Tension-Band Laminoplasty: A Laminoplasty with Minimal Surgical Intervention to the Spinoligamentous Complex for Better Postoperative Neck Function

Abstract

The development of surgical techniques for cervical laminoplasty in Japan has shown that the key issue in obtaining better postoperative function of the neck is preserving the integrity of the spinoligamentous (SL) complex in lamina-enlarging procedures [1]. The characteristic structural changes after laminoplasty, namely, loss of lordosis with a mild anterior tilt of the cervical spine accompanied by neck stiffness [2], result from damage to the SL complex. These structural changes produce fatigue in the neck with axial pain, a reduction in the range of motion (ROM) of the neck, and a loss of smoothness in neck movements. All of these dysfunctions cause considerable inconvenience in the activities of daily living [3,4]. The loss of a posterior supporting force by cutting the spinous processes and/or spinous ligaments causes a forward inclination of the neck and the outflow of osteoblastic substances from inside the bone through the exposed bone marrow of the spinous processes and laminae. This might be a major cause of both the stiffness of the healed soft tissue and the posterior segmental fusion between laminae or spinous processes [5]. All these facts indicate that surgical intervention in the SL complex should be minimal for the best possible postoperative neck function. In 1989 [6], we developed a tension-band laminoplasty (TBL) which allowed sufficient spinal cord decompression while maintaining the maximal integrity of the SL complex. In TBL, the tension-band effect of the preserved ligaments allowed early postoperative neck mobilization, facilitated the union of spacers, and prevented postoperative soft tissue contracture. The operative procedures and results are described below.