Lumbar Laminoplasty Research Articles

Clinical and Radiographic Results of Expansive Lumbar Laminoplasty in Patients with Spinal Stenosis

Clinical and Radiographic Results of Expansive Lumbar Laminoplasty in Patients with Spinal Stenosis

Spinal stenosis at the adjacent level after expansive lumbar laminoplasty

Spinal stenosis at the adjacent level after expansive lumbar laminoplasty

Clinical and radiographic results of expansive lumbar laminoplasty in patients with spinal stenosis.

In 1981, we developed a technique of expansive lumbar laminoplasty to alleviate the problems of conventional laminectomy in the treatment of spinal stenosis. The purposes of this study were to assess the long-term outcome following expansive lumbar laminoplasty and to investigate the postoperative problems. Fifty-four patients underwent expansive lumbar laminoplasty for the treatment of spinal stenosis. There were forty-three men and eleven women with a mean age of 52.6 years. The average length of follow-up was 5.5 years. Preoperatively, twenty-five patients had degenerative stenosis; thirteen, stenosis due to spondylolisthesis; twelve, combined stenosis (disc herniation and stenosis); and six, hyperostotic stenosis. (Two patients with hyperostotic stenosis and spondylolisthesis were included in both groups.) The clinical results were assessed with use of the Japanese Orthopaedic Association score, and the rate of recovery was calculated. Radiographic findings were analyzed on the basis of the cross-sectional area of the spinal canal, kyphosis, range of motion of the lumbar spine, and the rate of interlaminar fusion. The average recovery rate at the time of the last follow-up was 69.2% for patients with degenerative stenosis, 66.5% for patients with combined stenosis, 65.2% for those with hyperostotic stenosis, and 54.7% for those with spondylolisthesis. The factors resulting in a poor recovery were an older age and insufficient decompression of the lateral stenosis. During the follow-up period, the Japanese Orthopaedic Association score became worse for seven patients, six patients had lesions develop at the level adjacent to the laminoplasty, and five patients had spondylolisthesis develop. Interlaminar fusion was observed in twenty-two patients (41%). The satisfactory results of expansive lumbar laminoplasty were maintained at an average of 5.5 years after surgery. The best indications for the lumbar laminoplasty procedure were young and active patients with central spinal stenosis.

椎弓形成時のhole in one guideの使用経験

椎弓形成時のhole in one guideの使用経験

Clinical results of lumbar laminoplasty with spinous flap for lumbar canal stenosis with sagittal saw

Clinical results of lumbar laminoplasty with spinous flap for lumbar canal stenosis with sagittal saw

Expansive lumbar laminoplasty for degenerative spinal stenosis in patients below 70 years of age.

We reviewed the clinical and radiological results of patients with lumbar degenerative spinal stenosis who underwent expansive laminoplasty with a mean follow-up term of 5.6 years. Twenty-seven patients underwent open-door-type expansive lumbar laminoplasty, which has both decompression and stabilization effects. Clinical results were assessed based on the score system devised by the Japanese Orthopaedic Association (JOA score). The number and causes of repeat surgery were also evaluated. Radiological changes, such as degenerative scoliosis and spondylolisthesis, were evaluated at the operated levels and at levels L1-L5. There was marked recovery of clinical symptoms assessed by pre- and postoperative JOA score. Nearly 80% of patients obtained good or excellent results. Only one patient (4%) required additional surgery, which involved discectomy at the caudal level of the laminoplasty. Radiographic evaluation revealed that postoperative changes of spondylolisthesis and scoliosis were slight both in the expanded area and the L1-L5 levels. Range of motion of the disc space angle in the expanded area showed a significant decrease postoperatively. However, pre- and postoperative radiological changes showed no significant correlation with JOA score changes and repeat surgery. In conclusion, lumbar fusion after posterior decompression in active patients with spinal stenosis offers satisfactory clinical results concomitantly with a relatively small risk of repeat surgery.