The Midterm Surgical Outcome of Modified Expansive Open-Door Laminoplasty

Abstract

Laminoplasty is a standard technique for treating patients with multilevel cervical spondylotic myelopathy. Modified expansive open-door laminoplasty (MEOLP) preserves the unilateral paraspinal musculature and nuchal ligament and prevents facet joint violation. The purpose of this study was to elucidate the midterm surgical outcomes of this less invasive technique. We retrospectively recruited 65 consecutive patients who underwent MEOLP at our institution in 2011 with at least 4 years of follow-up. Clinical conditions were evaluated by examining neck disability index, Japanese Orthopaedic Association (JOA), Nurick scale, and axial neck pain visual analog scale scores. Sagittal alignment of the cervical spine was assessed using serial lateral static and dynamic radiographs. Clinical and radiographic outcomes revealed significant recovery at the first postoperative year and still exhibited gradual improvement 1–4 years after surgery. The mean JOA recovery rate was 82.3% and 85% range of motion was observed at the final follow-up. None of the patients experienced aggravated or severe neck pain 1 year after surgery or showed complications of temporary C5 nerve palsy and lamina reclosure by the final follow-up. As a less invasive method for reducing surgical dissection by using various modifications, MEOLP yielded satisfactory midterm outcomes.

Cervical Spondylotic Myelopathy: Pathophysiology and Surgical Approaches

“…The pain subscore was already low before the operation and became even lower at 1 year post operation. Yeh et al [39] preserved the C2 and C7 muscle attachments and reported similar results with other studies. Similarly, Sakaura et al [40] performed the C3-C6 laminoplasty and reported that the postoperative axial neck pain was 5% at 1 year and 0% at the final follow-up.…”

“…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.…”

“…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.…”

“…Similarly, several studies used the NDI score as a parameter of clinical outcome and reported that laminoplasty improved the NDI score within 1-2 years of post operation [39,43]. Interestingly, Shin et al [35] used the Frankel score to measure the clinical outcome of laminoplasty and found an improvement in the Frankel score from 3.93 to 4.53 at 12 months post operation.…”