Expansive Open-door Laminoplasty Research Articles

Expansive Open-Door Cervical Laminoplasty: In Situ Reconstruction of Extensor Muscle Insertion on the C2 Spinous Process Combined With Titanium Miniplates Internal Fixation.

Retrospective cohort study.To evaluate efficacy and relevant problems of in situ reconstruction of extensor muscle insertion on the C2 spinous process combined with titanium miniplates internal fixation in expansive open-door cervical laminoplasty in order to improve surgical treatment effect.Expansive open-door cervical laminoplasty has been widely applied in clinical practice, but there are a series of postoperative problems. Therefore, decreasing postoperative complications in order to more effectively relieve symptoms remains a subject for additional research.From October 2011 to September 2013, a total of 60 patients who suffered cervical canal stenosis were treated by expansive open-door laminoplasty with in situ reconstruction of extensor muscle insertion on the C2 spinous process combined with titanium miniplates internal fixation. Changes of cervical curvature index (CI) and range of motion (ROM) were calculated using data from preoperative and postoperative cervical spine X-ray examinations. Clinical function was scored using the Japanese Orthopedics Association Scoring System (JOA) and the neck disability index (NDI).The mean CI before the operation and at 1-year postoperation were 10.49% ± 3.93% and 14.14 ± 2.85 (P < 0.05). The mean ROM values were 43.35 ± 7.55 before the operation, 34.83 ± 7.41 at 1-year postoperation (P < 0.05). The NDI scores decreased from 19.42 ± 4.12 to 7.37 ± 2.58, and the JOA scores increased from 8.87 ± 1.99 to 13.55 ± 1.72, representing significant improvement (P < 0.05). One patient had postoperative C5 nerve root palsy and completely recovered 1 month later. Neither collapse nor door closure in the open-door side occurred in any of the patients.Expansive open-door cervical laminoplasty with in situ reconstruction of extensor muscle insertion on the C2 spinous process combined with titanium miniplates internal fixation is a safe and effective surgical method, and can effectively decrease postoperative complications and achieve satisfactory clinical results.

Laminoplasty with adjunct anterior short segment fusion for multilevel cervical myelopathy associated with local kyphosis

BackgroundWhen treating patients who have multilevel cervical spondylotic myelopathy (MCSM) with short-segment kyphosis, instability, or major anterior foci, long-level anterior decompression with fusion is often a standard method but can cause obvious loss of range of motion and usually needs further posterior stabilization. For MCSM with correctable kyphosis or simple instability, laminectomy with lateral-mass instrumented fusion is also a treatment of choice, but all the involved segments are immobilized. Combining expansive open-door laminoplasty (EOLP) and anterior short-segment fusion may be an alternative treatment to save more motion segments. MethodsThis study included 109 patients who exhibited MCSM with combined local kyphosis, instability, and anterior pathology, and received EOLP and concomitant anterior short-segment fusion. The patients were enrolled from August 2005 to July 2012. Nurick scores and Japanese Orthopedics Association cervical myelopathy scores were used to evaluate the functional outcomes. Follow-up plain films were collected and magnetic resonance imaging was conducted to assess the radiographic outcomes. ResultsOne year after the operation, the Japanese Orthopedics Association recovery rate was 83.4 ± 16.6%. The improvement in the functional scores and decrease in neck pain were significant. The canal width improved without further collapse at 12 months. The preservation of range of motion was approximately 57% at 1 year. ConclusionEOLP with adjunct anterior short-segment decompression fusion yields an excellent outcome for MCSM patients who exhibit concomitant short-segment kyphosis, instability or major anterior pathology. Performing laminoplasty first is safer for the spinal cord due to its posterior shifting while anterior procedures are being done.

Cervical open-door laminoplasty technique with simple sutures and bone grafts: a single institutional study with 30 consecutive cases.

