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spasms in the legs. The laminoplasty is a surgical procedure that creates more space for the spinal cord and exiting nerve roots along the cervical spine. There are three most commonly used methods of poste- rior cervical laminoplasty including the open door, double door, and muscle-sparing techniques. 2,6 Each option has its own advantages as well as disadvantages. Deciding which technique to use depends on a variety of patient factors. Some factors to consider include age, preexisting medical conditions, spinal curvature, mobility of the spine in flexion as well as extension, the number of levels involved, and loca- tion of stenosis. 4,6 The ideal patient for a posterior cervical laminoplasty will display two or more levels with a normal curvature of the spine. There also will be no excessive move- ment in flexion or extension, and no neck pain. 2 A N A T O M Y The cervical spine includes seven vertebrae. Each is routinely named C1 to C7 superior to inferior. The anatomy of C3-C6 consists of the body, pedicle, lamina, and spinous process. 1 The anatomy of C1, C2, and C7 have slight anatomy differences from C3-C6. The C1 vertebrae is named atlas and has a unique ring-like shape used in support of the head. C2 is named axis and has tooth- like projects that fit into the ring of C1. They work together to allow the head to rotate front to back and side to side. C7, or vertebra prominens, is unique because of its distinctive long spinous process. 1 Each vertebra protects the spinal cord and allows for movement of the body. The vertebra also acts as an exit for nerve roots from the spinal cord allowing the peripheral nervous system to send impulses to and from the brain. 1 The constriction of the spinal cord at any level can cause neurological malfunctions. 6 R O O M S E T U P A N D P O S I T I O N I N G The room setup and positioning of the patient is one of the most important parts of the procedure. Without proper attention to a patient in the prone position, the situation can become fatal. 5 Other risks of a patient being placed in the prone position include increased bleeding in the vertebral veins, pressure on the abdominal structures, increased opti- cal pressure, air way complications, and an increased risk of cardiac arrest. With proper interventions, these risks can be eliminated or greatly reduced. The use of egg-create foam, pillows, and gel chest rolls assist in the reduction of prone positioning risks to the patient. The patient is usually administered general anesthesia with an endotracheal tube. Special caution is used during intubation to not move the cervical spine as there is an elevated risk for damaging the spinal cord. 2,4 After intuba- tion, the patient is prepped for attachment to the Mayfield halo. Three sites are prepped for the placement of skull pins that will be attached to the Mayfield for proper distraction and positioning of the patient. Depending on the severity of spinal stenosis, the physician may order sensory and motor monitoring during the procedure. Somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP) are two common methods to monitor both sensory and motors of the patient before, during, and after surgery. 4,6 Both forms of monitoring are done by technician specialized in neuro- physiological monitoring. Prior to flipping the patient prone, a set of baseline motors will be collected. The patient is then flipped onto the operating room table. The use of gel rolls, egg-crate padding, and pillows will be used to keep the patient comfortable and protected. It is important to take extreme caution while flipping the patient to ensure there is constant support of the neck and spine. Care also must be taken to avoid accidental dislodgement of the endotracheal tube or other indwelling catheters placed prior to surgery. 5 The Mayfield attachment is connected and positioned to keep the cervical spine in a neutral position. 2 The patient’s arms are typically tucked down to the sides of the patient with a long draw sheet and foam, securing the sheet and arms with towel clips on the patient’s back. Tape is usually applied from the shoulders to the hips around the bottom of the table for visualization as well as assistance in intraoperative fluoroscopy. To further assist with visualiza- tion, the patient is placed in 20 to 30 degrees of Trendelen- burg. 2 A C-arm is placed at the head of the bed to gain lat- eral views of the cervical spine. It is important to ensure that | The Surgical Technologist | AUGUST 2019 368 The cervical laminoplasty is used to treatmany conditions such as tumors and cysts on the spinal cord, cervical myelopathy, and various neuromuscular disorders. 3,6