Laminoplasty and Laminectomy Hybrid Decompression for the Treatment of Cervical Spondylotic Myelopathy with Hypertrophic Ligamentum Flavum: A Retrospective Study

Abstract

ObjectiveTo report the outcomes of a posterior hybrid decompression protocol for the treatment of cervical spondylotic myelopathy (CSM) associated with hypertrophic ligamentum flavum (HLF).BackgroundLaminoplasty is widely used in patients with CSM; however, for CSM patients with HLF, traditional laminoplasty does not include resection of a pathological ligamentum flavum.MethodsThis study retrospectively reviewed 116 CSM patients with HLF who underwent hybrid decompression with a minimum of 12 months of follow-up. The procedure consisted of reconstruction of the C4 and C6 laminae using CENTERPIECE plates with spinous process autografts, and resection of the C3, C5, and C7 laminae. Surgical outcomes were assessed using Japanese Orthopedic Association (JOA) score, recovery rate, cervical lordotic angle, cervical range of motion, spinal canal sagittal diameter, bone healing rates on both the hinge and open sides, dural sac expansion at the level of maximum compression, drift-back distance of the spinal cord, and postoperative neck pain assessed by visual analog scale.ResultsNo hardware failure or restenosis was noted. Postoperative JOA score improved significantly, with a mean recovery rate of 65.3±15.5%. Mean cervical lordotic angle had decreased 4.9 degrees by 1 year after surgery (P<0.05). Preservation of cervical range of motion was satisfactory postoperatively. Bone healing rates 6 months after surgery were 100% on the hinge side and 92.2% on the open side. Satisfactory decompression was demonstrated by a significantly increased sagittal canal diameter and cross-sectional area of the dural sac together with a significant drift-back distance of the spinal cord. The dural sac was also adequately expanded at the time of the final follow-up visit.ConclusionHybrid laminectomy and autograft laminoplasty decompression using Centerpiece plates may facilitate bone healing and produce a comparatively satisfactory prognosis for CSM patients with HLF.

Relationship between Enlargement of the Cross-Sectional Area of the Dural Sac and Neurological Improvements after Cervical Laminoplasty: Differences between Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament

“…This suggests that the previous reports that adopted the maximum compression level as the neurologically symptomatic level might not have assessed the neurologically symptomatic level accurately. Regarding the dural sac, satisfactory decompressions were previously demonstrated by a significantly increased sagittal diameter and cross-sectional area of the dural sac together with a significant drift-back distance of the spinal cord in 116 CSM 23) patients after laminectomy and laminoplasty hybrid decompression, and in 82 OPLL 24) patients after extensive laminectomy. This suggests that the postoperative cross-sectional area of the dural sac at the symptomatic level can be a predictor of postoperative neurological outcome.…”

The Midterm Surgical Outcome of Modified Expansive Open-Door Laminoplasty

“…The results of this study are limited because of the relatively small case number of MEOLP, the retrospective design, and the lack of a comparison group. In addition, longer term follow-up is required to evaluate the progressive degenerative disc change within the laminoplasty and adjacent segment [ 30 ] following MEOLP.…”

Letter to the editor: Does Segmental Kyphosis Affect Surgical Outcome after a Posterior Decompressive Laminectomy in Multisegmental Cervical Spondylotic Myelopathy?

“…The cervical musculature attaches to the C2 and C7 vertebrae, and these attachments are essential for maintaining cervical sagittal alignment and lordosis [ 5 ]. Even though the authors have taken care to preserve C2 muscular attachments, the laminectomy was distally extended to the C7 level in all patients, with further extension of laminectomy across the cervicothoracic junction in 7 patients.…”