Acta Neurochirurgica

, 151:739 | Cite as

Decompressive laminoplasty in multisegmental cervical spondylotic myelopathy: bilateral cutting versus open-door technique

  • Siamak Asgari
  • Hischam Bassiouni
  • Nagi Massoud
  • Marc Schlamann
  • Dietmar Stolke
  • I. Erol Sandalcioglu
Clinical Article

Abstract

Purpose

The aim of the study was to evaluate patients with multisegmental cervical spondylotic myelopathy (MCM) surgically treated via a dorsal approach. Two different laminoplasty techniques were compared by assessment of enlargement of the spinal canal and the neurological outcome.

Methods

Thirteen patients (mean age 49 years, 11 males) underwent decompressive laminoplasty over a 7-year period. The average duration of symptoms was 21 months. The pre- and postoperative degree of myelopathy was assessed by both the Nurick grading and the Japanese Orthopaedic Association myelopathy score (JOA score). Preoperatively, the mean Nurick grade was 3.1 and the mean JOA score was 11. Two different techniques of expansive laminoplasty were used. Six patients underwent a bilateral cutting (BL) technique with retropositioning of the laminae and bilateral mini-plating (BL group). Seven patients were operated on by simple open-door (OD) laminoplasty with unilateral mini-plating (OD group). Postoperatively, CT scans were obtained for all patients to measure the sagittal diameter of the spinal canal. The mean clinical and radiological follow-up was 33 months.

Results

Four to five laminae were involved in all patients.The mean operation time was 180 min. Complications occurred in two patients of BL group, with immediate postoperative neurological deterioration due to ventral displacement of the laminae. Overall, the average sagittal diameter (SD) of the spinal canal increased from 9.2 ± 1.3 mm to 12.4 ± 1.3 mm after surgery. The average enlargement of SD was significantly higher for the OD group (p < 0.0075 ). In total, the improvement rate was 38% according to the Nurick grading and 69% according to the JOA score. For the OD group, improvement rates were 57% (Nurick) and 71% (JOA).

Conclusions

Decompressive laminoplasty is comparable with anterior surgery in neurological outcome. The OD technique seems to be superior to our BL technique regarding both the enlargement of SD and complication rate.

