ORIGINAL ARTICLE Posterior Cervical Laminoplasty Using a New Plating System Technical Note Harel Deutsch, MD,* Praveen V. Mummaneni, MD,† Gerald E. Rodts, MD,† and Regis W. Haid, MD‡ Background: Laminoplasty is well described in the Japanese litera- ture as a surgical option for treating ossification of the posterior lon- gitudinal ligament (OPLL). The open door technique has gained in- creasing popularity in the United States and Europe to treat not only OPLL but also cervical stenotic myelopathy. An obstacle to its wide- spread use is the lack of a suitable fixation plate to adequately secure the fractured lamina to the lateral mass. Our objective was to demon- strate the advantages of a novel miniplate (Ti-Mesh LP system; Medtronic Sofamor Danek, Memphis, TN, USA) that is ideally suited for fixing the lamina to the lateral mass. Methods: We used the Ti-Mesh LP miniplate system to perform laminoplasties on five patients, all male, with a mean preoperative Nurick score of 2.8. Four patients had congenital cervical stenosis with myelopathy and one had OPLL. Open door laminoplasties were performed on all patients. The plates were implanted with a claw po- sitioned on the trapdoor lamina and a flat plate on the lateral mass. Results: The system was implanted successfully in all patients. The mean number of levels fixated was 4.4. There were no intraoperative or postoperative complications after >5 months follow-up. Conclusions: The new Ti-Mesh LP cranial miniplate and screw sys- tem facilitates posterior cervical laminoplasty procedures by elimi- nating the need to contour cranial miniplates for use in the cervical spine. Its unique claw construct and angled design are ideal for hold- ing a trapdoor laminoplasty in the open position. We have used this system successfully and without complications to perform decom- pressive posterior cervical laminoplasties in five patients. Key Words: cervical spine, instrumentation, cervical myelopathy (J Spinal Disord Tech 2004;17:317–320) P osterior cervical laminectomies are commonly performed to decompress the cervical spinal cord. Extensive ex- perience with cervical laminectomies has demonstrated up to 20% of patients develop postoperative cervical kyphotic deformity. 1 An initial solution to postoperative kyphosis involved lateral mass plating. Lateral mass plating significantly ex- tended surgical time and introduced a new source of morbid- ity. 2 Laminoplasty was developed as a surgical technique intended to prevent postoperative deformity. Various refine- ments have been introduced, including the use of titanium miniplates to stabilize the posterior elements in an open posi- tion. This article describes a new modification of the plating system to increase ease of use, postoperative canal sagittal di- ameter, and structural rigidity. METHODOLOGY Patients We used the Ti-Mesh LP miniplate system (Ti-Mesh LP system; Medtronic Sofamor Danek, Memphis, TN, USA) to perform laminoplasties on five male patients with a mean age of 58.2 years (range 52–73 years) and a mean preoperative Nurick score of 2.8 (range 2–4) (Table 1). Open door laminoplasties were performed on all pa- tients. Patients were positioned prone, and a midline approach was used to expose the cervical lamina. A high-powered air drill (Midas Rex Pneumatic Tools, Fort Worth, TX, USA) with an AM-8 drill bit was used to create two channels just medial to the articular processes. On one side, the channel was carried all the way down to the underlying ligament, while on the other side, a thin rim of cortex was left. The lateral mass joint cap- sules were preserved. The ligamentum flavum and soft tissue were released to allow for dorsal lamina rotation and spinal canal decompression. 3 The plates were then implanted with a claw positioned on the trapdoor lamina and a flat plate on the lateral mass (Fig. 1). Five to 7-mm screws were used for fixation (Fig. 2). Plates were placed at each laminoplasty level. The wound was closed in a standard fashion in layers, and a postoperative drain was left in place. The patient was nursed on a regular surgical floor. Patients were instructed to wear a soft cervical collar for com- fort. Physical therapy was initiated on postoperative day 1. Received for publication April 17, 2003; accepted August 4, 2003. From the *Department of Neurosurgery, Rush University, Chicago, IL; †De- partment of Neurosurgery, Emory University, Atlanta, GA; and ‡Atlanta Brain and Spine Care, Atlanta, GA. The following authors are consultants for Medtronic Sofamor Danek: Regis W. Haid, MD, Gerald E. Rodts, MD, and Praveen V. Mummaneni, MD. Reprints: Praveen V. Mummaneni, MD, Department of Neurosurgery, Emory Clinic, 550 Peachtree Rd., Suite 806, Atlanta, GA 30308, USA (e-mail: praveen_mummaneni@emoryhealthcare.org). Copyright © 2004 by Lippincott Williams & Wilkins J Spinal Disord Tech • Volume 17, Number 4, August 2004 317