- General
- It had been observed that detaching posterior cervical muscles, particularly the semispinalis cervicis from the C2 spinous process, was linked to postoperative kyphosis and axial neck pain.
- Shiraishi's technique (2002)
- involved exposing laminae while preserving the attachments of the semispinalis cervicis and multifidus muscles.
- A midline gap between the interspinalis muscles is opened with retractors to expose the interlaminar space.
- By severing the attachments of the interspinalis muscles, the cephalad aspect of the spinous process and parts of lamina and rotator muscles can be exposed.
Kim's myoarchitectonic spinolaminoplasty
- Preserving attachments of all posterior muscles (semispinalis cervicis, multifidus, semispinalis capitis) and reconstructing the midline fascia, leading to improved outcomes in terms of lordosis preservation, range of motion, and reduced axial neck pain.
- Attachments of all posterior muscles are preserved while expanding the spinal canal.
- Semispinalis cervicis and multifidus are attached to the sides of the spinous process.
- Cross section of the cervical spine and layers of nuchal muscles:
- The trapezius is in the 1st layer.
- The splenius is in the 2nd layer.
- The semispinalis capitis is in the 3rd layer of the nuchal ligament.
- The fascia in the midline of the trapezius is sharply cut.
- The midline fascia of the splenius is sharply divided, and the tip of the spinous process is exposed
- The spinous process is split in the midline with a sagittal saw, and through this opening, the spinous process is cut off from the lamina.
- The spinous process is retracted laterally with the semispinalis cervicis attachment intact.
- The lamina is drilled in the midline.
- Hinge gutters are made at the border between the lamina and the lateral mass, preserving the attachment of the multifidus.
- The laminal flaps are elevated on the hinges and are inter-bridged using a hydroxyapatite implant.
- The split halves of the spinous process with the attached semispinalis cervicis is attached to the hydroxyapatite implant.
- The three layers of the nuchal ligament are firmly reconstructed in the midline.
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