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Comparative Effectiveness of Open-Door Laminoplasty Versus French-Door Laminoplasty in Cervical Compressive Myelopathy

Nakashima, Hiroaki MD*; Kato, Fumihiko MD; Yukawa, Yasutsugu MD; Imagama, Shiro MD*; Ito, Keigo MD; Machino, Masaaki MD; Ishiguro, Naoki MD*

doi: 10.1097/BRS.0000000000000252
Cervical Spine

Study Design. Prospective randomized study.

Objective. This study aimed to prospectively compare the surgical results of the open- and French-door laminoplasty.

Summary of Background Data. Cervical laminoplasty is a common surgical procedure for the treatment of cervical compressive myelopathy. These procedures are primarily classified as either open- or French-door laminoplasties. Only few prospective studies comparing the surgical results of the 2 procedures are available.

Methods. A total of 92 patients with cervical compressive myelopathy who underwent cervical laminoplasty were prospectively enrolled and randomized into the following 2 groups according to the type of laminoplasty: open-door and French-door groups. A single attending spine surgeon performed all surgical procedures. The following factors were evaluated: surgical duration, blood loss, perioperative complications, neurological assessment using the Japanese Orthopedic Association score, and recovery rate. Radiological evaluations included assessment of the cervical lordotic angle and cervical range of motion. In addition, the ratio of postoperative spinal lamina opening was evaluated by magnetic resonance imaging.

Results. There were no differences in perioperative complications and neurological outcomes between the 2 groups. The mean reduction in cervical lordotic angle after surgery was significantly greater in the open-door group than the French-door group (3.0° vs. 5.6°). Postoperative cervical range of motion significantly decreased in the open-door group than in the French-door group (19.3° vs. 26.0°). Postoperative cervical lordotic angle in the extension position significantly diminished in the open-door group than in the French-door group (7.9° vs. 14.1°). The ratio of opening of the spinal lamina after surgery was significantly larger in the open-door group than in the French-door group.

Conclusion. The 2 laminoplasty methods showed almost the same neurological recovery as well as perioperative complications. In cases of open-door laminoplasty, postoperative cervical alignment became more kyphotic and cervical range of motion was more restricted than that in French-door laminoplasty cases after surgery. French-door laminoplasty is preferable to open-door laminoplasty for postoperative cervical alignments.

Level of Evidence: 1

The surgical results of open- and French-door laminoplasties were prospectively compared. There were no differences in the neurological outcome and postoperative complications between the 2 groups. However, postoperative cervical kyphosis and decreased cervical range of motion occurred more frequently in the open-door laminoplasty than in French-door laminoplasty.

*Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; and

Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan.

Address correspondence and reprint requests to Hiroaki Nakashima, MD, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Shouwa-ku, Nagoya, Aichi 466-8560, Japan; E-mail: hirospine@gmail.com

Acknowledgment date: July 22, 2013. First revision date: December 6, 2013. Acceptance date: January 6, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins