Double-door laminoplasty for treatment of cervical whiplash injury

Abstract

Objective To analyze efficacy of double door laminoplasty for treatment of whiplash injury of the cervical spine.Methods Forty-one cases of cervical whiplash injury treated surgically from January 2001 to October 2011 and available to follow up were analyzed retrospectively.There were 32 males and 9 females with mean age of (51.0 ± 12.0) years (range,28 to 74 years).Causes of injury included traffic accidents in 30 cases,fall on the ground in 8,and high fall in 3.All cases were combined with developmental cervical stenosis and six with ossification of the posterior longitudinal ligament.Posterior double-door laminoplasty was operated in 36 cases and one-stage surgery via anterior-posterior approach in 5 cases.Cases were grouped according to their ages,preoperative cervical Japanese Orthopedic Association (JOA) score,and operation time.Results were compared among groups.Results Operation lasted for 70-180 minutes (mean,121.9 minutes) and showed blood loss of 30-500 ml (mean,177.8 ml).All cases were followed up for 12 to 110 months (mean,59.4 months).Overall JOA score averaging 14.7 points improved significantly after operation with mean improvement rate of 77.8％ (P ＜0.01).Whereas between non-elderly and elderly groups,postoperative JOA improvement rate [(79.6 ± 18.8)％ vs (73.5 ±22.8)％] and excellent rate (90％ vs 83％) were similar.For cases grouped according to their preoperative JOA score,the results were satisfactory for all groups,but the differences were insignificant.Besides,JOA score at the last follow-up differed significantly among groups (P ＜ 0.0l).Improvement rate of JOA score was better in early surgery group than in late surgery group [(84.6±13.3)％ vs (75.4±24.0)％,P＜0.05].Conclusions Double door laminoplasty is reliable in treatment of cervical whiplash injury on condition that surgical indications are grasped strictly.Elderly or gravely injured patients can also have considerable recovery of neurological function,but patients with severe injury or late surgery are associated with poor prognosis. Key words: Spinal cord injuries; Cervical vertebrae; Whiplash injury