Etiology and surgical strategies of reoperation after cervical laminoplasty

English Keywords:Cervical laminoplasty  Reoperation  Ossification of posterior longitudinal ligament

English Abstract:

  【Abstract】 Objectives: To evaluate the etiology and surgical strategies of reoperation after cervical laminoplasty. Methods: All the patients who received reoperation in our center from May 2006 to April 2016 after cervical laminoplasty were retrospectively evaluated, and to analyze radiographic parameters, clinical data and mJOA scores. Results: Forty-three patients were included in this study, and the interval between the two surgeries was 2-204 months(47.8±51.4 months). The etiology of reoperation included: (1)technique related reasons, 7 cases of lamina closure, 2 cases of nerve root or spinal cord compression due to hinge fracture; (2)inadequate decompression, 15 cases of large anterior compression, 1 case of cervical kyphosis; (3)disease progression, 14 cases of progressive ossification of posterior longitudinal ligament, 4 cases of herniated disc or osteophyte. Patients with large anterior soft compression, localized ossification of posterior longitudinal ligament or kyphosis were treated with anterior approach. Patients with lamina closure, nerve root or spinal cord compression due to hinge fracture or large ossification of posterior longitudinal ligament were treated with posterior approach. There were 28 cases of anterior approach and 14 cases of posterior approach, 1 case of combined approach. The mJOA score before the reoperation was 5.5-16(11.6±2.8), which increased to 8-17(13.7±2.1) at 3 months of follow-up. The rate of mJOA score improvement was 0-100%[（36.6±25.2）%]. Conclusions: The etiology of reoperation after cervical laminoplasty includes technique related reasons, inadequate decompression and disease progression. Personalized anterior or/and posterior approach reoperations with sufficient decompression guarantee fine clinical results.