Keywords

Cervical myelopathy Laminoplasty Open-door Spondylosis 

References

  1. 1.
    Aboulker J, Metzger J, David M, Engel P, Ballivet J (1965) Les myelopathies cervicales d’origine rachidienne. Neurochirurgie 11:87–198Google Scholar
  2. 2.
    Asgari S (1995) [Operative treatment of cervical myelopathy and its results under consideration of modern neuroradiological methods]. Doctoral thesis, University of Essen, Essen, p 67Google Scholar
  3. 3.
    Bishara SN (1971) The posterior operation in treatment of cervical spondylosis with myelopathy: a long-term follow-up study. J Neurol Neurosurg Psychiatry 34:393–398PubMedCrossRefGoogle Scholar
  4. 4.
    Brain WR, Northfield D, Wilkinson M (1952) The neurological manifestations of cervical spondylosis. Brain 75:187–225PubMedCrossRefGoogle Scholar
  5. 5.
    Callahan RA, Johnson RM, Margolis RN, Keggi KJ, Albright JA, Southwick WO (1977) Cervical facet fusion for control of instability following laminectomy. J Bone Joint Surg Am 59:991–1002PubMedGoogle Scholar
  6. 6.
    Cloward RB (1958) The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:602–617PubMedCrossRefGoogle Scholar
  7. 7.
    Dereymaeker A, Mulier J (1958) La fusion vertebrale par voie ventrale dans la discopathie cervicale. Rev Neurol 99:597–616PubMedGoogle Scholar
  8. 8.
    Edwards CC 2nd, Heller JG, Murakami H (2002) Corpectomy versus laminoplasty for multilevel cervical myelopathy: an independent matched-cohort analysis. Spine 27:1168–1175PubMedCrossRefGoogle Scholar
  9. 9.
    Epstein JA, Janin Y, Carras R, Lavine LS (1982) A comparative study of the treatment of cervical spondylotic myeloradiculopathy. Experience with 50 cases treated by means of extensive laminectomy, foraminotomy, and excision of osteophytes during the past 10 years. Acta Neurochir (Wien) 61:89–104CrossRefGoogle Scholar
  10. 10.
    Epstein NE (1999) Laminectomy with posterior wiring and fusion for cervical ossification of the posterior longitudinal ligament, spondylosis, ossification of the yellow ligament, stenosis, and instability: a study of 5 patients. J Spinal Disord 12:461–466PubMedGoogle Scholar
  11. 11.
    Fager CA (1973) Results of adequate posterior decompression in the relief of spondylotic cervical myelopathy. J Neurosurg 38:684–692PubMedCrossRefGoogle Scholar
  12. 12.
    Gooding MR, Wilson CB, Hoff JT (1975) Experimental cervical myelopathy. Effects of ischemia and compression of the canine cervical spinal cord. J Neurosurg 43:9–17PubMedCrossRefGoogle Scholar
  13. 13.
    Gorter K (1976) Influence of laminectomy on the course of cervical myelopathy. Acta Neurochir (Wien) 33:265–281CrossRefGoogle Scholar
  14. 14.
    Guigui P, Benoist M, Deburge A (1998) Spinal deformity and instability after multilevel cervical laminectomy for spondylotic myelopathy. Spine 23:440–447PubMedCrossRefGoogle Scholar
  15. 15.
    Heller JG, Edwards CC 2nd, Murakami H, Rodts GE (2001) Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis. Spine 26:1330–1336PubMedCrossRefGoogle Scholar
  16. 16.
    Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:519–528PubMedGoogle Scholar
  17. 17.
    Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K (1981) Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine 6:354–364PubMedCrossRefGoogle Scholar
  18. 18.
    Hirabayashi K, Satomi K (1988) Operative procedure and results of expansive open-door laminoplasty. Spine 13:870–876PubMedCrossRefGoogle Scholar
  19. 19.
    Hosono N, Yonenobu K, Ono K (1996) Neck and shoulder pain after laminoplasty. A noticeable complication. Spine 21:1969–1973PubMedCrossRefGoogle Scholar
  20. 20.
    Iizuka H, Nakajima T, Iizuka Y, Sorimachi Y, Ara T, Nishinome M, Takagishi K (2007) Cervical malalignment after laminoplasty: relationship to deep extensor musculature of the cervical spine and neurological outcome. J Neurosurg Spine 7:610–614PubMedCrossRefGoogle Scholar
  21. 21.
    Itoh T, Tsuji H (1985) Technical improvements and results of laminoplasty for compressive myelopathy in the cervical spine. Spine 10:729–736PubMedCrossRefGoogle Scholar
  22. 22.
    Iwasaki M, Okuda S, Miyauchi A, Sakaura H, Mukai Y, Yonenobu K, Yoshikawa H (2007) Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament. Part 1: Clinical results and limitations of laminoplasty. Spine 32:647–653PubMedCrossRefGoogle Scholar
  23. 23.
    Jamjoom A, Williams C, Cummins B (1991) The treatment of spondylotic cervical myelopathy by multiple subtotal vertebrectomy and fusion. Br J Neurosurg 5:249–255PubMedCrossRefGoogle Scholar
  24. 24.
    Kato Y, Iwasaki M, Fuji T, Yonenobu K, Ochi T (1998) Long-term follow-up results of laminectomy for cervical myelopathy caused by ossification of the posterior longitudinal ligament. J Neurosurg 89:217–223PubMedCrossRefGoogle Scholar
  25. 25.
    Kohno K, Kumon Y, Oka Y, Matsui S, Ohue S, Sakaki S (1997) Evaluation of prognostic factors following expansive laminoplasty for cervical spinal stenotic myelopathy. Surg Neurol 48:237–245PubMedCrossRefGoogle Scholar
  26. 26.
    Kojima T, Waga S, Kubo Y, Kanamaru K, Shimosaka S, Shimizu T (1989) Anterior cervical vertebrectomy and interbody fusion for multi-level spondylosis and ossification of the posterior longitudinal ligament. Neurosurgery 24:864–872PubMedCrossRefGoogle Scholar
