A segmental partial laminectomy for cervical spondylotic myelopathy: anatomical basis and clinical outcome in comparison with expansive open-door laminoplasty.

摘要

STUDY DESIGN: A comparative study regarding the clinical outcome of the 2-different surgical procedures for patients with cervical spondylotic myelopathy (CSM). OBJECTIVES: To describe the anatomic basis of a segmental partial laminectomy (SPL) for the treatment of cervical spondylotic myelopathy and to compare the clinical outcome with traditional C3 to C7 expansive open-door laminoplasty (ELAP). SUMMARY OF BACKGROUND DATA: Laminoplasty has been widely accepted for the treatment of CSM. However, some disadvantages have also been recognized. To resolve these problems, a SPL was performed. No previous studies have been reported regarding this surgical procedure. METHODS: A total of 13 human cadavers were studied to analyze the spinal cord compression of cervical spondylosis. Twenty-six patients who underwent a SPL and 13 age- and gender-matched patients who underwent traditional C3-C7 ELAP were analyzed for their Japanese Orthopedic Association score, axial neck pain, and radiographic parameters (lordotic angle and ROM of cervical spine). RESULTS: Based on cadaver studies, compression of the spinal cord was present in the articular segment, but not in the intraosseous segment. The removal of the ligamentum flavum and the superior edge of the lower lamina was sufficient for minimum posterior decompression of the cervical spinal cord.In comparison with the ELAP, the patients who underwent an SPL showed a similar recovery of the Japanese Orthopedic Association score, but the maintenance of the sagittal alignment and the range of motion were better after the SPL and postoperative neck and/or shoulder complaints also seemed to be reduced. CONCLUSION: A SPL, may therefore, be a useful and effective surgical procedure for cervical spondylotic myelopathy.