Open Door Laminoplasty - Hinge Creation and Fracture Avoidance: 2-Dimensional Operative Video

This surgical video demonstrates a technique for an open-door laminoplasty with its associated risks.1-3 The key to maintaining a strong hinge that can be opened without fracture lies in gradual, slow drilling of the hinge followed by sequential, progressively wider opening of the laminoplasty. This is in contradistinction to a single opening maneuver, which "cracks" the hinge and can result in fracture and disconnection of the lamina from the spine. We present our technique of C4-6 right-sided open-door laminoplasty. A C3 laminectomy is performed instead of a laminoplasty in order to prevent any muscular dissection of C2. This not only maintains the strong muscular attachment to C2, but it also helps alleviate postoperative pain since the muscles are maintained.4-6 The top of C7 is drilled to decompress the C6-7 level, and the C7 spinous process, along with its strong attachment to T1, is maintained to prevent kyphosis. The video highlights methods for maintaining key muscular and ligamentous attachments (C2 muscles and C7-T1 ligament) to decrease kyphosis risk, progressive hinge opening to help mitigate the risk of hinge fracture, and methods to help decrease postoperative pain (avoiding laminoplasty of C3, maintaining muscular and ligamentous attachments as stated above, and contouring the spinous processes in a manner that avoids protrusion into the paraspinal muscles). We have received informed consent of this patient to submit this video.