BackgroundExpansive open-door laminoplasty is widely accepted as a reliable procedure for cervical myelopathy. However, one acknowledged complication is spring-back complication or closure of the door which may result in restenosis of cervical canal and neurologic deterioration. The study aimed for addressing our cervical open-door laminoplasty technique with sutures and bone grafts and subsequently the follow-up outcomes.MethodsThirty consecutive patients who underwent open-door laminoplasty with the novel technique were included and followed for minimum 5 years from Jan 2006 to Dec 2007. Anteroposterior diameter (APD) of the vertebral canal of C4 was measured in lateral cervical radiographs. Neurologic scenarios were noted using the Japanese Orthopaedic Association (JOA) scores.ResultsTwenty-five males (83.3%) and five (16.7%) females with an average follow-up of 68 months were enrolled. The preoperative APD was 13.22 mm (±1.15), whereas the postoperative APD increased to 31.23 mm (±2.43) with an expansion ratio of 136.23% (P < 0.05). The JOA score increased from 8.5 preoperatively to 13.45 postoperatively with a recovery rate of 58.2% (P < 0.05). The elevated laminas were maintained open during the follow-up period.ConclusionsOur technique with sutures and bone graft for laminoplasty is a simple and efficient method for maintaining the decompression of cervical canal and neurologic improvement.

Evaluation of postoperative kyphosis and expansive open-door laminoplasty for cervical spondylotic myelopathy

Evaluation of postoperative kyphosis and expansive open-door laminoplasty for cervical spondylotic myelopathy

All levels versus alternate levels plate fixation in expansive open door cervical laminoplasty.

Background:Expansive open door laminoplasty with the use of titanium miniplate is becoming popular. Usually, the plate is applied at each level to prevent re-closure of the opened lamina. However, it is also used at alternating levels (i.e., C3, C5 and C7) in clinical settings in order to reduce the cost. Whether they have any difference in clinical efficacy? There is a lack of comparative data between the two kinds of plate fixation in the literature.Materials and Methods:83 patients who underwent cervical laminoplasty with alternating levels plate fixation (51 patients in Group A) or all levels plate fixation (32 patients in Group B) between January 2008 and October 2012 were evaluated in our institute retrospectively. Clinical and radiologic outcomes were assessed.Results:No statistical difference was found in the mean operation time, blood loss, incidence of significant axial symptoms and C5 palsy, preoperative anteroposterior diameter (APD) and preoperative Japanese Orthopedic Association score between the two groups. However, Group B showed a higher rate of neurologic recovery after surgery. Postoperative increased APD and open angle in Group B were significantly larger than Group A. The mean cost for Group B (12801 ± 460.6 USD) was higher than Group A (8906 ± 566.7 USD).Conclusions:Despite the higher cost of all level fixation, it is more effective in maintaining the expansion of the spinal canal and can obtain better clinical improvement compared to alternating levels fixation.

Explorations to the outcome of different angles of open-door expansive laminoplasty in multi-segmental cervical spondylotic myelopathy

Objective To explore the outcome of different angles of open-door expansive laminoplasty in multi-segmental cervical spondylotic myelopathy.Methods We studied 99 patients presented with multi-segmental cervical spondylotic myelopathy.All patients were treated with open-door expansive laminoplasty by microplate.According to different opening angles which were measured by CT scan after operation,the patients were divided into group A (15°-30°,61 patients) and group B (＞ 30°,38 patients).There were no significant difference of the general situations between patients from the two groups before taking treatments.Record the operation time,the mean intraoperative blood loss and JOA score,cervical curvature,incidence rates of C5 nerve root palsy six months after operation.Results All patients were followed up for an average duration of 21.27 months (range 12-45 months).All incisions were healed by first intention.No patients suffered re-close of door.The operation time was (11O.13 ± 13.47),(109.16 ± 12.79) minutes minutes in group A,B respectively,and there are no significant difference (P ＞0.05).The mean volume of bleeding was (150.29 ±31.64) ml,(152.07 ±31.37) ml in group A,B respectively,and there are no significant difference (P ＞ 0.05).There were no significant difference when compared the JOA scores (P ＞ 0.05) and Cervical curvature (C2-C7) (P ＞ 0.05) 6 months after operations of the patients from the two groups.The incidence of C5 nerve root palsy was 1.64％,7.89％ in group A,B respectively,and there were significant difference (P ＜ 0.05).Conclusion The opening angle between 15° and 30° of open-door expansive laminoplasty by microplate can achieve a better outcome when compared witb angle above 30°. Key words: Microplate; Multi-segmental; Cervical spondylotic myelopathy; Open-door expansive laminoplasty

The severity of operative invasion to the posterior muscular-ligament complex influences cervical sagittal balance after open-door laminoplasty.

