Hemilaminectomy with Contralateral Sublaminar for Decompression Multilevel Cervical Spondylotic Myelopathy

Abstract

Objective: Cervical hemilaminectomy with contralateral sublaminar decompression for multilevel cervical myelopathy is reported with surgical results. Methods: A retrospective study was performed for 15 patients with multilevel cervical myelopathy who underwent cervical hemilaminectomy with contralateral sublaminar decompression at Cathay Medical Center in Taiwan between January 2001 and April 2003. All had undergone magnetic resonance imaging (MRI) scans preoperatively. All underwent MRI scans 6 months after the operation. The duration of follow-up ranged from 12 to 35 months (mean, 24 months). The radiological results were evaluated by the Pavlov ratio at the narrowest level. The clinical results were measured by the Nurick score. Results: The average duration of symptoms was 15 months (range, 6 months to 4 years). The mean operative levels are 4.6 (range, 3-5). The Nurick Functional Disability Score improved from 2.8 (range, 1-5) preoperatively to 1.8 (range 0-4) postoperatively. Improved muscle power of upper extremities was reported in 20%, and improvement in spastic gait, in 13%. Eleven patients (73%) showed improvement in symptoms of numbness and paresthesia. The average sagittal expansion improved from an average of 50% (range, 30-60%) to 70% (range, 55-80%). The average sagittal diameter improved from an average of 12.5 millimeters (range, 9.5-15 millimeters) to 15.5 millimeters (range, 14-19 millimeters). The mean increase in canal area at the narrowest level was 50% (range, 25-75%). Cervical hemilaminectomy with contralateral sublaminar decompression provided good surgical results in 60% of patients with minimal morbidities 3 months after the operation and 80% of patients at 12 months of follow-up or longer. Spinal stability was well maintained in all patients. Conclusions: Cervical hemilaminectomy with contralateral sublaminar decompression is a safe and effective procedure and can be performed in patients with multilevel cervical spondylotic myelopathy.