Kosin Med J.  2021 Dec;36(2):169-174. 10.7180/kmj.2021.36.2.169.

The Importance of Lamina Size Measurement and Proper Implants Selection before Laminoplasty : Two Case Reports

• Kim DH
• Lee SH
• Kim DH
• Nam KH
• Han IH
• Choi BK

• KMID: 2524661
• DOI: http://doi.org/10.7180/kmj.2021.36.2.169

Abstract

Open door laminoplasty using plates is a safe and effective procedure for multi-level cord compression. To achieve stable laminar arch, various types of plate have been developed and used. Now, we introduce two rare complications related to the laminar shelf of plate. In the first case, we used the wider laminar shelf plate because the elevated lamina did not fit well into the usual laminar shelf. During follow-up, cord compression due to laminar shelf was observed. And in the second case, the laminar shelf of plate did not fit into the elevated lamina, so we inserted it with a little bit of force. But the patient’s symptom was not improved. On CT image, the inner cortical bone of the lamina was fractured. To prevent these complications, surgeons need to consider the thickness of the lamina and the size of the laminar shelf before surgery.

Keyword

Bone plate; Laminoplasty; Postoperative complications; Spinal cord compression

Figure

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  Fig. 1 (A) Spinal cord compression due to OPLL on the pre-operative magnetic resonance image. (B) Spinal cord compression and subtle signal intensity change of spinal cord were identified on the magnetic resonance image. (C) The wide lamina shelf of plate protruded into the epidural space on computed tomography image.

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  Fig. 2 (A) Inner cortical bone fracture with epidural space invasion was shown on the computed tomography. (B) An illustration cord compression caused by inner cortical bone fracture. Inner cortical bone fracture was caused by using a smaller laminar shelf plate than a laminar size.

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  Fig. 3 An illustration of a plate with laminar shelf. It consists of two distinctive designs; lamina shelf (red arrow) and kickstand design (red dot circle) which allow stable positioning between the cut edge of the lamina and lateral mass.

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