Open-Door Cervical Laminoplasty with Preservation of Posterior Structures

摘要

Objective To demonstrate that preservation of all posterior structures during open-door laminoplasty (ODL) is associated with a significant preservation of motion. Methods Fifteen patients underwent cervical ODL by one surgeon for treatment of cervical spondylotic myelopathy. An open-door technique was employed, and the laminae on the open side were reconstructed using miniplates with allograft strut bone graft. All spinous processes and interspinous and supraspinous ligaments were preserved within the operative levels and between supra- and subjacent levels in all patients. Postoperative radiographs were obtained 1.5, 3, 6, and 12 months. Computed tomography scans were obtained at 12 months. Results There were no significant intraoperative or perioperative complications. Postoperatively, the neutral angle was 6.8?±?11.5 degrees (95% confidence interval: 0.5 to 13.1), representing a loss of lordosis of 3 degrees (not significant). The difference between the preoperative and postoperative arc range of motion was 5.96?±?11.9 degrees (confidence interval: ?0.62 to 12.5). The average percent loss of motion was 3.5%?±?(0.1 to 6.9%). Four patients had an increased range of motion postoperatively. Conclusion Open-door laminoplasty with preservation of all posterior structures provides greater preservation of motion than has been previously described. Keywords: laminoplasty, open-door laminoplasty, cervical spondylotic myelopathy, range of motion, alignment Although open-door laminoplasty (ODL) is a well-known and frequently utilized technique for the treatment of cervical myelopathy, long-term follow-up studies demonstrate results consistent with significant postoperative loss of motion. 1 2 3 A critical review by Ratliff and Cooper in 2003 reported a mean decrease of 50% range of motion (ROM), with losses between 17% and 80% across 23 studies. 4 Furthermore, it has been shown that laminoplasty causes a loss of lordosis and loss of sagittal alignment. Despite the multitude of approaches to ODL for the treatment of cervical myelopathy, no studies have shown the clinical and radiographic results of ODL with preservation of all posterior structures. We hypothesize that the preservation of all structures will result in maintenance of sagittal alignment and range of subaxial motion. Here we present the results of 15 patients who underwent ODL with preservation of all posterior structures with mean 12.9-month follow-up that to our knowledge provides the first report of this technique.