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

Clinical article

Restricted access


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).


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).


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.


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.



  • View in gallery

    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.

  • View in gallery

    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.

  • View in gallery

    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.

  • View in gallery

    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.

  • View in gallery

    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.

  • View in gallery

    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.

  • View in gallery

    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.


  • 1

    Baba HFurusawa NImura SUda TNaito KOhata K: Late radiographic findings after anterior cervical fusion for spondylotic radiculomyelopathy. Spine (Phila Pa 1976) 18:216721731993

  • 2

    Bradford FKSpurling RG: The Intervertebral Disc Springfield, ILCharles C Thomas1941

  • 3

    Eyre DBenya PBuckwalter JGatersion BHeinegard DOegema T: The intervertebral disc: basic science perspectives. Frymoyer JWGordon SL: New Perspectives on Low Back Pain Park Ridge, ILAmerican Academy of Orthopaedic Surgeons1989. 147207

  • 4

    Flynn TB: Neurologic complications of anterior cervical interbody fusion. Spine (Phila Pa 1976) 7:5365391982

  • 5

    Fox MWOnofrio BM: Transdural approach to the anterior spinal canal in patients with cervical spondylotic myelopathy and superimposed central soft disc herniation. Neurosurgery 34:6346421994

  • 6

    Fujimoto YBaba ISumida TTanaka NOka SKawagoe H: Microsurgical transdural discectomy with laminoplasty: new treatment for paracentral and paracentroforaminal cervical disc herniation associated with spinal canal stenosis. Spine (Phila Pa 1976) 27:7157212002

  • 7

    Goffin Jvan Loon JVan Calenbergh FPlets C: Long-term results after anterior cervical fusion and osteosynthetic stabilization for fractures and/or dislocations of the cervical spine. J Spinal Disord 8:4995081995

  • 8

    Gore DRSepic SB: Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients. Spine (Phila Pa 1976) 9:6676711984

  • 9

    Herkowitz HNKurz LTOverholt DP: Surgical management of cervical soft disc herniation. A comparison between the anterior and posterior approach. Spine (Phila Pa 1976) 15:102610301990

  • 10

    Hilibrand ASCarlson GDPalumbo MAJones PKBohlman HH: Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:5195281999

  • 11

    Hirabayashi KMiyakawa JSatomi KMaruyama TWakano K: Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976) 6:3543641981

  • 12

    Hirabayashi KWatanabe KWakano KSuzuki NSatomi KIshii Y: Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine (Phila Pa 1976) 8:6936991983

  • 13

    Iwasaki MEbara SMiyamoto SWada EYonenobu K: Expansive laminoplasty for cervical radiculomyelopathy due to soft disc herniation. Spine (Phila Pa 1976) 21:32381996

  • 14

    Lunsford LDBissonette DJJannetta PJSheptak PEZorub DS: Anterior surgery for cervical disc disease. Part 1: Treatment of lateral cervical disc herniation in 253 cases. J Neurosurg 53:1111980

  • 15

    Morishita YNaito MHymanson HMiyazaki MWu GWang JC: The relationship between the cervical spinal canal diameter and the pathological changes in the cervical spine. Eur Spine J 18:8778832009

  • 16

    Robinson RASmith GW: Anterolateral disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp 96:2232241955. (Abstract)

  • 17

    Sasai KSaito TOhnari HYamamoto TKasuya TWakabayashi E: Microsurgical posterior herniotomy with en bloc laminoplasty: alternative method for treating cervical disc herniation. J Spinal Disord Tech 18:1711772005

  • 18

    Smith GWRobinson RA: The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40-A:6076241958

  • 19

    Stookey B: Compression of spinal cord and nerve roots by herniation of the nucleus pulposus in the cervical region. Arch Surg 40:4174321940

  • 20

    Stookey B: Compression of the spinal cord due to ventral extradural cervical chondromas. Diagnosis and surgical treatment. Arch Neurol Psychiatry 20:2752911928

  • 21

    Taylor AS: X. Unilateral laminectomy. Ann Surg 51:5295331910

  • 22

    Teramoto TOhmori KTakatsu TInoue HIshida YSuzuki K: Long-term results of the anterior cervical spondylodesis. Neurosurgery 35:64681994

  • 23

    Yoshida MTamaki TKawakami MHayashi NAndo M: Indication and clinical results of laminoplasty for cervical myelopathy caused by disc herniation with developmental canal stenosis. Spine (Phila Pa 1976) 23:239123971998




All Time Past Year Past 30 Days
Abstract Views 68 68 13
Full Text Views 70 70 2
PDF Downloads 208 208 2
EPUB Downloads 0 0 0


Google Scholar