Long-term clinical results of microsurgical transdural discectomy with laminoplasty: follow-up results over 10 years

Clinical article

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Object

In this retrospective analysis the authors describe the long-term clinical results of microsurgical transdural discectomy with laminoplasty (MTDL) in patients with cervical disc herniation (CDH).

Methods

Thirty patients (21 males, 9 females; mean age at surgery 55 years) with CDH had surgical treatments consisting of MTDL between 1990 and 1998. All patients demonstrated signs or symptoms of cervical myelopathy and/or radiculomyelopathy. Clinical outcomes were evaluated by the Japanese Orthopaedic Association (JOA) scoring system and by recovery rate (RR). The degenerative grades of the intervertebral discs were also evaluated based on preoperative, postoperative, and final follow-up MR images. The average follow-up period was 14.1 years (range 10–22 years).

Results

Twenty (67%) of the 30 patients completed the follow-up in this study. The preoperative JOA scores in these patients averaged 11.8, and the postoperative scores at the final follow-up averaged 15.5 (average RR 69.6%). None of these patients required reoperation after MTDL. Although disc degeneration progressed during the follow-up period, there were no cases of clinical deterioration, recurrence of disc herniation, or postoperative kyphotic deformity.

Conclusions

Sufficient clinical results were obtained after the MTDL for a long-term follow-up period exceeding 10 years. The MTDL may be an option for an alternative procedure if the patients are correctly selected and the procedure is safely performed.

Abbreviations used in this paper:ACDF = anterior cervical discectomy and fusion; CDH = cervical disc herniation; ESCP = evoked spinal cord potential; JOA = Japanese Orthopaedic Association; MTDL = microsurgical transdural discectomy with laminoplasty; RR = recovery rate.

Article Information

Address correspondence to: Nobuhiro Tanaka, M.D., Department of Orthopaedic Surgery, Institute of Biomedical & Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551, Japan. email: nobut@hiroshima-u.ac.jp.

Please include this information when citing this paper: published online April 5, 2013; DOI: 10.3171/2013.3.SPINE12673.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    The dorsal dura mater after a left, open, and expansive laminoplasty. The upper portion of each photograph shows the lifted laminae; the medial and lower portions show the articular facets of the cervical spine; the lateral side and left view show the cephalad side; and the right portion shows the caudal side. Upper: The dorsal dura mater at the level of the cervical disc herniation was longitudinally incised, while the arachnoid membrane was preserved. Lower: The surgical procedure proceeded within the space between the subdural and the extraarachnoid space, and the dentate ligament (arrow) was transected.

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    Discectomy procedure. A: The cervical cord and rootlets were slowly retracted to the medial aspect using a small spatula, and the ventral dura mater was then incised vertically about 1 cm. B: The disc fragments were milked through the hole of the ventral dura mater with a blunt hook and spatula. C: The fragments were removed using a small pituitary rongeur.

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    Repair of the dura mater. Upper: After the discectomy, the ventral dura mater was repaired using 6-0 nylon sutures. Lower: The dorsal dura mater was repaired in a watertight fashion using 6-0 nylon sutures.

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    Graph showing JOA scores at preoperative, midterm, and final follow-up examinations. The scores were significantly improved after surgery and were maintained without statistical differences between midterm and final follow-up evaluations. *p < 0.05.

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    Magnetic resonance images obtained in a 51-year-old man. Preoperative sagittal T1- (A) and T2-weighted (B) images show disc herniation at C5–6 (arrow) with multilevel canal stenosis, especially at C4–5 and C6–7 (arrowheads). Axial T1- (C) and T2-weighted (D) images demonstrate a paracentral disc herniation.

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    Follow-up MR images acquired 14.2 years after surgery in the same patient in Fig. 5. Postoperative sagittal T1- (A) and T2-weighted (B) images show a well-decompressed spinal cord after C3–6 laminoplasty with transdural discectomy. Axial T1- (C) and T2-weighted (D) images demonstrate no significant recurrences of the disc herniation.

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    Postoperative flexion (left) and extension (right) radiographs acquired in the same patient in Figs. 5 and 6. The postoperative range of motion of the cervical spine was 45° without any axial pain.

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