The aim of this study was to investigate how the severity of operative invasion to the posterior muscular-ligament complex impacts postoperative cervical sagittal balance. Ninety cases of open-door expansive laminoplasty due to cervical spondylotic myelopathy were reviewed. Fifty-three patients underwent laminoplasty with unilateral preservation of the muscular-ligament complex (unilateral elevation group). Thirty-seven patients underwent traditional open-door laminoplasty (bilateral elevation group). Preoperative and postoperative cervical sagittal parameters, including C2-C7 sagittal vertical axis (SVA), C0-2 Cobb angle and T1 slope, were compared. The cervical curvature, range of motion (ROM) and JOA score were also compared. The average follow-up time was 16.7 months (range 3-40 months). C2-C7 SVA significantly increased in the bilateral elevation group (+4.9 mm, P = 0.005) but remained unchanged in the unilateral elevation group (-0.2 mm, P = 0.414). The C0-2 Cobb angle increased in both groups (+4.1°, P < 0.001; +2.5°, P = 0.002). The T1 slope also increased in both groups (+1.1°, P = 0.015; +0.7°, P = 0.042). The postoperative C3-C7 curvature significantly decreased in the bilateral elevation group (-4.1°, P < 0.001). The C3-C7 ROM decreased in both groups (-17.9°, P < 0.001; -15.1°, P < 0.001). C2-C7 SVA was positively correlated with the T1 slope (Pearson = 0.468, P < 0.001) and negatively correlated with the C3-C7 curvature (Pearson = -0.322, P = 0.001). The C0-2 Cobb angle was positively correlated with C2-C7 SVA (Pearson = 0.303, P = 0.004) and negatively correlated with the C3-C7 curvature (Pearson = -0.362, P < 0.001). There was no significant between-group difference in the JOA improvement rate. Open-door laminoplasty significantly affected postoperative cervical sagittal balance, with the cervical vertebra appearing to tilt forward. As the severity of surgical invasion to the posterior muscular-ligament complex increased, the loss of cervical sagittal balance also increased.

Changes of sagittal balance of cervical spine after open-door expansive laminoplasty

To explore the changes of sagittal balance of cervical spine after open-door expansive laminoplasty. The clinical and radiological data were analyzed retrospectively for 90 patients undergoing open-door expansive laminoplasty due to cervical spondylotic myelopathy. The Japanese Orthopedic Association (JOA) score and 3 cervical sagittal parameters including C2-C7 SVA, C0-2 Cobb angle and T1-Slope on lateral view radiographs were recorded before operation and at the final follow-up. The average follow-up period was 16.7 (3-40) months. The post-operative JOA score rose to 14.6 ± 0.2 from pre-operative 12.2 ± 0.3 with 43.5% ± 4.2% recovery rate. The post-operative values of C2-C7 SVA, C0-2 Cobb angle and T1-Slope were significantly different from pre-operative ones (P = 0.022, P < 0.001, P = 0.002) . C2-C7 SVA increased to (23.0 ± 1.2) mm from pre-operative (20.7 ± 1.1) mm. C0-2 Cobb angle increased (23.1 ± 0.8) ° from pre-operative (19.9 ± 0.8)°; T1-Slope increased to (26.2 ± 0.7)° from pre-operative (25.1 ± 0.7)°. The changes of C0-2 Cobb angle and T1-Slope were correlated with that of C2-C7 SVA respectively (Pearson = 0.469, P < 0.001) (Pearson = 0.303, P = 0.004) . Patients with higher preoperative T1-Slope had less JOA improvement (31.5% vs 53.7%, P = 0.019) than those with lower preoperative T1-Slope after laminoplasty. The sagittal balance of cervical spine significantly changes after open-door expansive laminoplasty with forward tilting of cervical vertebra. And compensation occurs by excessive high-strength contraction of posterior muscles to maintain lordosis in upper cervical spine. A higher pre-OP T1-Slope affects the outcomes of open-door expansive laminoplasty.

