Laminoplasty--a possible treatment for cervicogenic headache? Some ideas on the trigger mechanism of CeH

Cervicogenic headache (CeH) has been treated successfully by ventral decompressive surgery and segmental fusioning. Usually ventral fusioning is performed during one operation on one or two neighbouring segments only. We performed dorsal decompressive laminotomy and laminoplasty on eight patients with more than two segmental degenerative diseases narrowing the cervical spinal canal. The bilateral sawn laminae were moved dorsally and fixed with miniplates and screws. Six patients were relieved from headache and two improved postoperatively. Ventral decompressive surgery and fusioning frees from irritating mechanisms all nociceptively innervated tissues such as disc, dorsal ligament, facet joint capsule, nerve root and dura. On the other hand, after dorsal laminoplasty only the dura is freed from irritation or compression. Relief of headache after this surgical treatment shows that the dura, with its nociceptive nerve fibres, could be an important trigger mechanism of CeH.