A less-invasive cervical laminoplasty for spondylotic myelopathy that preserves the semispinalis cervicis muscles and nuchal ligament

Clinical article

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Object

Modified cervical laminoplasty techniques have been developed to reduce postoperative axial neck pain and preserve function in patients with cervical spondylotic myelopathy (CSM). However, the previous studies demonstrating satisfactory surgical outcomes had a retrospective design. Here, the authors aimed to prospectively evaluate the 2-year outcomes of a modified cervical laminoplasty technique for CSM that preserves the paravertebral muscles.

Methods

Outcomes were analyzed for 40 patients (22 men and 18 women; mean age, 66.6 years; age range 44–92 years) with CSM who underwent C4–6 laminoplasty with C-3 and C-7 partial laminectomies or C-3 total and C-7 partial laminectomies and received hydroxyapatite spacers. Neurological, pain severity, and spinal radiographic evaluations were performed preoperatively and at 3, 6, 12, 18, and 24 months postoperatively. Plain radiography and MRI of the cervical spine were performed to evaluate the range of motion (ROM), sagittal alignment, and cross-sectional areas of the deep extensor muscles. The extent of bone–spacer bonding and bony union at the gutter was assessed by CT.

Results

The mean preoperative Japanese Orthopaedic Association CSM score was 10.2, but it increased to 14.4 by 24 months after surgery. Eleven patients had axial neck pain preoperatively, but only 3 reported mild pain at 24 months, and in all 3 cases the pain was mild. The mean angle of lordosis was 11.7° preoperatively and 12.0° 2 years postoperatively. Although the ROM at the C2–7 levels was significantly reduced 3 months postoperatively, an increasing trend was observed up to 12 months, and 86% of the preoperative ROM was achieved by 2 years postoperatively. The mean paravertebral muscle cross-sectional areas were 833 ± 215 mm2 preoperatively and 763 ± 197 mm2 24 months postoperatively, but the difference was not statistically significant. The rates of bone–spacer bonding and bony union at the gutter were low during the early stages but increased to 90% and 93%, respectively, by 2 years after surgery.

Conclusions

The modified laminoplasty technique used in this study ensured very good neurological status and ROM after 2 years and was associated with low incidences of axial neck pain and serious complications. This simple and easy operative method could benefit future laminoplasty protocols.

Abbreviations used in this paper:CSM = cervical spondylotic myelopathy; HA = hydroxyapatite; JOA = Japanese Orthopaedic Association; Oc = occiput; ROM = range of motion.

Article Information

Address correspondence to: Masayuki Umeda, M.D., Ph.D., Department of Orthopedic Surgery, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka 573-1191, Japan. email: gnsumd@hotmail.com.

Please include this information when citing this paper: published online March 29, 2013; DOI: 10.3171/2013.2.SPINE12468.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Images obtained in a 72-year-old man with CSM. Sagittal plain radiograph (A) and sagittal CT image (B) obtained 2 years after partial laminectomy on the caudal side of the C-3 vertebra and rostral side of the C-7 vertebra.

  • View in gallery

    Illustration of open-door C4–6 laminoplasty with HA spacers. C-3 total laminectomy and C-7 dome decompressions on the proximal ventral side of the arcus vertebrae were performed. The insertions of the paravertebral muscles, including the semispinalis, into the C-2 spinous processes and the continuity of the nuchal ligament and paravertebral muscles at the C-7 spinous processes were completely conserved.

  • View in gallery

    Magnetic resonance images obtained in a 61-year-old woman with CSM. A: Preoperative sagittal T2-weighted MR image demonstrating spinal canal compression at the C2–3 and C6–7 levels. B: Postoperative sagittal T2-weighted MR image showing decompression at the C2–3 and C6–7 levels by C-3 total and C-7 partial laminectomies, respectively.

  • View in gallery

    Changes in the neurological status evaluated preoperatively and postoperatively according to the CSM scoring system of the JOA. The bars indicate standard deviations. *p < 0.05 compared with the preoperative JOA scores by the Mann-Whitney U-test.

  • View in gallery

    Incidences of axial neck pain (AP) preoperatively and at 3, 6, 12, 18, and 24 months postoperatively. Pain was classified into 4 grades: severe (pain medication or local injection regularly needed), moderate (physiotherapy or compression regularly needed), mild (no treatment needed), and none.

  • View in gallery

    Changes in the cross-sectional areas of the cervical posterior deep extensor paravertebral muscles (PVM) calculated from preoperative and postoperative axial T2-weighted MR images. The bars indicate standard deviations. *p < 0.05 compared with the preoperative measurements by the Mann-Whitney U-test.

  • View in gallery

    Postoperative changes in bone–spacer bonding and bony union at the gutters. Bone–spacer bonding was defined as the absence of a clear space between the bone and the spacer. Bony union at the gutters was considered to have occurred when both cortices were observed.

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