Surgical management of multilevel cervical spinal stenosis and spinal cord injury complicated by cervical spine fracture.

BackgroundThere are few reports regarding surgical management of multilevel cervical spinal stenosis with spinal cord injury. Our purpose is to evaluate the safety and feasibility of open-door expansive laminoplasty in combination with transpedicular screw fixation for the treatment of multilevel cervical spinal stenosis and spinal cord injury in the trauma population.MethodsThis was a retrospective study of 21 patients who had multilevel cervical spinal stenosis and spinal cord injury with unstable fracture. An open-door expansive posterior laminoplasty combined with transpedicular screw fixation was performed under persistent intraoperative skull traction. Outcome measures included postoperative improvement in Japanese Orthopedic Association (JOA) score and incidence of complications.ResultsThe average operation time was 190 min, with an average blood loss of 437 ml. A total of 120 transpedicular screws were implanted into the cervical vertebrae between vertebral C3 and C7, including 20 into C3, 34 into C4, 36 into C5, 20 into C6, and 10 into C7. The mean preoperative JOA score was 3.67 ± 0.53. The patients were followed for an average of 17.5 months, and the average JOA score improved to 8.17 ± 1.59, significantly higher than the preoperative score (t = 1.798, P < 0.05), with an average improvement of 44.7 ± 11.7%. Postoperative complications in four patients included cerebrospinal fluid leakage, delayed wound healing, pulmonary infection, and urinary system infection. All four patients were responsive to antibiotic treatment; one died from respiratory failure 3 months postoperatively.ConclusionsThe open-door expansive laminoplasty combined with posterior transpedicular screw fixation is feasible for treating multilevel cervical spinal stenosis and spinal cord injury complicated by unstable fracture. Its advantages include minimum surgical trauma, less intraoperative blood loss, and satisfactory stable supportive effect for reduction of fracture.

Expansive open-door laminoplasty secured with titanium miniplates is a good surgical method for multiple-level cervical stenosis.

BackgroundLaminoplasty is an effective procedure for treating cervical spondylotic myelopathy (CSM). Little information is available regarding the surgical outcomes of expansive open-door laminoplasty (EOLP) when securing with titanium miniplates without bone grafting. This study is aimed to elucidate the efficacy of and problems associated with EOLP secured with titanium miniplates without bone grafting, thereby enhancing future surgical outcomes.MethodsThis is a retrospective study. The study participants comprised 104 patients who underwent cervical EOLP secured with titanium miniplates without bone graft for CSM treatment between August 2005 and March 2011. The clinical results were evaluated based on the Japanese Orthopedic Association (JOA) and Nurick scores. The radiographic outcomes were determined based on plain film and magnetic resonance imaging findings, which were assessed and compared.ResultsLateral cervical spine X-rays exhibited improvement in the Pavlov ratio of the spinal canal at 1 day postoperation, and this ratio did not change at 1 year postoperation. The mean cervical curvature from C2 to C7 decreased 0.21° ± 10.09° and the mean cervical range of motion was deteriorated by 35% at 12 months (P < 0.05). The Nurick score improved from 3.19 ± 1.06 to 0.92 ± 1.32 (P < 0.05). The mean JOA recovery rate was 75% ± 21.1% at 1 year. The mean level of postoperative neck pain at 3 months was 3.09 ± 2.31, as determined using the visual analogue scale (VAS). Increased age, concomitant thoracolumbar stenosis, depression disorder, and preexisting myelomalacia negatively affected the JOA recovery rate (P < 0.05). A decreased preoperative Nurick score and superior sensory function in the upper extremities were powerful predictors of an enhanced JOA recovery rate. The postoperative complications involved hematoma formation 0.9%, reversible C5 nerve palsy 2.8%, and moderate to severe neck pain (VAS ≥ 4) 42%. No cases of lamina closure or collapse were observed.ConclusionEOLP secured with titanium miniplates without bone grafting is a safe and effective surgical method for treating most patients with CSM.

