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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



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.


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.


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.


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.

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  1. Asgari S, Bassiouni H, Massond N, Schlamann M, Stolke D (2009) Decompressive laminoplasty in multisegmental cervical spondylotic myelopathy: bilateral cutting versus open door technique. Acta Neurochir 151:739–749

    Article  Google Scholar 

  2. Fujita K, Tsuji N, Nishimura Y (1998) Surgical results of the double door laminoplasty splitting the spinous processes preserving the posterior supporting structures. Spinal Surg 12:293–300

    Google Scholar 

  3. Goel A (1997) Vascularized pedicle laminoplasty. Surg Neurol 48:442–445

    PubMed  Article  CAS  Google Scholar 

  4. Handa Y, Kubota T, Ishii H, Sato K, Tsuchida A, Arai Y (2002) Evaluation of prognostic factors and clinical outcome in elderly patients in whom expansive laminoplasty is performed for cervical myelopathy due to multisegmental spondylotic canal stenosis. A retrospective comparison with younger patients. J Neurosurg 96:173–179

    PubMed  Google Scholar 

  5. Hidai Y, Ebara S, Kamimura M, Tateiwa Y, Itoh H, Kinoshita T, Takaoka K, Ohatsuka K (1999) Treatment of cervical compressive myelopathy with a new dorsolateral decompressive procedure. J Neurosurg 90(4 Suppl):178–185

    PubMed  CAS  Google Scholar 

  6. 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(6):610–614

    Article  Google Scholar 

  7. Johnson KD, Frierson KE, Keller TS, Cook C, Scheinberg R, Zerwekh J, Meyer L, Sciadini MF (1996) Porous ceramics as bone graft substitutes in long bone defects: a biomechanical, histological, and radiographic analysis. J Orthop Res 14:351–369

    PubMed  Article  CAS  Google Scholar 

  8. Kadoya S (1992) Japanese Society of Spine Surgery: grading and scoring system for neurological function in degenerative cervical spine scale. Neurol Med Chir (Tokyo) 32:40–44

    Article  CAS  Google Scholar 

  9. Kaner T, Sasani M, Oktenoglu T, Ozer AF (2009) Clinical outcome following cervical laminoplasty for 19 patients with cervical spondylotic myelopathy. Turk Neurosurg 19(2):121–126

    PubMed  Google Scholar 

  10. Kokubun S, Kashimoto O, Tanaka Y (1994) Histological verification of bone bonding and ingrowth into porous hydroxyapatite spinous process spacer for cervical laminoplasty. Tohoku J Exp Med 173:337–344

    PubMed  Article  CAS  Google Scholar 

  11. Kotani Y, Abumi K, Ito M, Sudo H, Takahata M, Ohshima S (2009) Minimum 2-year outcome of cervical laminoplasty with deep extensor muscle preserving approach impact on cervical spine function and quality of life. Eur Spine J 18(5):663–671

    PubMed  Article  Google Scholar 

  12. Lee TT, Manzano GR, Green BA (1997) Modified open-door cervical expansive laminoplasty for spondylotic myelopathy: operative technique, outcome and predictors for gait improvement. J Neurosurg 86:64–68

    PubMed  Article  CAS  Google Scholar 

  13. Matsuda Y, Shibata T, Oki S (1999) Outcome of surgical treatment for cervical myelopathy in patients more 75 years of age. Spine 24:529–534

    PubMed  Article  CAS  Google Scholar 

  14. Matz PG, Anderson PA, Groff MW, Heary RF, Holly LT, Kaiser MG, Mummaneni PV, Ryken TC, Choudry TF, Vresilovic EJ, Ressnick DK (2009) Cervical laminoplasty for treatment of cervical degenerative myelopathy. J Neurosurg (Spine) 11:157–169

    Article  Google Scholar 

  15. Okada M, Minamide A, Endo T, Yoshida M, Kawakami M, Ando M (2009) A prospective randomized study of clinical outcome in patients with cervical compressive myelopathy treated with open door or French door laminoplasty. Spine 34(11):1119–1126

    PubMed  Article  Google Scholar 

  16. Ratliff JK, Cooper PR (2003) Cervical laminoplasty: a critical review. J Neurosurg 98:230–238

    PubMed  Google Scholar 

  17. Satomi NY, Kohno T (1999) Long term follow-up studies of open door expansive laminoplasty for cervical stenotic myelopathy. Spine 24:507–510

    Google Scholar 

  18. Takayasu M, Takagi T, Nishizawa T, Osuka K, Nakajima T, Yoshida J (2002) Bilateral open-door cervical expansive laminoplasty with hydroxyapatite spacers and titanium screws. J Neurosurg (spine 1) 96:22–28

    Article  Google Scholar 

  19. Tani S, Isoshima A, Nagashima Y, Numoto RT, Abe T (2002) Laminoplasty with preservation of posterior cervical elements: surgical technique. Neurosurgery 50:97–102

    PubMed  Article  Google Scholar 

  20. Terao S, Sobue G, Hashizume Y (1996) Age related changes of the myelinated fibers in the human spinal ventral horn cells with special reference to loss of small neurons in the intermediate zone: a quantitative analysis. Acta Neuropathol 92:109–114

    PubMed  Article  CAS  Google Scholar 

  21. Yang SC, Niu CC, Chen WJ, Wu CH, Yu SW (2008) Open door laminoplasty for multilevel cervical spondylotic myelopathy: good outcome in 12 patients using suture anchor fixation. Acta Orthop 79(1):62–66

    PubMed  Article  Google Scholar 

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Correspondence to Sanjiv Sinha.

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Sinha, S., Jagetia, A. 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. Acta Neurochir 153, 975–984 (2011).

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  • Cervical spondylosis
  • Ossified posterior longitudinal ligaments
  • Myelopathy
  • Radiculomyelopathy
  • Expansive laminoplasty
  • Bilateral open-door laminoplasty