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-   -   Considering a "Lami" Variant/Posterior Spine Surgery? (http://www.ispine.org/forum/ispine/107-considering-lami-variant-posterior-spine-surgery.html)

necknose 11-17-2006 10:41 AM

Considering a "Lami" Variant/Posterior Spine Surgery?
 
Fellow Spineys.

Don't expect your (US) ortho/neuro spine surgeon to have a clue about the foregoing.

"Lami" Surgery:
Used for posterior spine pathologies, and for multi-level surgery where an anterior surgery, fusion for example, would leave the patient w/greatly reduced mobility and the postulated accelerated adjacent segment disease do to immobilized/fused segments:

If you're considering one of the "lami" surgeries: laminectomy, laminoplasty, backdoor/frenchdoor laminectomy, etc..

Google: "skip laminectomy", "split laminectomy".

There are variants by other names but I'm not sure how close they are to the skip/split variants.

This "lami" variant is a vast improvement over its predecessors. It is done with a microscope, reducing incision size, and is 99% muscle sparing. Incredible! The frequent sad aftermath, of chronic pain, muscle adhesions, etc., that seem to be the inevitable consequence of most variants of "lami" surgery, are greatly diminished w/this approach.

In some cases instrumentation is used but not always.

This operation is so superior to other "lami's" that any "lami"/posterior entry spine surgery candidate should research it and bring it to their surgeon's attention. If this technique isn't known or offered by the surgeon in question search the web and the surgical community for practitioners.

If you come up empty, surgeon-wise, PM me.

:)

Good luck.

mmglobal 11-18-2006 03:26 AM

necknose,

Interesting post. I have not had time to research much, but here are a few quick thoughts.

I observed a 5-level open door laminoplasty surgery a few weeks ago. Very interesting stuff. When reading about the skip laminoplasty, it certainly makes sense to preserve as much integrity of the muscle/bone/ligament systems as possible. However there must be some trade-offs.

If you could have seen this procedure, you would not believe how much room they open up in the canal area. At 4 of the 5-levels, they were able to insert a 6mm spacer in the lamina. The amount of room added is dramatic. The ability to visualize the field, decompress, etc... is dramatic. Yes, this comes at a cost of a more invasive procedure.

I'll bet that the converse of my last statement is true as well. In the skip procedure they are fully decompressing alternating levels. If you need a lot of decompression, then the skip procedure will be too much of a compromise. That ribbon rasp tool looked very cool.

I'm sure that there are other trade-offs... this is just a quick reply. I'm totally swamped putting zeegers' party together. any chance you can come down? There may be someone flying a private plane down from the bay area???

Mark


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