Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy.

BACKGROUND: Laminoplasty is a well-recognized technique for decompressing the cervical spine in cases of spondylotic myelopathy and ossification of the posterior longitudinal ligament. This technique, originally popularized in Asia, is becoming more widespread, but to date there have been few reports of clinical series from North American centers.

METHODS: Retrospectively we reviewed (1986-2001) 204 cases of open door laminoplasty. All patients presented with symptoms and magnetic resonance imaging (MRI) findings consistent with myelopathy secondary to multisegmental cervical stenosis with spondylosis and underwent decompression from C3 to C7. Improvement in myelopathy was assessed with the Nurick Score.

RESULTS: Average age was 63 years (range 36 to 92). Follow-up averaged 16 months. Postoperatively, Nurick scores improved by 1 point in 78 patients, 2 points in 37 patients, 3 points in 7 patients, and 4 points in 5 patients; 74 patients experienced no improvement, and 3 patients deteriorated by one point. There was no statistical difference in myelopathy outcomes when comparing patients older and younger than 75 years of age. In two patients there was radiographic progression of kyphosis, but in no case was subsequent fusion required. Six patients without neck pain preoperatively developed new intractable neck pain after surgery.

CONCLUSIONS: Open door expansile laminoplasty is a safe and effective method for treating cervical spondolytic myelopathy. Laminoplasty is thus an alternative to anterior surgery that can be accomplished quickly with minimal blood loss, minimizing risks in elderly patients.