Abstract
Study Design
This was a retrospective study.
Purpose
To evaluate the short term outcomes of a novel self-developed technique of performing uninstrumented open-door cervical laminoplasty (ODCL) in patients with cervical myelopathy secondary to ossified posterior longitudinal ligament (OPLL).
Review of Literature
Published literature on cervical laminoplasties largely focuses on the outcomes of instrumented variants.
Materials and Methods
Retrospective data were collected from 54 patients who underwent uninstrumented ODCL for cervical OPLL at a single institution from January 2010 to February 2017. The preoperative and postoperative modified Japanese Orthopaedic Association score (mJOA) and Nurick grading were documented. Cervical lordotic angle at C2-C7 and range of motion (ROM) were obtained from the preoperative and postoperative lateral cervical radiographs in neutral and flexion extension views, respectively. Descriptive and analytical statistics were generated by SAS 9.4 University Edition (SAS Institute, Cary. North Carolina, USA).
Results
The average age was 58.6 ± 7.8 years. The average time of presentation from the onset of symptoms was 7.6 ± 3 months. Of the 54 patients who were included in the study, majority (48.14%) had segmental type of OPLL while C3–C6 was the most commonly operated level (66.67%). The mean operating time was 115 ± 31 min with a mean blood loss of 165.9 ± 75 ml. There was a significant improvement in the mJOA scores (9.2 ± 1.1-13.7 ± 0.9, P < 0.0001) and Nurick grading (3.4 ± 0.8-1.6 ± 0.5, P < 0.0001) at 24-month followup. Preoperative C2–C7 angle had an average decrease of 4.5° at 24-month followup (19.3 ± 7.2-14.8 ± 8.8, P < 0.0001). There was a mean reduction of 4.3° ± 3.78° noted in the C2–C7 ROM between the preoperative and final followup.
Conclusion
Uninstrumented ODCL is an easily reproducible and economical alternative to the standard instrumented laminoplasty with equivalent short term outcomes. This technique is a valuable option in the treatment of cervical OPLL, especially in regions with scarce resources.
Similar content being viewed by others
References
Wang MY, Shah S, Green BA. Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy. Surg Neurol 2004;62:487–92.
An HS, Al-Shihabi L, Kurd M. Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine. J Am Acad Orthop Surg 2014;22:420–9.
Shinomiya K, Okamoto A, Kamikozuru M, Furuya K, Yamaura I. An analysis of failures in primary cervical anterior spinal cord decompression and fusion. J Spinal Disord 1993;6:277–88.
Sodeyama T, Goto S, Mochizuki M, Takahashi J, Moriya H. Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord. Spine (Phila Pa 1976) 1999;24:1527–31.
Baisden J, Voo LM, Cusick JF, Pintar FA, Yoganandan N. Evaluation of cervical laminectomy and laminoplasty. A longitudinal study in the goat model. Spine (Phila Pa 1976) 1999;24:1283–8.
Fields MJ, Hoshijima K, Feng AH, Richardson WJ, Myers BS. A biomechanical, radiologic, and clinical comparison of outcome after multilevel cervical laminectomy or laminoplasty in the rabbit. Spine (Phila Pa 1976) 2000;25:2925–31.
Steinmetz MP, Resnick DK. Cervical laminoplasty. Spine J 2006;6:274S–81S.
Kang SH, Rhim SC, Roh SW, Jeon SR, Baek HC. Postlaminoplasty cervical range of motion: Early results. J Neurosurg Spine 2007;6:386–90.
Kim SJ, Song JH, Kim MH, Park HK, Kim SH, Shin KM, et al. The prognostic implications of radiologicalfindings after laminoplasty in cervical myelopathy patients. J Korean Neurosurg Soc 1997;26:961–70.
Benzel EC, Lancon J, Kesterson L, Hadden T. Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord 1991;4:286–95.
Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 1972;95:87–100.
Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976) 1981;6:354–64.
Sakaura H, Hosono N, Mukai Y, Iwasaki M, Yoshikawa H. C3–6 laminoplasty for cervical spondylotic myelopathy maintains satisfactory long term surgical outcomes. Global Spine J 2014;4:169–74.
Yuan W, Zhu Y Liu X, Zhu H, Zhou X, Zhou R, et al. Postoperative three-dimensional cervical range of motion and neurological outcomes in patients with cervical ossification of the posterior longitudinal ligament: Cervical laminoplasty versus laminectomy with fusion. Clin Neurol Neurosurg 2015;134:17–23.
