Open-door laminoplasty with suture anchor fixation for cervical myelopathy in ossification of the posterior longitudinal ligament.

摘要

Expansive laminoplasty was developed to achieve posterior spinal cord decompression while preserving cervical spine stability. In the classic Hirabayashi procedure, the lamina door is tethered open by sutures between the spinous process and facet capsule or paravertebral muscle. The authors present a modified technique, which enhances secure fixation and prevents restenosis owing to hinge closure. Twenty-seven patients (7 females, 20 males) with cervical myelopathy secondary to ossification of the posterior longitudinal ligament were enrolled. Each patient underwent unilateral open-door laminoplasty with suture anchor fixation. Tying and fixation of the sutures onto the holed lateral mass screws was used instead of the conventional method. Radiography, magnetic resonance imaging, and computed tomography scanning were used for imaging studies. The Nurick score was used to assess myelopathy severity, whereas the Japanese Orthopedic Association score was adopted to compare clinical outcome before and after surgery. Mean follow-up period was 38 months (range, 18 to 60). Ten patients had 5 levels of decompression (C3-7), and 17 patients had 4 (C3-6, 12 patients; C4-7, 5 patients). All patients experienced functional improvement of at least 1 Nurick score after surgery. The Japanese Orthopedic Association score increased significantly from 7.5+/-3.2 before surgery to 13.2+/-1.6 at final follow-up. Postoperative radiography and computed tomography scan demonstrated significantly increased sagittal diameter and canal expansion. No neurologic deterioration owing to hinge reclosure or major surgery-related complications were observed. In conclusion, unilateral open-door laminoplasty with suture anchor fixation effectively maintains expansion of the spinal canal and resists closure while preserving alignment and stability. This modified technique has a low complication rate and provides marked functional improvement in patients with cervical myelopathy owing to ossification of the posterior longitudinal ligament.