OPEN-DOOR PLASTY FOR EARLY RECOVERY APPROACH
Toward less invasive cervical surgery.
Understand the procedure. Explore the evidence. Consider your options with your doctor.
Illustration: OS NEXUS No.18, Fig.9. Reproduced with permission.
MIST-OPERA / exLAP
Information provided by: Wataru Narita (Kameoka Municipal Hospital Spine Center)
Page updated:
Numbness in the hands, difficulty with fine movements, or trouble walking can sometimes come from compression of the spinal cord in the neck. This page walks through the Cervical OPERA Method by indication, differences from conventional surgery, risks, and possible consultation destinations.
Numbness, hand clumsiness, and gait disturbance are reviewed.
MRI, CT, and X-rays show compression and bone shape.
OPERA, conventional laminoplasty, anterior surgery, and fusion are compared.
Check hospitals where instructed physicians are affiliated.
Definition
exLAP is the name used in the textbook and research papers for the exoscopic OPERA technique: exoscopic minimally invasive open-door laminoplasty. The Opera Laminoplasty System is the medical device used to maintain the position of the opened lamina, not the name of the operation.
Wataru Narita began developing the cervical OPERA method alongside the Opera Laminoplasty System in 2020 (information provided by the developer). The device approval number is 30500BZX00045000. The first package insert is dated April 1, 2023, and the third edition June 20, 2025. These are document publication and revision dates, not the approval date.
Actual indication depends on symptoms, MRI and CT findings, cervical alignment, and general condition.
The method aims to preserve the concept of broad cervical decompression while reducing surgical burden through a small incision, preservation of muscle attachments, magnified visualization, and laminar support.
Marked kyphosis, K-line negative OPLL, instability requiring fusion, infection, poor bone quality, or systemic risk may lead to consideration of another procedure.
Difference
The difference is not only the incision size. The concept links a small approach, visualization, soft-tissue preservation, and stable maintenance of the opened lamina.
Textbook Figures
The following cited figures are from the chapter “Open-door cervical laminoplasty performed through a 3 cm incision: an attempt using exoscope and XR” in New OS NEXUS No.18.
Original Technique Pages
The following material is intended for physicians and healthcare professionals. Pages 158-165 of the surgical technique chapter are reproduced with printing marks, page numbers, and lower print-production/footer information removed so that the text and illustrations are easier to read.
After confirming cervical alignment on a preoperative lateral X-ray, the head is fixed with a Mayfield clamp in a neutral to slightly flexed position. Both shoulders are taped downward so that the operative level can be checked more easily.
The technique uses a blunt right-angle Gelpi retractor, a compact high-speed burr with an irrigation nozzle, 3 mm and 1.5 mm diamond burrs, and a blunt right-angle suction tube. Preoperative axial CT is used to understand laminar thickness and adjust the depth of the lateral gutter. Three-dimensional CT is used to review spinous process shape and facet osteophytes before planning the working corridor.
Positioning is especially important in a small-incision procedure. If the preoperative alignment is straight or kyphotic, routine slight flexion may create excessive kyphosis and make exposure through a small incision difficult.
The surgeon stands on the patient's left side. After palpating the C2 and C7 spinous processes, a two-fingerbreadth incision, about 35 mm for the authors, is designed. In many cases the incision is placed from the C3 spinous process caudally, roughly over C3 to C5. The midline nuchal ligament is opened precisely, the C3 to C6 midline is reached, and the level is confirmed by X-ray. A blunt right-angle Gelpi retractor is placed. The tips of the C3 to C6 spinous processes are split with a high-speed diamond burr while preserving the semispinalis cervicis attachments, and the laminae are exposed only as far laterally as needed for the lateral gutters.
The C2 semispinalis cervicis is fully preserved. The lower edge of the C2 lamina and the upper edge of the C3 lamina are exposed with a high-speed burr to identify the C2/3 ligamentum flavum. If there is no C2/3 stenosis, the ligamentum flavum is detached from the C3 lamina with a curved curette. If C2/3 stenosis is present, a 3 to 4 mm domeplasty of the lower C2 lamina is performed until the ligament can be detached from the C2 side. During this step the exoscope camera is tilted most cranially.
The lateral gutters of the C3 to C5 laminae are made with a high-speed burr. The authors use the right side as the hinge side and the left side as the open side. On the open side, the bone is cooled intermittently with saline to avoid thermal injury; when operating alone, a burr with a saline-drip nozzle is preferred. For C6, only the hinge-side gutter is first created, and the procedure then moves to C6/7 fenestration. Because the C6/7 view looks caudally, the lower edge of C6 can obstruct access to the ligamentum flavum. Removing a few millimeters of the distal C6 lamina makes the C6/7 ligamentum flavum easier to identify. The upper edge of C7 is exposed, and the ligamentum flavum is detached from C7 with a curved curette. If C6/7 stenosis is present, the upper C7 lamina is removed sufficiently with a burr or 2 mm Kerrison rongeur. The open side of C6 is cut only after the C6/7 fenestration is complete.
