Bilateral open-door expansive laminoplasty using unilateral posterior midline approach with preservation of posterior supporting elements for management of cervical myelopathy and radiculomyelopathy--analysis of clinical and radiological outcome and surgical technique.

摘要

BACKGROUND: The purpose of this study was to evaluate bilateral open-door cervical laminoplasty for management of cervical canal stenosis secondary to multisegmental cervical spondylosis and ossified posterior longitudinal ligament. The importance of unilateral posterior approach with preservation of posterior supporting element is emphasized. METHODS: Thirty-four patients had expansive laminoplasty. Posterior tension band consisting of nuchal ligaments and supraspinous and interspinous ligaments was secured. Paraspinal deep extensor muscles attached to one side of spinous process were also preserved. Hydroxyapatite-collagen spacers were positioned between split laminae in midline and secured with Ethibond. All patients had features of myelopathy with weakness, hypertonia, clonus, and hyperreflexia in both upper and lower limbs. Bladder and bowel involvement was seen in 11.7% and sexual dysfunction in 5.8%. Preoperative dynamic study of cervical spine, MRI, and/or CT were done in all patients and compared with postoperative studies to see the efficacy of the surgical procedure. RESULTS: Preoperative and postoperative neurosurgical cervical spine scale was used to compare results in relation to age, sex, duration of symptoms, neurosurgical cervical spine score, bladder, bowel, and sexual abnormalities. Elderly patients, lower neurosurgical score, signs and symptoms of more than 2 years, and bladder, bowel, and sexual dysfunction had poorer outcome. Complications were few. All patients had adequate diameter of spinal canal postoperatively. Cervical alignment and range of motion of segment subjected to laminoplasty were preserved satisfactorily in follow-up. CONCLUSIONS: Bilateral open-door expansive laminoplasty using unilateral posterior midline approach provides preservation of posterior supporting tension band and excellent reconstruction of spinal canal. This technique also does not compromise contralateral paraspinal muscles attached to spinous process.