Laminar Reclosure After Single Open-door Laminoplasty Using Titanium Miniplates Versus Suture Anchors

Laminar closure is associated with expansive open-door laminoplasty. Suture anchor fixation and titanium miniplate fixation are used to prevent laminar reclosure. However, few studies have compared the clinical effects of the 2 fixation methods. The authors performed a prospective study of 55 patients with cervical spondylotic myelopathy who underwent single open-door laminoplasty with suture anchor fixation (n=30) or titanium miniplate fixation (n=25) from June 2005 to May 2011. Clinical and radiologic outcomes were evaluated at 1 week and 1 year postoperatively. There were no significant differences between the 2 groups in terms of Japanese Orthopaedic Association (JOA) scores, JOA recovery rates at 1 week postoperatively, and the incidence of C5 palsy. Compared with the suture anchor group, the recovery rate in the titanium miniplate group was significantly higher at 1 year postoperatively, and the incidence of axial symptoms and mean axial symptom scores were significantly lower at 1 week, but not 1 year, postoperatively. Radiologic examination showed no significant differences in the anteroposterior diameter of the spinal cord and the vertebral body-to-spinal cord distance between the 2 groups. At 1 year postoperatively, the opening angle in the suture anchor group was significantly less than that in the titanium miniplate group. Titanium miniplate fixation is more effective than suture anchor fixation in preventing laminar closure, accompanied by a higher JOA recovery rate at 1-year follow-up and a lower incidence of axial symptoms.

Expansive open-door laminoplasty for cervical spondylotic myelopathy

Expansive open-door laminoplasty for cervical spondylotic myelopathy

Risk factors associated with upper extremity palsy after expansive open-door laminoplasty for cervical myelopathy

Background contextPostoperative paresis, so-called C5 palsy, of the upper extremities is a common complication of cervical surgery. There have been several reports about upper extremity palsy after cervical laminoplasty for patients with cervical myelopathy. However, the possible risk factors remain unclear. PurposeTo investigate the factors associated with the development of upper extremity palsy after expansive open-door laminoplasty for cervical myelopathy. Study designA retrospective review of medical records. Patient sampleA total of 102 patients (76 men and 26 women) were eligible for analysis in this study. The mean age of the patients was 58.7 years (range 35–81 years). Sixteen patients (13 men and 3 women, average age 62.8 years) with palsy were categorized as Group P, and eighty-six patients (63 men and 23 women, average age 57.8 years) without palsy as Group C. Outcome measuresThe demographic data collected from both groups were age, sex, duration of symptoms, disease, and type of surgical procedure. Cervical curvature index, width of the intervertebral foramen (WIF) at C5, anterior protrusion of the superior articular process (APSAP), number of compressed segments, high–signal intensity zone at the level corresponding to C3–C5 (HIZ:C3–C5), and posterior shift of the spinal cord (PSSC) were also evaluated. MethodsUpper extremity palsy was defined as weakness of Grade 4 or less of the key muscles in the upper extremity by manual muscle test without any deterioration of myelopathic symptoms after surgery. Comparisons were made with screen for the parameters with significant differences, and then we further analyzed these parameters by logistic regression analysis (the forward method) to verify the risk factors of the upper extremity palsy. ResultsSignificant differences in diagnosis, the type of procedure, WIF, APSAP, and HIZ:C3–C5 were observed between the two groups. No statistical difference in PSSC between the groups was noted (2.06 vs. 2.53 mm, p=.247). In logistic regression analysis, ossification of the posterior longitudinal ligament (OPLL), cervical open-door laminoplasty together with posterior instrumented fusion (CLP+PIF), and WIF were found to be significant risk factors for postoperative upper extremity palsy. ConclusionsPatients with preoperative foraminal stenosis, OPLL, and additional iatrogenic foraminal stenosis because of CLP+PIF were more likely to develop postoperative upper extremity palsy. Attention should be given to the WIF determined on preoperative computed tomography of the C5 root. To prevent iatrogenic foraminal stenosis, appropriate distraction between spine segments should be provided during placement of the rod.

