Cervical laminoplasty: a critical review

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> The technique of cervical laminoplasty was developed to decompress the spinal canal in patients with multilevel anterior compression caused by ossification of the posterior longitudinal ligament or cervical spondylosis. There is a paucity of data confirming its superiority to laminectomy with regard to neurological outcome, preserving spinal stability, preventing postlaminectomy kyphosis, and the development of the “postlaminectomy membrane.”</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> The authors conducted a metaanalysis of the English-language laminoplasty literature, assessing neurological outcome, change in range of motion (ROM), development of spinal deformity, and complications. Seventy-one series were reviewed, comprising more than 2000 patients.</jats:p> <jats:p content-type="fine-print">All studies were retrospective, uncontrolled, nonrandomized case series. Forty-one series provided postoperative recovery rate data in which the Japanese Orthopaedic Association Scale was used for assessing myelopathy. The mean recovery rate was 55% (range 20–80%). The authors of 23 papers provided data on the percentage of patients improving (mean ∼80%). There was no difference in neurological outcome based on the different laminoplasty techniques or when laminoplasty was compared with laminectomy. There was postlaminoplasty worsening of cervical alignment in approximately 35% and with development of postoperative kyphosis in approximately 10% of patients who underwent long-term follow-up review. Cervical ROM decreased substantially after laminoplasty (mean decrease 50%, range 17–80%). The authors of studies with long-term follow up found that there was progressive loss of cervical ROM, and final ROM similar to that seen in patients who had undergone laminectomy and fusion. In their review of the laminectomy literature the authors could not confirm the occurrence of postlaminectomy membrane causing clinically significant deterioration of neurological function. Postoperative complications differed substantially among series. In only seven articles did the writers quantify the rates of postoperative axial neck pain, noting an incidence between 6 and 60%. In approximately 8% of patients, C-5 nerve root dysfunction developed based on the 12 articles in which this complication was reported.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> The literature has yet to support the purported benefits of laminoplasty. Neurological outcome and change in spinal alignment are similar after laminectomy and laminoplasty. Patients treated with laminoplasty develop progressive limitation of cervical ROM similar to that seen after laminectomy and fusion.</jats:p>

The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: biomechanical study and first results of ATPS prototyping

“…Anterior surgical strategies are increasingly recognized as advantageous for multilevel cervical decompression of the anteriorly compromised spinal cord, providing the ability for anterior release, durable reconstruction of physiologic alignment and instrumented fusion through a less traumatic approach compared to the posterior neck dissection [3,6,20,37,38,40,[45][46][47]55]. With anterior procedures, decompression of the neurologic structures can be accomplished by means of segmental discectomy or partial corpectomy.…”

Clinical results of and patient satisfaction with cervical laminoplasty for considerable cord compression with only slight myelopathy

“…It is generally believed that the predictive factors for a good surgical outcome may include shorter duration of disease and milder neuroimaging [1,2], suggesting that early or prophylactic surgery for myelopathy may be effective. However, we should remember that surgery is always accompanied by the possibility of major and minor complications [4], which makes the indications for surgery in patients with considerable cord compression but slight myelopathy controversial.…”

“…This technique is well established and the reported complication rates are acceptable, but some problems such as axial symptoms or C5 palsy have not been fully resolved [4][5][6]. The long term results of this technique is satisfactory, with the preservation of the enlarged cervical canal area and the maintenance of JOA scores for cervical myelopathy (JOA score, Table 1, maximum score 17 points) [7].…”

Full-endoscopic cervical arcocristectomy for the treatment of spinal stenosis: results of a cadaver study

“…However, the ideal surgical treatment option for cervical spondylotic myelopathy remains controversial. So far, published data could not report one surgical technique to be superior to others [6,8,9,11,13,17,18,20]. The major disadvantage of posterior surgical approaches is cervical muscular pain due to an extensive dissection of the paracervical muscles from the spinous processes and laminae, especially in multilevel maneuvers.…”