel ACDF would risk high non-fusion rates or significant motion loss
What to Expect
1Before Surgery
MRI and CT myelogram confirm the extent of cord compression across multiple levels. Cervical alignment (lordosis) is assessed on standing X-rays — laminoplasty works best when the cervical spine has normal or near-normal curvature. Pre-operative neurological testing documents baseline myelopathy. General anesthesia is required; hospital stay is 2–3 days.
2The Procedure
The surgeon makes an incision at the back of the neck. For "open-door" laminoplasty (the most common technique), a trough is cut on one side of the lamina and a full cut on the other side, allowing the lamina to swing open like a door hinge. Titanium plates or sutures hold the lamina in the open position. The expanded canal reduces pressure on the spinal cord across all treated levels. The procedure typically takes 2–3 hours for 3–5 levels.
3Recovery
Most patients walk the day after surgery and are discharged in 2–3 days. A cervical collar is worn for 4–6 weeks. Return to light activity is typically 4–6 weeks; more strenuous activity at 3 months. Physical therapy begins at 6–8 weeks. Neurological improvement from myelopathy often occurs gradually over 6–12 months as the spinal cord recovers from chronic compression.
Typical Outcomes
Laminoplasty is effective for multilevel cervical myelopathy — approximately 80% of patients stabilize or improve neurologically after surgery. Improvement is most notable for hand function, walking, and fine motor skills. Recovery of function from myelopathy can take 6–12 months. Laminoplasty avoids the motion loss and adjacent segment risks of multilevel ACDF, making it a preferred option for appropriate candidates.
Risks & Considerations
- C5 palsy — temporary shoulder weakness from nerve root traction during surgery (5–10%)
- Axial neck pain — post-operative neck and shoulder pain from muscle dissection
- Loss of cervical range of motion — less than fusion but more than baseline
- Closure of the laminoplasty opening over time (re-stenosis, rare)
- Infection
- Not appropriate if significant cervical kyphosis (forward curve) — risk of worsening cord compression
Frequently Asked Questions
How is laminoplasty different from cervical laminectomy?
Cervical laminectomy removes the lamina entirely, creating decompression but risking spinal instability and kyphosis (forward buckling) over time — which is why posterior cervical fusion is often added. Laminoplasty preserves the lamina by hinging it open, maintaining more stability without requiring fusion. This allows more cervical motion to be preserved.
Is laminoplasty done for neck pain?
Laminoplasty is not primarily indicated for axial (mechanical) neck pain. It is designed to treat spinal cord compression (myelopathy) from multilevel stenosis. Axial neck pain is common after laminoplasty due to the posterior muscle approach, and some patients experience more neck pain immediately post-op than before surgery. Pain typically improves over 3–6 months.
Can I have laminoplasty if I already have neck fusion at one level?
Laminoplasty can sometimes be performed alongside or adjacent to a prior fusion, depending on the anatomy and the reason for the prior surgery. This is a complex decision requiring an experienced cervical spine surgeon to evaluate imaging and surgical history.
How much neck movement will I keep after laminoplasty?
Most patients retain 70–80% of pre-operative cervical range of motion after laminoplasty. Flexion/extension is typically preserved better than rotation. This is significantly more motion than multilevel ACDF would provide, and in many patients the motion restriction from stenosis before surgery was already limiting movement.
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Medical disclaimer: This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with any questions you may have regarding a medical condition or surgical procedure. Last reviewed March 2026. CPT: 63050.