Preoperative design of expansive open-door laminoplasty: A computer-assisted morphometric analysis

Whereas the expansive open-door laminoplasty (EL) has been applied widely and the bone gutter on the hinge side is essential for EL, little is known regarding the mandatory width of the bone gutter. This study addressed the essential parameters of bone gutters for EL. Preoperative axial CT images of 20 patients suffering from cervical myelopathy were downloaded and entered into a computer. EL was then simulated using a computer-assisted technique and the thickness of the laminae at the gutter sites was measured. Accordingly, the width of the bone gutter was linked mathematically with the angle of the lifted lamina and the thickness of the lamina at the lamina-lateral mass junction. Furthermore, the average thickness of the laminae at the gutter site was 6.19 mm, and the appropriate bone gutter for EL was 5.13 to 7.15 mm. The width of the bone gutter can thus be planned precisely preoperatively, which may help improve the safety and accuracy of expansive open-door laminoplasty.

頚椎症性脊髄症に対する両開き式 (観音開き) 椎弓形成術と頚椎後弯の検討

頚椎症性脊髄症に対する両開き式 (観音開き) 椎弓形成術と頚椎後弯の検討

The effect of expansive open-door laminoplasty on spinal canal diameter: an experimental study on rabbits

The aim of this experimental study was to evaluate the effect of expansive open-door laminoplasty with simple suture fixation on spinal canal diameter in a rabbit model. Twenty white New Zealand rabbits were operated on with C4-C7 Hirabayashi open-door laminoplasty. The spinal canal diameter was evaluated radiologically on preoperative day 1 and postoperative days 1 and 42. The mean spinal canal diameter was 6.42 mm preoperatively, 8.04 mm on postoperative day 1 and 8.02 mm at day 42. There was a significant difference between the mean preoperative and postoperative day 1 spinal canal diameter (p<0.001). There was no significant difference between the mean spinal canal diameter at postoperative day 1 and 42 (p>0.05). Our results suggest that the open-door laminoplasty with simple suture fixation is an effective method to expand the spinal canal diameter. No recurrent narrowing is expected in short term.

Morphological Features and Clinical Significance of Epidural Membrane in the Cervical Spine

A prospective clinical study. To elucidate the histomorphological features and clinical significance of the epidural membrane (EM) in the cervical spine based on operative and histological findings. The anatomical features of the EM have been mostly discussed on the basis of cadaver studies in the whole spine. However, the histomorphological features and clinical significance of the EM in the cervical spine based on operative findings have never been reported. Eighty-seven patients with cervical spondylotic myelopathy who had undergone an expansive open-door laminoplasty under microscopy were evaluated with a more than 2-year follow-up period. The most damaged spinal segment was determined in each patient from the preoperative neurological and image findings along with the remaining symptoms at follow-up. The morphological features of the EM were observed and recorded in each patient during decompression. For histology, specimens of common and remarkable types of the EM obtained from 16 patients were examined. The age at surgery averaged 64.5 years; there were 58 men and 29 women. With regard to the most damaged spinal segment, there were 14 cases at the C3-C4 level, 37 at the C4-C5 level, 32 at the C5-C6 level, and 4 at the C6-C7 level. The EM was an adipo-fibro-vascular tissue with various histomorphologies, blending with the periradicular sheath. Some EMs showed notable findings: obstructing dural tube expansion (13 cases, 14.9%), compressing a nerve root or disturbing its mobility (4 cases, 4.6%), and the combined type (1 case, 1.1%). All of them were located at approximately the most damaged spinal segment. In addition, some EMs had interesting histological features, such as harboring many small arteries, calcified debris, and metaplastic bone fragments. The EM can develop into remarkable structures with spondylosis and aging in patients with cervical spondylotic myelopathy, affecting surgical outcomes as well as successful decompression procedures. A sound understanding of the histomorphological features of the EM is required to obtain satisfactory surgical outcomes in the limited field afforded by minimally invasive surgery.

