Modified open-door laminoplasty for multiple-segment cervical spondylotic myelopathy

English Keywords:Cervical spondylotic myelopathy  Single open-door laminoplasty  Anchoring method  Axial syndrome  Semispinalis cervicis

English Abstract:

  【Abstract】 Objectives: To discuss the clinical effect of C3　laminectomy and C4-C7 open-door laminoplasty for cervical spondylotic myelopathy(CSM). Methods: From January 2009 to October 2011, 74 patients underwent extensive open-door laminoplasty, detailed as C3 laminectomy reserving attachment of musculus semi-spinalis cervicis and C4-C7 modified open-door laminoplasty. 57 patients got follow-up. Among them, there were 31 males and 26 females. The ages ranged from 50 to 71 years with a mean age of 63 years. The JOA scores were 4-11 points, with a mean of 8.5±2.0 before the operation. The range of motion was 23°-49° with a mean of 37.4°±10.3°. The cervical curvature index was 6.0%-22.0%, with a mean of (13.9±7.4)%. The preoperative and postoperative JOA scores were recorded. The JOA score and the incidence of axial symptom were reviewed. At six months after the operation, the change of ROM and cervical curvature index was noted. Results: The mean operative time was 70min ranging from 50 to 110min. The mean volume of blood loss was 230ml ranging from 150ml to 600ml. No complication such as spinal cord injury or cerebrospinal fluid leakage was noted. 41 patients had early postoperative neck pain, which resolved after corresponsive management. The rate of evident axial symptom was 15.8%. Two patients developed wound infection. Six patients were complicated with C5 nerve root palsy, which alleviated after symptomatic treatment. The patients with postoperative neurological deficit improved to different degrees. The postoperative JOA scores were 10-17 points, with a mean of 13.8±2.3 points, which showed significant difference (P<0.05). The JOA improvement rate was 29.0%-77.3%, with a mean of (57.0±19.7)%. Loss of cervical curvature index was (2.9±2.4)%. The range of motion was 18°-46° with a mean of 28.2°±10.8°, and the loss of ROM was 8.2°±5.1°.　No door-reclose was noted during follow-up. Conclusions: C3　laminectomy reserving attachment of musculus semi-spinalis cervicis and C4－C7 open-door laminoplasty for cervical spondylotic myelopathy is reliable and simple.