  27. 27.
    Mihara H, Kondo S, Takeguchi H, Kohno M, Hachiya M (2007) Spinal cord morphology and dynamics during cervical laminoplasty: evaluation with intraoperative sonography. Spine 32:2306–2309PubMedCrossRefGoogle Scholar
  28. 28.
    Nolan JP Jr, Sherk HH (1988) Biomechanical evaluation of the extensor musculature of the cervical spine. Spine 13:9–11PubMedCrossRefGoogle Scholar
  29. 29.
    Nurick S (1972) The natural history and the results of surgical treatment of the spinal cord disorder associated with cervical spondylosis. Brain 95:101–108PubMedCrossRefGoogle Scholar
  30. 30.
    Nurick S (1972) The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95:87–100PubMedCrossRefGoogle Scholar
  31. 31.
    Orabi M, Chibbaro S, Makiese O, Cornelius JF, George B (2008) Double-door laminoplasty in managing multilevel myelopathy: technique description and literature review. Neurosurg Rev 31:101–110PubMedCrossRefGoogle Scholar
  32. 32.
    Roberts AH (1966) Myelopathy due to cervical spondylosis treated by collar immobilization. Neurology 16:951–954Google Scholar
  33. 33.
    Roselli R, Pompucci A, Formica F, Restuccia D, Di Lazzaro V, Valeriani M, Scerrati M (2000) Open-door laminoplasty for cervical stenotic myelopathy: surgical technique and neurophysiological monitoring. J Neurosurg 92:38–43PubMedGoogle Scholar
  34. 34.
    Sakou T, Miyazaki A, Tomimura K, Maehara T, Frost HM (1979) Ossification of the posterior longitudianl ligament of the cervical spine: subtotal vertebrectomy as a treatment. Clin Orthop Relat Res:58-65Google Scholar
  35. 35.
    Sandalcioglu IE, Gasser T, Asgari S, Lazorisak A, Engelhorn T, Egelhof T, Stolke D, Wiedemayer H (2005) Functional outcome after surgical treatment of intramedullary spinal cord tumors: experience with 78 patients. Spinal Cord 43:34–41PubMedCrossRefGoogle Scholar
  36. 36.
    Saunders RL, Bernini PM, Shirreffs TG Jr, Reeves AG (1991) Central corpectomy for cervical spondylotic myelopathy: a consecutive series with long-term follow-up evaluation. J Neurosurg 74:163–170PubMedCrossRefGoogle Scholar
  37. 37.
    Seifert V, Stolke D (1991) Multisegmental cervical spondylosis: treatment by spondylectomy, microsurgical decompression, and osteosynthesis. Neurosurgery 29:498–503PubMedCrossRefGoogle Scholar
  38. 38.
    Sekhon LH (2007) Posterior cervical decompression and fusion for circumferential spondylotic cervical stenosis: review of 50 consecutive cases. J Clin Neurosci 14:185–186CrossRefGoogle Scholar
  39. 39.
    Shaffrey CI, Wiggins GC, Piccirilli CB, Young JN, Lovell LR (1999) Modified open-door laminoplasty for treatment of neurological deficits in younger patients with congenital spinal stenosis: analysis of clinical and radiographic data. J Neurosurg 90:170–177PubMedCrossRefGoogle Scholar
  40. 40.
    Smith GW, Robinson RA (1958) The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40:607–624PubMedGoogle Scholar
  41. 41.
    Vasavada AN, Li S, Delp SL (1998) Influence of muscle morphometry and moment arms on the moment-generating capacity of human neck muscles. Spine 23:412–422PubMedCrossRefGoogle Scholar
  42. 42.
    Wang MY, Shah S, Green BA (2004) Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy. Surg Neurol 62:487–492 discussion 492-483PubMedCrossRefGoogle Scholar
  43. 43.
    Wiedemayer H, Sandalcioglu IE, Aalders M, Wiedemayer H, Floerke M, Stolke D (2004) Reconstruction of the laminar roof with miniplates for a posterior approach in intraspinal surgery: technical considerations and critical evaluation of follow-up results. Spine 29:E333–342PubMedCrossRefGoogle Scholar
  44. 44.
    Wiedemayer H, Schoch B, Stolke D (1998) Osteoplastic laminotomy using titanium microplates for reconstruction of the laminar roof: a technical note. Neurosurg Rev 21:93–97PubMedCrossRefGoogle Scholar
  45. 45.
    Wohlert L, Buhl M, Eriksen EF, Fode K, Klaerke A, Kroyer L, Lindeberg H, Madsen CB, Strange P, Espersen JO (1984) Treatment of cervical disc disease using Cloward's technique. III. Evaluation of cervical spondylotic myelopathy in 138 cases. Acta Neurochir 71:121–131CrossRefGoogle Scholar
  46. 46.
    Yonenobu K, Hosono N, Iwasaki M, Asano M, Ono K (1992) Laminoplasty versus subtotal corpectomy. A comparative study of results in multisegmental cervical spondylotic myelopathy. Spine 17:1281–1284PubMedCrossRefGoogle Scholar
  47. 47.
    Yukawa Y, Kato F, Ito K, Horie Y, Hida T, Ito Z, Matsuyama Y (2007) Laminoplasty and skip laminectomy for cervical compressive myelopathy: range of motion, postoperative neck pain, and surgical outcomes in a randomized prospective study. Spine 32:1980–1985PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Siamak Asgari
    • 1
  • Hischam Bassiouni
    • 2
  • Nagi Massoud
    • 1
  • Marc Schlamann
    • 3
  • Dietmar Stolke
    • 1
  • I. Erol Sandalcioglu
    • 1
  1. 1.Departments of NeurosurgeryUniversity Hospital of EssenEssenGermany
  2. 2.Westpfalz-KlinikumKaiserslauternGermany
  3. 3.Department of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital of EssenEssenGermany

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