Multifactor Analysis on the Outcomes of Cervical Spondylotic Myelopathy with Expansive Open-Door Laminoplasty

To examine clinical outcomes following expansive open-door laminoplasty (EOLP) in the treatment of multilevel cervical spondylotic myelopathy (CSM) and the factors that influence these outcomes. This retrospective analysis in CSM patients following EOLP investigated the relationship between recovery rate, based on the Japanese Orthopaedic Association (JOA) score, and the impact of age, duration of CSM, and axial symptoms, including the effect of EOLP on cervical curvature. In total, 79 CSM patients were included. Overall, the preand postoperative (1 year after surgery) mean±SD JOA scores were 9.6±1.4 and 14.7±1.9, respectively, indicating an improvement of 68.9%. Factors that were significantly related to 'excellent' (≥75%) or 'good' (≥50%-<75%) recovery rates included a high preoperative JOA score, short duration of CSM (≤12 months) and patient age<50 years. Significant reductions in cervical curvature angle were only observed in patients with axial symptoms. These results indicate that CSM should be treated early. The severity of CSM, the patient's age, cervical curvature angle, operation technique and axial symptoms play important roles in clinical outcomes.

Expansive Open-door Laminoplasty With Titanium Miniplate Versus Sutures

Expansive laminoplasty is an effective treatment for cervical myelopathy. Since the design of classic open-door laminoplasty with the use of suture, the procedure has been modified to reduce complications such as restenosis, axial symptoms, and segmental motor paralysis. Expansive open-door laminoplasty with the use of titanium miniplate is becoming popular. It is effective in expanding spinal canal dimensions with good clinical efficacy. However, a lack of studies exist comparing titanium miniplate fixation with classical suture fixation.We performed a retrospective study of 54 patients with cervical myelopathy. Twenty-nine patients (4 women and 25 men) receiving expansive open-door laminoplasty by titanium miniplate fixation were classified as the modified group, and 25 patients (5 women and 20 men) fixed with suture served as the control group. Clinical and radiologic outcomes were assessed. No significant differences were observed in Japanese Orthopaedic Association scores and the recovery rate of C5 palsy. The incidence of axial symptoms in the modified group was significantly lower than that in control group. Radiologic examination showed that postoperative C2-C7 lordosis and range of motion of the cervical spine in the modified group were preserved. No significant differences were observed in mean anteroposterior diameter and open angle in the 2 groups. Both surgical protocols were effective in preventing reclosure of open laminae. Furthermore, the modified laminoplasty was superior in reducing the incidence of axial symptoms and loss of cervical lordosis and range of motion.

Effect of cervical curvature and intervertebral height on the surgical outcome of posterior decompression

Objective To analyze the effect of cervical.curvature and intervertebral height on the surgical outcome of posterior decompression in patients with multi-level cervical spondylotic myelopathy.Method A total of 50 patients with multi-segment cervical spondylotic myelopathy (≥ 3 segments),treated with posterior decompression from June 2006 to January 2009 were retrospectively analyzed.Twenty six patients underwent cervical omni-posterior decompression and lateral mass screw internal fixation (group A); 24patients underwent expansive open-door laminoplasty (group B).The effects of changing of cervical curvature and intervertebral height on JOA score and VAS score were analyzed.Results All patients were followed up for 8 months to 4 years (average,24 ±5.5 months).There were statistical differences of cervical curvature angles between preoperative and 3 days postoperatively in group A,while no statistical differences in group B.There were no statistical differences of cervical curvature angles between 3 days,6 months and 3 years postoperatively in group A,while there were differences in group B After further analysis of the loss of cervical curvature and intervertebral height,the result showed that JOA score and VAS score in the low-loss group were better than those in the high-loss group.Conclusion Lateral mass screw internal fixation after cervical omni-posterior decompression had many advantages such as reducing the change of cervical curvature,the loss of intervertebral height and incidence of cervical axial symptoms. Key words: Cervical vertebrae; Spinal cord compression; Treatment outcome