Expansive open-door laminoplasty secured with titanium miniplates is a good surgical method for multiple-level cervical stenosis

Abstract

BackgroundLaminoplasty is an effective procedure for treating cervical spondylotic myelopathy (CSM). Little information is available regarding the surgical outcomes of expansive open-door laminoplasty (EOLP) when securing with titanium miniplates without bone grafting. This study is aimed to elucidate the efficacy of and problems associated with EOLP secured with titanium miniplates without bone grafting, thereby enhancing future surgical outcomes.MethodsThis is a retrospective study. The study participants comprised 104 patients who underwent cervical EOLP secured with titanium miniplates without bone graft for CSM treatment between August 2005 and March 2011. The clinical results were evaluated based on the Japanese Orthopedic Association (JOA) and Nurick scores. The radiographic outcomes were determined based on plain film and magnetic resonance imaging findings, which were assessed and compared.ResultsLateral cervical spine X-rays exhibited improvement in the Pavlov ratio of the spinal canal at 1 day postoperation, and this ratio did not change at 1 year postoperation. The mean cervical curvature from C2 to C7 decreased 0.21° ± 10.09° and the mean cervical range of motion was deteriorated by 35% at 12 months (P < 0.05). The Nurick score improved from 3.19 ± 1.06 to 0.92 ± 1.32 (P < 0.05). The mean JOA recovery rate was 75% ± 21.1% at 1 year. The mean level of postoperative neck pain at 3 months was 3.09 ± 2.31, as determined using the visual analogue scale (VAS). Increased age, concomitant thoracolumbar stenosis, depression disorder, and preexisting myelomalacia negatively affected the JOA recovery rate (P < 0.05). A decreased preoperative Nurick score and superior sensory function in the upper extremities were powerful predictors of an enhanced JOA recovery rate. The postoperative complications involved hematoma formation 0.9%, reversible C5 nerve palsy 2.8%, and moderate to severe neck pain (VAS ≥ 4) 42%. No cases of lamina closure or collapse were observed.ConclusionEOLP secured with titanium miniplates without bone grafting is a safe and effective surgical method for treating most patients with CSM.

Cervical Spondylotic Myelopathy: Pathophysiology and Surgical Approaches

“…Most of these studies used the JOA score as a parameter of clinical outcome. They reported that laminoplasty provided significant enhancement of the JOA score in the short-term, mid-term, and long-term follow-up [34][35][36][37][38][39]. However, Sakaura et al [40] reported that the average JOA score was at its highest point in 12 months of follow-up and decreased slightly to 14.9 in the final follow-up.…”

“…Similarly, Heller et al [42] reported that both laminoplasty approaches exhibited similar good clinical outcomes. Furthermore, the recovery rate (RR) of laminoplasty was greater than 50% in the short-term, mid-term, and long-term follow-up [35,[38][39][40][41]. On the other hand, Uehara et al [34] reported that RR was 47.1% in the final follow-up, but 55.9% immediately after operation.…”

“…Several studies showed that laminoplasty reduced cervical ROM in various degrees [34,35,[37][38][39][40]. As shown in Table 2, it seems that the preservation of C2 and C7 muscle attachments have an important role in the preservation of cervical ROM postoperatively.…”

Cervical Spondylotic Myelopathy Release by Unilateral Open-Door Laminoplasty with Miniplate Alone: Three Years Follow-up

“…The normal cervical aging process, congenital narrowing aggravated by acute trauma and bony malformations were identified as the primary causes of cervical stenosis that result in myelopathy. [1][2][3][4][5] Titanium miniplates fixation can be used to instantly reconstruct the spinal canal to restore its integrity. A relatively stable mechanical environment is conducive to bone slot healing on the door axial side and is also conducive to left and right muscle strength balance in the neck.…”

“…With these methods, decompression is achieved and the biomechanical integrity is maintained. [3][4][5] Since the design of classic open-door laminoplasty with the use of sutures, this procedure has modification to reduce complications, such as restenosis and axial symptoms.…”