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

Gregor Schmeiser, Janina Isabel Bergmann, Luca Papavero, Ralph Kothe, Gregor Schmeiser, Janina Isabel Bergmann, Luca Papavero, Ralph Kothe

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.

Conflict of interest statement

None declared.

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/).

Figures

Fig. 1
Fig. 1
Clinical case of unilateral laminoplasty and stabilization in a 63-year-old male patient, with multisegmental degenerative cervical myelopathy. The preoperative modified Japanese Orthopaedic Association (mJOA) score was 12/17, whereas the postoperative mJOA was 16/17. (a) Preoperative sagittal T2 magnetic resonance imaging (MRI). (b) Postoperative anteroposterior (left) and sagittal (right) X-rays. (c) Postoperative sagittal T2 MRI.
Fig. 2
Fig. 2
Clinical case of unilateral laminoplasty and stabilization in a 63-year-old male patient with multisegmental degenerative cervical myelopathy. The preoperative modified Japanese Orthopaedic Association (mJOA) score was 12/17, whereas the postoperative mJOA score was 16/17. (a) Skin incision. (b) Lateral mass (LM) after hole preparation for LM screws (arrows). (c) Preparation of the entry point at the lamina of C6 with a punch (arrow). (d) Laminotomy performed with a baby craniotome. (e) LM screw instrumentation and plate fixation after laminoplasty.
Fig. 3
Fig. 3
Clinical case of a laminectomy with bilateral stabilization in a 67-year-old female patient with multisegmental degenerative cervical myelopathy. The preoperative modified Japanese Orthopaedic Association (mJOA) score was 10/17 and the postoperative mJOA score was 14/17. (a) Preoperative sagittal T2 magnetic resonance imaging (MRI). (b) Intraoperative situs. (c) Postoperative anteroposterior (left) and sagittal (right) X-rays. (d) Postoperative sagittal T2 MRI.
Fig. 4
Fig. 4
Clinical outcomes in patients treated for multilevel degenerative cervical myelopathy (mDCM) with unilateral lateral mass screw fixation (uLP).
Fig. 5
Fig. 5
Clinical outcomes in patients treated for multilevel degenerative cervical myelopathy (mDCM) with lateral mass screw fixation (LC).

References

    1. Karadimas S K, Gatzounis G, Fehlings M G. Pathobiology of cervical spondylotic myelopathy. Eur Spine J. 2015;24 02:132–138.
    1. Bartels R HMA, van Tulder M W, Moojen W A, Arts M P, Peul W C. Laminoplasty and laminectomy for cervical sponydylotic myelopathy: a systematic review. Eur Spine J. 2015;24 02:160–167.
    1. Roselli R, Pompucci A, Formica F.Open-door laminoplasty for cervical stenotic myelopathy: surgical technique and neurophysiological monitoring J Neurosurg 200092(1, Suppl)38–43.
    1. Nakashima H, Imagama S, Yukawa Y. Multivariate analysis of C-5 palsy incidence after cervical posterior fusion with instrumentation. J Neurosurg Spine. 2012;17(02):103–110.
    1. Nassr A, Eck J C, Ponnappan R K, Zanoun R R, Donaldson W F, III, Kang J D. The incidence of C5 palsy after multilevel cervical decompression procedures: a review of 750 consecutive cases. Spine. 2012;37(03):174–178.
    1. 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.
    1. 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.
    1. McAfee P C, Boden S D, Brantigan J W. Symposium: a critical discrepancy-a criteria of successful arthrodesis following interbody spinal fusions. Spine. 2001;26(03):320–334.
    1. Tetreault L, Nouri A, Kopjar B, Côté P, Fehlings M G. the minimum clinically important difference of the modified Japanese Orthopaedic Association Scale in patients with degenerative cervical myelopathy. Spine. 2015;40(21):1653–1659.
    1. Carreon L Y, Glassman S D, Campbell M J, Anderson P A. 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.
    1. 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.
    1. Yang L, Gu Y, Shi J. Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy. Orthopedics. 2013;36(01):e79–e87.
    1. Lee C-H, Lee J, Kang J D. 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.
    1. Phan K, Scherman D B, Xu J, Leung V, Virk S, Mobbs R J. Laminectomy and fusion vs laminoplasty for multi-level cervical myelopathy: a systematic review and meta-analysis. Eur Spine J. 2017;26(01):94–103.
    1. Albert T J, Vacarro A. Postlaminectomy kyphosis. Spine. 1998;23(24):2738–2745.
    1. 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.
    1. Nowinski G P, Visarius H, Nolte L P, Herkowitz H N. A biomechanical comparison of cervical laminaplasty and cervical laminectomy with progressive facetectomy. Spine. 1993;18(14):1995–2004.
    1. 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.
    1. 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.
    1. Dmitriev A E, Kuklo T R, Lehman R A, Jr, Rosner M K. 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.
    1. Schmeiser G, Schilling C, Grupp T M, 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.
    1. Su N, Fei Q, Wang B-Q. 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.
    1. 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.

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