Procedure

1. GA

2. Foley catheter insertion

3. Mayfield skull tong apply

4. Prone position

5. Draping

6. Midline skin incsion

7. Dissected paraspinal muscle subperiosterally

8. use x-ray to confirm position of C2 level

9. Use cutting bur and diamond bur for laminotomy

10. bur medial to facet joints to make paramedian gutter

11. Double door opening laminoplasty was done

12. ARCH plate introduced with screw

13. Wound irrigation and haemostasis

14. +/-Place the autograft at the gutters

15. Insert drainage and wound closingInstrumentation

Closure