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Open-door laminoplasty

What can the unilateral approach offer?

Open-door-Laminoplastie

Was kann der unilaterale Zugang bieten?

Abstract

Objective

Multilevel posterior decompression of subaxial cervical spinal canal stenosis through a less-invasive unilateral approach.

Indications

Degenerative cervical myelopathy due to multilevel subaxial spinal canal stenosis.

Contraindications

Cervical kyphosis or instability, bilateral radiculopathy due to foraminal stenosis, involvement of C2 or C7.

Surgical technique

Unilateral subaxial approach with detachment of muscles only on one side. The ipsilateral laminae C6 to C3 are cut at the laminofacet junction and opened up. The loss of resistance is usually due to a greenstick fracture in the proximity of the contralateral laminofacet junction. The opened laminae are fixed with Z‑shaped thin titanium plates. If necessary, the laminoplasty can be combined with a unilateral fixation and fusion by the same approach.

Postoperative management

Early mobilization 4–6 h postoperatively. No orthosis necessary.

Results

A total of 131 patients (77 men, mean age 67 years) with a multilevel cervical spondylotic myelopathy (CSM) underwent surgery using a posterior approach. In 52 patients (40%), a unilateral approach was performed (laminoplasty: n = 30; laminoplasty/fusion: n = 22). In this group, the mean operation time was less compared with two other techniques (unilateral approach: 110 min; laminectomy/fusion: 150 min; 360° approach: 210 min). The postoperative European myelopathy score (EMS) improved from 12.8 to 15.2. The overall complication rate was 17% (unilateral approach: 9%; laminectomy/fusion: 18%; 360° approach: 27%).

Zusammenfassung

Operationsziel

Multisegmentale dorsale Dekompression des subaxialen zervikalen Spinalkanals über einen weniger invasiven unilateralen Zugang.

Indikationen

Degenerative zervikale Myelopathie aufgrund einer multisegmentalen subaxialen zervikalen Stenose.

Kontraindikationen

Zervikale Kyphose oder Instabilität, bilaterale Radikulopathie bei Foramenstenose, Notwendigkeit der Laminoplastie der Halswirbel HW 2 und HW 7.

Operationstechnik

Unilateraler subaxialer Zugang mit subperiostaler Ablösung der Muskulatur auf einer Seite. Die ipsilateralen Hemilaminae werden von HW 6 bis HW 3 am Übergang zwischen Bogen und Gelenk durchtrennt und angehoben. Der Widerstandsverlust zur Gegenseite folgt üblicherweise einer Grünholzfraktur im kontralateralen Übergangsbereich von Bogen zu Gelenk. Die angehobenen Halbbögen werden mit Z‑förmigen Titanplättchen fixiert. Bei Bedarf kann die Laminoplastie durch eine unilaterale Stabilisierung und Fusion über den gleichen Zugang ergänzt werden.

Weiterbehandlung

Frühe Mobilisierung 4–6 h nach Operation, Nachbehandlung ohne HWS-Orthese.

Ergebnisse

Insgesamt wurden 131 Patienten (77 Männer, Durchschnittsalter 67 Jahre) mit einer degenerativen multisegmentalen zervikalen Myelopathie über einen dorsalen Zugang operiert. Bei 52 Patienten (40 %) kam ein unilateraler Zugang zur Anwendung (Laminoplastie: n = 30; Laminoplastie/Fusion: n = 22). In dieser Gruppe war die durchschnittliche Operationszeit kürzer als bei den beiden anderen Verfahren (unilateraler Zugang 110 min; Laminektomie/Fusion 150 min; 360°-Zugang 210 min). Der postoperative europäische Myelopathie-Score (EMS) verbesserte sich von 12,8 auf 15,2. Die durchschnittliche Komplikationsrate betrug 17 % (unilateraler Zugang 9 %; Laminektomie/Fusion 18 %; 360°-Zugang 27 %).

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References

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Funding

This study was supported by a research grant from the Deutsche Arthrose-Hilfe and the World Arthrosis Organization.

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Authors

Corresponding author

Correspondence to R. Kothe MD, PhD.

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Conflict of interest

L. Papavero is a consultant for Medicon e. G., Tuttlingen, Germany. R. Kothe and G. Schmeiser declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Editor

H.M. Mayer, Munich

Illustrator

R. Himmelhan, Mannheim

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Kothe, R., Schmeiser, G. & Papavero, L. Open-door laminoplasty. Oper Orthop Traumatol 30, 3–12 (2018). https://doi.org/10.1007/s00064-017-0527-3

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  • DOI: https://doi.org/10.1007/s00064-017-0527-3

Keywords

  • Cervical spondylotic myelopathy
  • Surgical decompression
  • Surgical procedures, operative
  • Unilateral stabilization
  • Subaxial cervical spine

Schlüsselwörter

  • Zervikale spondylogene Myelopathie
  • Operative Dekompression
  • Operatives chirurgisches Verfahren
  • Unilaterale Stabilisierung
  • Subaxiale Halswirbelsäule