Cervical laminoplasty for cervical myeloradiculopathy

Abstract

The role for treatment of conditions resulting in cervical spondylotic myeloradiculopathy through posterior approaches is discussed. The indications and advantages of a posterior approach andin particular laminoplasty are reviewed. Various techniques of laminoplasty are presented. The senior author's technique and series in expansive open door laminoplasty is also reviewed. The series was a prospective study performed to evaluate the clinical result, and the position of the open door laminae in the postoperative period. Cervical open door expansive laminoplasty was performed on 22 patients for cervical spondylotic myeloradiculopathy. Preoperative Nurick's classification and the Japanese Orthopaedic Association score averaged 1.9 and 11.9, respectively. At follow-up (mean, 25.9 months; range, 15 to 40 months), NUR 3 classification and JOA scores improved to 0.8 and 15.3, respectively. Digital analysis of serial computed tomography scans shows an average increase in the anteroposterior sagittal diameter of 58% (7.1 mm) with an associated settling of 10% (1.7 mm). Early postsurgical complications include one complete loss of an open door laminar position, and two cases of transient radiculopathy. The transient cases of radiculopathy were related to a fracture of the laminar hinge causing root impingement in one case, and the other caused by nerve root traction at the nonhinged side. Recommendations include a generous open door for the laminoplasty in anticipation of postoperative settling, and foraminal decompression for foraminal radiculopathy. Laminoplasty provides excellent clinical results in patients with myeloradiculopathy caused by cervical spondylotic stenosis and ossification of the posterior longitudinal ligament.