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A Novel Technique for Laminoplasty Augmentation of Spinal Canal Area Using Titanium Miniplate Stabilization: A Computerized Morphometric Analysis

O'Brien, Michael F., MD*; Peterson, David, FRCS; Casey, Adrian T. H., FRCS; Crockard, H. Alan, FRCS

Cervical Spine

Study Design Titanium miniplates are used to secure the posterior elements in the open position after expansive open-door laminoplasty. Preoperative and postoperative spinal canal dimensions are measured to assess the effectiveness of this technique.

Objectives To develop a simple yet effective technique to stabilize the posterior elements after laminoplasty, and to compare preoperative and postoperative spinal canal dimensions to accepted normal values.

Summary of Background Data Expansive open-door laminoplasty has been offered as a simple alternative to laminectomy, which has been associated with postoperative kyphosis. Although the technique of laminoplasty is effective, a simple and reliable method of holding the posterior elements open has not been described.

Methods Ten myelopathic patients with multilevel cervical canal stenosis secondary to spondylosis or ossification of the posterior longitudinal ligament were treated with an expansive open-door laminoplasty. The posterior elements were stabilized in the open position with titanium miniplates. Computer-assisted morphometric analysis was performed on preoperative and postoperative computed tomography scans to obtain spinal canal dimensions. Plain radiographs were used to monitor construct integrity.

Results The preoperative sagittal canal diameter was 8.2 ± 0.96 mm, and the canal area was 180.6 ± 33.7 mm2. These dimensions increased after surgery to 16.6 ± 1.5 mm and 321.9 ± 29.7 mm2, respectively. The titanium miniplate constructs did not fail during the follow-up period (mean, 26.4 months), and the decompression was maintained. The single significant complication was a transient C5 radiculopathy.

Conclusions Normal canal dimensions can be reestablished with open-door laminoplasty. Achieving and maintaining an increased sagittal canal diameter is probably the most important change in anatomic parameters to facilitate neurologic recovery. The use of titanium miniplates to stabilize the posterior elements after laminoplasty is a simple, durable, and effective technique to maintain the increased sagittal diameter of the spinal canal.

From the *Center for Spinal Disorders, Denver, Colorado, and the Department of Surgical Neurology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom.

Presented at the 22nd Annual Meeting of the Cervical Spine Research Society, November 30-December 2, 1994, Baltimore, Maryland.

Acknowledgment date: February 8, 1995.

First revision date: July 24, 1995.

Acceptance date: August 31, 1995.

Device status category: 9.

Address reprint requests to: Michael F. O'Brien, MD; Center for Spinal Disorders, P.C.; 8515 Pearl St., Suite 350; Thornton, CO 80229

© Lippincott-Raven Publishers.