Risk factors for closure of lamina after open-door laminoplasty

Clinical article

Morio Matsumoto Departments of Advanced Therapy for Spine & Spinal Cord Disorders and

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Kota Watanabe Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan

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Takashi Tsuji Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan

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Ken Ishii Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan

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Hironari Takaishi Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan

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Masaya Nakamura Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan

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Yoshiaki Toyama Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan

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Kazuhiro Chiba Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan

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Object

This retrospective study was conducted to evaluate the prevalence and clinical consequences of postoperative lamina closure after open-door laminoplasty and to identify the risk factors.

Methods

Eighty-two consecutive patients with cervical myelopathy who underwent open-door laminoplasty without plates or spacers in the open side (Hirabayashi's original method) were included (62 men and 20 women with a mean age of 62 years and a mean follow-up of 1.8 years). In 67 patients the cause of cervical myelopathy was spondylotic myelopathy, and in 15 it was caused by ossification of posterior longitudinal ligament. Radiographic measurements were made of the anteroposterior diameters of the spinal canal and vertebral bodies from C3–6, and the presence of kyphosis were assessed. Lamina closure was defined as ≥ 10% decrease in the canal-to-body ratio at the final follow-up compared with that immediately after surgery at ≥ 1 vertebral level. The impact of lamina closure on neck pain, patient satisfaction, Japanese Orthopaedic Association scores, and recovery rates were also evaluated.

Results

The mean canal-to-body ratio at C3–6 was 0.69–0.72 preoperatively, 1.25–1.28 immediately after surgery, and 1.18–1.24 at the final follow-up examination. Lamina closure was observed in 34% of patients and was not associated with sex, age, or cause of myelopathy, but was significantly associated with the presence of preoperative kyphosis (p = 0.014). Between patients with and without lamina closure, there was no significant difference in preoperative (9.7 ± 3.1 vs 10.6 ± 2.5) and postoperative (13.7 ± 2.4 vs 13.1 ± 2.7) Japanese Orthopaedic Association scores, recovery rates (53.9 ± 29.9% vs 44.3 ± 29.5%), neck pain scores (3.5 ± 0.7 vs 3.3 ± 1.0), or patient satisfaction level (4.0 ± 1.4 vs 4.8 ± 1.0).

Conclusions

Lamina closure at ≥ 1 vertebral level occurred in 34% of patients. Although patients with lamina closure obtained equivalent recovery from myelopathy in a short-term follow-up, they tended to be less satisfied with surgery compared with those who did not have closure. The only significant risk factor identified was the presence of preoperative cervical kyphosis, and preventative methods for lamina closure, therefore, should be considered for patients with preoperative kyphosis.

Abbreviations used in this paper:

CBR = canal-to-body ratio; CI = confidence interval; JOA = Japanese Orthopaedic Association; OPLL = ossification of posterior longitudinal ligament; SD = standard deviation; VB = vertebral body.
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