Download PDF
CC BY-NC-ND 4.0 · J Neurol Surg A Cent Eur Neurosurg 2022; 83(05): 494-501
DOI: 10.1055/s-0041-1739224
Surgical Technique

Surgical Treatment of Multilevel Degenerative Cervical Myelopathy: Open-Door Laminoplasty and Fixation via Unilateral Approach. A Feasibility Study

Gregor Schmeiser 
1   Department of Spine Surgery, Schoen-Klinik Hamburg-Eilbek, Hamburg, Germany
,
Janina Isabel Bergmann
1   Department of Spine Surgery, Schoen-Klinik Hamburg-Eilbek, Hamburg, Germany
,
Luca Papavero 
1   Department of Spine Surgery, Schoen-Klinik Hamburg-Eilbek, Hamburg, Germany
,
Ralph Kothe
2   Clinic for Spine Surgery, Schoen Clinic Hamburg Eilbek, Academic Hospital of the Eppendorf University Medical Center, Hamburg, Germany
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective We compared open-door laminoplasty via a unilateral approach and additional unilateral lateral mass screw fixation (uLP) with laminectomy and bilateral lateral mass screw fixation (LC) in the surgical treatment of multilevel degenerative cervical myelopathy (mDCM).

Methods A retrospective cohort analysis of 46 prospectively enrolled patients (23 uLP and 23 LC). The minimum follow-up was 1 year. Neck and arm pains were evaluated with visual analog scales and disability with the Neck Disability Index (NDI). Myelopathy was rated with the modified Japanese Orthopaedic Association (mJOA) score. Cervical sagittal parameters were measured on plain and functional X-ray films with a specific software. The statistical significance was set at p < 0.05. Fusion was defined as <2 degrees of intersegmental motion on flexion/extension radiographs.

Results The two groups were similar in age and comorbidities. The mean operation time and the mean hospital stay were shorter in the uLP group (p = 0.015). The intraoperative blood loss did not exceed 200 mL in both groups. At follow-up, the groups showed comparable clinical outcome data. The sagittal profile did not deteriorate in either group. Fusion rates were 67% in the uLP group and 92% in the LC group. No infections occurred in either group. In the LC group, one patient developed a transient C5 palsy. Revision surgery was required for a malpositioned screw (LC) and for one implant failure (uLP).

Conclusion Laminoplasty and unilateral fixation via a unilateral approach achieved comparable clinical and radiologic results with laminectomy and bilateral fixation, despite a lower fusion rate. However, the surgical traumatization was less.

