Laminoplasty and laminectomy hybrid decompression for the treatment of cervical spondylotic myelopathy with hypertrophic ligamentum flavum: a retrospective study.

Huairong Ding,Yaqi Zong,Yuan Xue,Pei Wang,Zhiyang Li,Yi Wang,Ying Zhao,Yanming Tang,Dong He,Massimo S Fiandaca

doi:10.1371/journal.pone.0095482

Huairong Ding, Yaqi Zong + Show 8 more

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https://doi.org/10.1371/journal.pone.0095482

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Abstract

ObjectiveTo report the outcomes of a posterior hybrid decompression protocol for the treatment of cervical spondylotic myelopathy (CSM) associated with hypertrophic ligamentum flavum (HLF).BackgroundLaminoplasty is widely used in patients with CSM; however, for CSM patients with HLF, traditional laminoplasty does not include resection of a pathological ligamentum flavum.MethodsThis study retrospectively reviewed 116 CSM patients with HLF who underwent hybrid decompression with a minimum of 12 months of follow-up. The procedure consisted of reconstruction of the C4 and C6 laminae using CENTERPIECE plates with spinous process autografts, and resection of the C3, C5, and C7 laminae. Surgical outcomes were assessed using Japanese Orthopedic Association (JOA) score, recovery rate, cervical lordotic angle, cervical range of motion, spinal canal sagittal diameter, bone healing rates on both the hinge and open sides, dural sac expansion at the level of maximum compression, drift-back distance of the spinal cord, and postoperative neck pain assessed by visual analog scale.ResultsNo hardware failure or restenosis was noted. Postoperative JOA score improved significantly, with a mean recovery rate of 65.3±15.5%. Mean cervical lordotic angle had decreased 4.9 degrees by 1 year after surgery (P<0.05). Preservation of cervical range of motion was satisfactory postoperatively. Bone healing rates 6 months after surgery were 100% on the hinge side and 92.2% on the open side. Satisfactory decompression was demonstrated by a significantly increased sagittal canal diameter and cross-sectional area of the dural sac together with a significant drift-back distance of the spinal cord. The dural sac was also adequately expanded at the time of the final follow-up visit.ConclusionHybrid laminectomy and autograft laminoplasty decompression using Centerpiece plates may facilitate bone healing and produce a comparatively satisfactory prognosis for CSM patients with HLF.

Highlights

Cervical spondylotic myelopathy (CSM) is a common cause of atraumatic quadriplegia in adults [1]
Posterior, or combined approaches have been developed [4,5,6], with posterior decompression being the logical treatment for a spinal cord that has been compressed dorsally by a hypertrophic ligamentum flavum [7,8,9]
To remove the hypertrophic ligamentum flavum (HLF) completely while partially preserving the posterior wall of the spinal canal, we have developed a hybrid decompression protocol, laminectomy at the C3, C5, and C7 levels and laminoplasty at the C4 and C6 levels with spinous process autograft using the Centerpiece Plate Fixation System (Medtronic Sofamor Danek, Memphis, TN, USA)

Summary

Introduction

Cervical spondylotic myelopathy (CSM) is a common cause of atraumatic quadriplegia in adults [1]. To remove the HLF completely while partially preserving the posterior wall of the spinal canal, we have developed a hybrid decompression protocol, laminectomy at the C3, C5, and C7 levels and laminoplasty at the C4 and C6 levels with spinous process autograft using the Centerpiece Plate Fixation System (Medtronic Sofamor Danek, Memphis, TN, USA). The aim of this retrospective study was to perform a preliminary review of the results of this hybrid decompression protocol. Laminoplasty is widely used in patients with CSM; for CSM patients with HLF, traditional laminoplasty does not include resection of a pathological ligamentum flavum

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Conclusion