Lee CH, Jahng TA, Hyun SJ, Kim KJ, Kim HJ. Expansive Laminoplasty Versus Laminectomy Alone Versus Laminectomy and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament: Is There a Difference in the Clinical Outcome and Sagittal Alignment? Clinical Spine Surgery 2016;29:E9–E15.
Kohno K, Kumon Y Oka Y Matsui S, Ohue S, Sakaki S. Evaluation of prognostic factors following expansive laminoplasty for cervical spinal stenotic myelopathy. Surg Neurol 1997;48:237–45.
Hukuda S, Mochizuki T, Ogata M, Shichikawa K, Shimomura Y. Operations for cervical spondylotic myelopathy. A comparison of the results of anterior and posterior procedures. J Bone Joint Surg Br 1985;67:609–15.
Kalb S, Martirosyan NL, Perez-Orribo L, Kalani MY Theodore N. Analysis of demographics, risk factors, clinical presentation, and surgical treatment modalities for the ossified posterior longitudinal ligament. Neurosurg Focus 2011;30:E11.
Yang L, Gu Y, Shi J, Gao R, Liu Y, Li J, et al. Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy. Orthopedics 2013;36:e79–87.
Manzano GR, Casella G, Wang MY, Vanni S, Levi AD. A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy. Neurosurgery 2012;70:264–77.
Heller JG, Edwards CC 2nd, Murakami H, Rodts GE. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: An independent matched cohort analysis. Spine (Phila Pa 1976) 2001;26:1330–6.
Shaffrey CI, Wiggins GC, Piccirilli CB, Young JN, Lovell LR. Modified open-door laminoplasty for treatment of neurological deficits in younger patients with congenital spinal stenosis: Analysis of clinical and radiographic data. J Neurosurg 1999;90:170–7.
Matsuzaki H, Hoshino M, Kiuchi T, Toriyama S. Dome-like expansive laminoplasty for the second cervical vertebra. Spine (Phila Pa 1976) 1989;14:1198–203.
Lara-Almunia M, Hernandez-Vicente J. Open door laminoplasty: Creation of A new vertebral arch. Int J Spine Surg 2017;11:6.
Mizayaki K, Hirohuji E, Ono S. Extensive simultaneous multi-segmental laminectomy and posterior decompression wit posterolateral fusion. J Jpn Spine Res Soc 1994;5:167.
Inoue H, Ohmori K, Ishida Y, Suzuki K, Takatsu T. Long term followup review of suspension laminotomy for cervical compression myelopathy. J Neurosurg 1996;85:817–23.
Wada E, Suzuki S, Kanazawa A, Matsuoka T, Miyamoto S, Yonenobu K. Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy: A long term followup study over 10 years. Spine (Phila Pa 1976) 2001;26:1443–7.
Lao L, Zhong G, Li X, Qian L, Liu Z. Laminoplasty versus laminectomy for multi-level cervical spondylotic myelopathy: A systematic review of the literature. J Orthop Surg Res 2013;8:45.
Chiba K, Toyama Y, Matsumoto M, Maruiwa H, Watanabe M, Hirabayashi K. Segmental motor paralysis after expansive open-door laminoplasty. Spine (Phila Pa 1976) 2002;27:2108–15.
Satomi K Ogawa J, Ishii Y, Hirabayashi K. Short-term complications and long term results of expansive open-door laminoplasty for cervical stenotic myelopathy. Spine J 2001;1:26–30.
Sakaura H, Hosono N, Mukai Y, Ishii T, Yoshikawa H. C5 palsy after decompression surgery for cervical myelopathy: Review of the literature. Spine (Phila Pa 1976) 2003;28:2447–51.
Yonenobu K, Wada E, Ono K. Laminoplasty. In: Clark CR, editor. The Cervical Spine. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 1057–71.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dhillon, C.S., Ega, S.R., Tantry, R. et al. Outcome Evaluation of Modified Uninstrumented Open-door Cervical Laminoplasty for Ossified Posterior Longitudinal Ligament with Cervical Myelopathy. JOIO 53, 510–517 (2019). https://doi.org/10.4103/ortho.IJOrtho_207_19
Published:
Issue Date:
DOI: https://doi.org/10.4103/ortho.IJOrtho_207_19