Keywords

cervical myelopathy - laminoplasty - laminectomy - Lateral mass screws


Publication History

Received: 21 December 2020

Accepted: 23 April 2021

Article published online:
15 December 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Karadimas SK, Gatzounis G, Fehlings MG. Pathobiology of cervical spondylotic myelopathy. Eur Spine J 2015; 24 (Suppl. 02) 132-138
    CrossrefPubMedGoogle Scholar
  • 2 Bartels RHMA, van Tulder MW, Moojen WA, Arts MP, Peul WC. Laminoplasty and laminectomy for cervical sponydylotic myelopathy: a systematic review. Eur Spine J 2015; 24 (Suppl. 02) 160-167
    CrossrefPubMedGoogle Scholar
  • 3 Roselli R, Pompucci A, Formica F. et al. Open-door laminoplasty for cervical stenotic myelopathy: surgical technique and neurophysiological monitoring. J Neurosurg 2000; 92 (1, Suppl) 38-43
    CrossrefPubMedGoogle Scholar
  • 4 Nakashima H, Imagama S, Yukawa Y. et al. Multivariate analysis of C-5 palsy incidence after cervical posterior fusion with instrumentation. J Neurosurg Spine 2012; 17 (02) 103-110
    CrossrefPubMedGoogle Scholar
  • 5 Nassr A, Eck JC, Ponnappan RK, Zanoun RR, Donaldson III WF, Kang JD. The incidence of C5 palsy after multilevel cervical decompression procedures: a review of 750 consecutive cases. Spine 2012; 37 (03) 174-178
    CrossrefPubMedGoogle Scholar
  • 6 Liu K, Shi J, Jia L, Yuan W. Surgical technique: Hemilaminectomy and unilateral lateral mass fixation for cervical ossification of the posterior longitudinal ligament. Clin Orthop Relat Res 2013; 471 (07) 2219-2224
    CrossrefPubMedGoogle Scholar
  • 7 Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine 1981; 6 (04) 354-364
    CrossrefPubMedGoogle Scholar
  • 8 McAfee PC, Boden SD, Brantigan JW. et al. Symposium: a critical discrepancy-a criteria of successful arthrodesis following interbody spinal fusions. Spine 2001; 26 (03) 320-334
    CrossrefPubMedGoogle Scholar
  • 9 Tetreault L, Nouri A, Kopjar B, Côté P, Fehlings MG. the minimum clinically important difference of the modified Japanese Orthopaedic Association Scale in patients with degenerative cervical myelopathy. Spine 2015; 40 (21) 1653-1659
    CrossrefPubMedGoogle Scholar
  • 10 Carreon LY, Glassman SD, Campbell MJ, Anderson PA. Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion. Spine J 2010; 10 (06) 469-474
    CrossrefPubMedGoogle Scholar
  • 11 Wang X-Y, Dai L-Y, Xu H-Z, Chi Y-L. Prediction of spinal canal expansion following cervical laminoplasty: a computer-simulated comparison between single and double-door techniques. Spine 2006; 31 (24) 2863-2870
    CrossrefPubMedGoogle Scholar
  • 12 Yang L, Gu Y, Shi J. et al. Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy. Orthopedics 2013; 36 (01) e79-e87
    CrossrefPubMedGoogle Scholar
  • 13 Lee C-H, Lee J, Kang JD. et al. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes. J Neurosurg Spine 2015; 22 (06) 589-595
    CrossrefPubMedGoogle Scholar
  • 14 Phan K, Scherman DB, Xu J, Leung V, Virk S, Mobbs RJ. Laminectomy and fusion vs laminoplasty for multi-level cervical myelopathy: a systematic review and meta-analysis. Eur Spine J 2017; 26 (01) 94-103
    CrossrefPubMedGoogle Scholar
  • 15 Albert TJ, Vacarro A. Postlaminectomy kyphosis. Spine 1998; 23 (24) 2738-2745
    CrossrefPubMedGoogle Scholar
  • 16 Kato M, Namikawa T, Matsumura A, Konishi S, Nakamura H. Effect of cervical sagittal balance on laminoplasty in patients with cervical myelopathy. Global Spine J 2017; 7 (02) 154-161
    CrossrefPubMedGoogle Scholar
  • 17 Nowinski GP, Visarius H, Nolte LP, Herkowitz HN. A biomechanical comparison of cervical laminaplasty and cervical laminectomy with progressive facetectomy. Spine 1993; 18 (14) 1995-2004
    CrossrefPubMedGoogle Scholar
  • 18 Sakaura H, Ohnishi A, Yamagishi A, Ohwada T. Differences in postoperative changes of cervical sagittal alignment and balance after laminoplasty between cervical spondylotic myelopathy and cervical ossification of the posterior longitudinal ligament. Global Spine J 2019; 9 (03) 266-271
    CrossrefPubMedGoogle Scholar
  • 19 Kothe R, Rüther W, Schneider E, Linke B. Biomechanical analysis of transpedicular screw fixation in the subaxial cervical spine. Spine 2004; 29 (17) 1869-1875
    CrossrefPubMedGoogle Scholar
  • 20 Dmitriev AE, Kuklo TR, Lehman Jr RA, Rosner MK. Stabilizing potential of anterior, posterior, and circumferential fixation for multilevel cervical arthrodesis: an in vitro human cadaveric study of the operative and adjacent segment kinematics. Spine 2007; 32 (06) E188-E196
    CrossrefPubMedGoogle Scholar
  • 21 Schmeiser G, Schilling C, Grupp TM, Papavero L, Püschel K, Kothe R. Unilateral laminoplasty with lateral mass screw fixation for less invasive decompression of the cervical spine: a biomechanical investigation. Eur Spine J 2015; 24 (12) 2781-2787
    CrossrefPubMedGoogle Scholar
  • 22 Su N, Fei Q, Wang B-Q. et al. Comparison of clinical outcomes of expansive open-door laminoplasty with unilateral or bilateral fixation and fusion for treating cervical spondylotic myelopathy: a multi-center prospective study. BMC Surg 2019; 19 (01) 116
    CrossrefPubMedGoogle Scholar
  • 23 Schulze M, Trautwein F, Vordemvenne T, Raschke M, Heuer F. A method to perform spinal motion analysis from functional X-ray images. J Biomech 2011; 44 (09) 1740-1746
    CrossrefPubMedGoogle Scholar