Because the field is limited, conventional suture-only fixation or hydroxyapatite spacer fixation can be difficult. The authors use the OPERA SYSTEM, which is compact and suited to minimally invasive manipulation. The laminar side of the plate can be bent to fit individual laminar shape. Each lamina is lifted with a curved curette and supported with a plate. The open-side ligamentum flavum is usually not cut. If elevation is stiff, additional drilling is performed on the hinge-side gutter; the lamina should not be forced upward. Each screw hole is prepared with a 1 to 2 mm burr, and the plate is fixed with two screws on the lateral mass side and two screws on the laminar side.
The laminar side of the plate can be bent to match laminar shape. After the lamina is raised with a curved curette, the plate is inserted and fixed without looseness because preserved soft tissue can promote reclosure. Unlike conventional suture fixation, this technique generally does not require passing sutures behind the lamina, cutting the open-side ligamentum flavum, or dissecting between the lamina and dura. Direct contact with the epidural venous plexus is reduced, making bleeding control easier.
After thorough irrigation, a 3.5 mm closed continuous suction drain is placed and the muscle layer is closed. Retraction of the Gelpi retractor by an assistant or scrub nurse allows the cranial and caudal ends of the muscle layer to be sutured under direct vision even through a small incision. Subcutaneous closure is followed by skin strips. Rehabilitation begins the day after surgery in the authors' department.
Because exoscope video is converted into digital data, integration with support devices such as XR is expected. CT navigation images can be displayed picture-in-picture on the exoscope monitor, allowing the surgeon to check the magnified surgical field and navigation image at the same time with less eye movement and improved operative efficiency.
Patient Flow
This page is not intended to rush treatment. It is an entry point for confirming symptoms and imaging, and for comparing surgery, conservative care, or another procedure.
Numbness, hand clumsiness, walking difficulty, falls, and bladder or bowel symptoms are reviewed.
MRI evaluates cord compression, CT evaluates ossification and laminar shape, and X-rays assess alignment or instability.
The team compares OPERA with anterior surgery, fusion, conventional laminoplasty, or nonoperative care.
Expected benefits, complications, limitations, postoperative course, and possible reoperation are discussed.
Related Facilities
On this site, related facilities means hospitals where physicians who have received operative instruction from Wataru Narita are affiliated. It does not mean official certification, permanent availability of the OPERA method, or a designated referral destination. Please confirm appointment rules, referral requirements, clinic days, and physicians on each facility's official website.
Meaning
For cervical disease, the appropriate treatment depends on symptoms, imaging, and general condition. This list is a practical cue for patients comparing consultation destinations by region and access.
Sendai, Miyagi
Shibuya, Tokyo
Ota, Tokyo
Mishima, Shizuoka
Okayama City
Kochi City
Located in Kita-ku, Okayama. Access from the Okayama Station area is mainly by bus or car; the official page provides bus, road, and parking information.
Located in Taihaku-ku, Sendai. From Sendai Station, take a Miyagi Kotsu bus for about 30 minutes and walk about 5 minutes from Sendai Nishitaga Hospital-mae.
Located in Kochi City. About 15 minutes by taxi or about 30 minutes by bus from JR Kochi Station. The hospital states that outpatient visits are generally by appointment.
Located in Shibuya, Tokyo. About 5 minutes on foot from Sangubashi Station on the Odakyu Line, or 8 minutes from JR Yoyogi Station.
2-20-25 Higashi-Rokugo, Ota-ku, Tokyo. About 6 minutes on foot from Zoshiki Station on the Keikyu Main Line; bus access from the JR Kamata Station area is also listed.
Located in Mishima, Shizuoka. About 5 minutes by car from the south exit of Mishima Station, or 2 minutes on foot from Mishima-Hirokoji Station.
Sources
The public hospital page describes MIST-OPERA as Open-door Plasty for Early Recovery Approach and lists Dr. Wataru Narita and the Spine Center.
A technical note and preliminary clinical study of exLAP in 28 cases, including acute postoperative neck pain.
OPENOVA and the package insert identify the implant, manufacturer, generic device name, and approval number 30500BZX00045000.
The cervical OPERA method (MIST-OPERA) is an open-door cervical laminoplasty that emphasizes a small incision and preservation of muscle attachments. It widens the space for the spinal cord from the back of the neck. The exoscopic technique is called exLAP.
It may be considered for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament (OPLL). Symptoms, the compression level, spinal alignment, instability and general health guide the choice between nonsurgical treatment and different operations.
No. Possible complications include C5 palsy, neck pain, infection, bleeding, neurological injury and reoperation. A small incision does not eliminate these risks.
There is no single timetable. Neurological symptoms, general health, postoperative recovery and the demands of your work determine the plan with your treating physician.
A preliminary 2024 study compared acute postoperative outcomes in 17 exLAP patients and 11 conventional laminoplasty patients, 28 in total. It does not establish long-term results or effectiveness for every patient.
Related facilities are hospitals where physicians instructed by Wataru Narita work. Confirm current availability, the treating physician, referral requirements and appointments with each hospital.
Ask the hospital where you plan to receive treatment. The procedure, admission length, insurance eligibility and cost-sharing affect the amount payable. An implant price is not the total cost of surgery and hospitalization.
Consultation
Whether the Cervical OPERA Method is appropriate is determined by symptoms and imaging. A referral letter, MRI, CT, and X-ray images are helpful for evaluation.
Last updated: October 2, 2026. This page is general medical information and does not replace individual diagnosis.
