Surgical outcome of laminoplasty for cervical spondylotic myelopathy: a single-institution experience

Abstract

Background/aim: Cervical spondylotic myelopathy (CSM) develops as a result of compression of the spinal cord in the cervical region. Early diagnosis and surgical treatment can limit the progression of symptoms. Various surgical approaches and strategies have been described in the literature. This study aims to evaluate the clinical and radiological results of open-door laminoplasty for the treatment of CSM.

Materials and methods: In this study, we retrospectively analyzed the patients who underwent expansive open-door laminoplasty secured with titanium miniplates. Thirty-four patients with CSM who were followed up postoperatively for more than 12 months were included in the study. The modified Japanese Orthopaedic Association (mJOA) score was used to assess the degree of myelopathy. We evaluated cervical sagittal alignment with C2–C7 Cobb angle, the ambulatory status with the Nurick grade, and measured postoperative neck pain with the visual analogue scale (VAS).

Results: Themeanm JOA score was 11 (range 6–15) preoperatively, and 13.5 (range 9–16) postoperatively with an average 55% recovery rate (range 0–75) (p < 0.001). Themean–Nurick grade was 2 (range 1–3) preoperatively and 1 (range 0–3) postoperatively (p < 0.001). The median cervical lordotic angle increased from 7.5 ° preoperatively to 12.5 ° postoperatively (p = 0.044). K-line (+) patients› mean mJOA scores significantly increased from 10.8 ± 1.7 to 13.3 ± 1.7 postoperatively (p < 0.001). The mean preoperative VAS reduced from 2.66 ± 1.4 to 1.59 ± 1.4 postoperatively (p < 0.001).

Conclusion: Open-door laminoplasty technique is an effective surgical procedure that can be used safely to treat cervical spondylotic myelopathy. Our findings suggest that it can limit the progression of symptoms and alter the poor prognosis in CSM.

Keywords: K-line; laminoplasty; sagittal balance; Cervical spondylotic myelopathy.

Figure 1A

Sagittal T2-weighted MRI of a patient is demonstrating severe cervical spinal canal stenosis from C3 to C7, especially C3–4 and C5–6 due to degenerative disc protrusions and narrow spinal canal, causes complete CSF erasure and spinal cord compression at these levels. There is a high T2 signal noted within the cord due to both edema and myelomalacia. B. Axial T2-weighted MRI at C5–6 level is demonstrating severe spinal canal stenosis. C. Axial CT at C5–6 level is demonstrating intense calcification and spinal cord compression. D. Preoperative sagittal CT is demonstrating dense osteophyte formation which is apparent in both anterior and posteriorly. E. Postoperative sagittal CT is showing enlargement and space gained in the spinal canal. F. Postoperative axial CT is showing open door laminoplasty with titanium screws and plate and enlargement of the spinal canal.

Figure 2

Lateralc-spine x-ray. We calculated both the Cobblor doticangle (LA) (angle between lower C2 end plate and superior C7 endplate) and the kyphosis line (K-line) (in the neutral position of the neck drawn between midpoints of the spinal canal C2 to C7).

Figure 3A

Postoperative sagittal T2 weighted MRI is demonstrating enlargement of the cervical spinal canal and relief of CSF passaged raw attention. B. Postoperative axial T2 weighted MRI is showing enlargement of the cervical spinal canal.

Figure 4

The patients’ median mJOA score increased from 11 (range 6–15) to 13.5 (range 9–16) postoperatively.

Figure 5

The patients› median Nurick grade decreased from 2 (range 1–3) to 1 (range 0–3) postoperatively.