Laminectomy for Spinal Cord Injury (SCI)

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A laminectomy in the setting of spinal cord injury is performed to decompress the spinal cord, manage intracanal pressure, and improve potential for neurological recovery.

- Relieve mechanical compression (bone fragments, hematoma, edema). - Reduce intrathecal pressure (ITP). - Allow for cord expansion without additional ischemia. - Facilitate duraplasty if needed. - Enable stabilization when combined with posterior fixation.

- Persistent compression on imaging. - Neurological deterioration. - Elevated ITP or spinal canal compartment syndrome. - Adjunct to fusion for unstable fractures.

- Removal of lamina at affected levels. - Extension to adjacent levels if necessary. - May be combined with:

• Duraplasty to expand the dura.
• Posterior instrumentation for stabilization.

- Spinal instability risk; may require fusion. - Incomplete decompression if anterior compression persists. - Risk of dural tear and CSF leak. - Risk of infection, hematoma, or neurological worsening.

In SCI, laminectomy is a critical surgical tool for cord decompression and pressure management, often combined with duraplasty and fusion to maximize recovery potential.

A systematic review explores the Spinal cord injury pathophysiology and evaluates evidence linking decompressive laminectomy and duraplasty to improved neuroplasticity and recovery.

A comprehensive search was conducted in PubMed, Web of Science, and Cochrane Library for studies on decompressive surgery in SCI. Inclusion criteria were original articles investigating pathophysiology, neuroplasticity mechanisms, or surgical outcomes. Data on pathophysiological changes, molecular markers, and functional outcomes were extracted.

From 1240 initial articles, 43 studies were included, encompassing both animal models and human clinical data. Findings highlighted the role of inflammatory cascades, blood-spinal cord barrier disruption, and neurotrophic factor modulation in recovery. Decompressive duraplasty was associated with improved intrathecal pressure (ITP) management and neuroplasticity markers, such as BDNF and GAP-43.

This review underscores the therapeutic potential of decompressive laminectomy and duraplasty in SCI. While evidence suggests benefits in promoting neuroplasticity, further research is needed to elucidate molecular mechanisms and refine interventions ¹⁾.

This systematic review offers a valuable synthesis of current knowledge linking decompressive surgery to neuroplasticity and recovery after SCI. However, methodological limitations, particularly around study heterogeneity and lack of critical appraisal depth, temper the strength of its conclusions. Future studies should focus on better standardization, precise mechanistic investigations, and controlled clinical trials to confirm and refine these preliminary findings.