Secondary Logo

Institutional members access full text with Ovid®

Long-term Results of Expansive Open-Door Laminoplasty for Cervical Myelopathy−Average 14-Year Follow-up Study

Chiba, Kazuhiro, MD, PhD; Ogawa, Yuto, MD, PhD; Ishii, Ken, MD, PhD; Takaishi, Hironari, MD, PhD; Nakamura, Masaya, MD, PhD; Maruiwa, Hirofumi, MD, PhD; Matsumoto, Morio, MD, PhD; Toyama, Yoshiaki, MD, PhD

doi: 10.1097/01.brs.0000250307.78987.6b
Cervical Spine
Buy

Study Design. Retrospective case series on long-term follow-up results of original expansive open-door laminoplasty for cervical myelopathy due to cervical spondylosis (CSM) and ossification of posterior longitudinal ligament (OPLL).

Objectives. To elucidate efficacy and problems of original open-door laminoplasty to improve future surgical outcomes.

Summary of Background Data. Little information is available on long-term outcomes of original open-door laminoplasty without grafts, implants, or instruments.

Method. The study group included 80 patients who underwent original open-door laminoplasty and were followed for minimum 10 years. Clinical results, including Japanese Orthopedic Association scores, recovery rates, occurrences of complications, and long-term deterioration were investigated. Cervical alignments, type of OPLL, cervical range of motion, anteroposterior diameter of spinal canal, and progression of OPLL were assessed on plain radiographs. Spinal cord decompression was verified on magnetic resonance imaging.

Results. Average Japanese Orthopedic Association score and recovery rate improved significantly until 3 years after surgery and remained at an acceptable level in both cervical spondylosis and OPLL patients with slight deterioration after 5 years. Segmental motor palsy developed in 8 patients. Late deterioration, mainly lower extremity motor score decline, developed in 8 CSM and 16 OPLL patients. Overall cervical range of motion decreased by 36%. Patients with cervical lordosis decreased gradually in both patient groups. Such changes in alignments did not affect surgical results in CSM patients, while OPLL patients with preoperative kyphosis had lower recovery rates than those with straight and lordotic alignments. OPLL progression that was detected in 66% of patients did not affect clinical results. Although infrequent, magnetic resonance imaging revealed atrophy of spinal cord, spinal cord compression at adjacent segments due to degenerative changes and OPLL progression.

Conclusions. Long-term results of open-door laminoplasty without bone graft, graft substitutes, or instruments were satisfactory. However, segmental motor paralysis, kyphosis, established before and after surgery, OPLL progression, and late deterioration due to age-related degeneration remain challenging problems.

Retrospective analysis on long-term results of conventional expansive open-door laminoplasty revealed that satisfactory outcomes were maintained over an average of 14 years with a slight decline after 5 years. Segmental motor paralysis, kyphosis, whether established before surgery or developed after surgery, and progression of ossification of posterior longitudinal ligament remain unsolved problems.

From the Department of Orthopaedic Surgery, Keio University, Tokyo, Japan.

Acknowledgment date: December 20, 2005. First revision date: February 26, 2006. Acceptance date: February 28, 2006.

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

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Kazuhiro Chiba, MD, PhD, Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan; E-mail: kchiba@sc.itc.keio.ac.jp

© 2006 Lippincott Williams & Wilkins, Inc.