C3–6 Laminoplasty for Cervical Spondylotic Myelopathy Maintains Satisfactory Long-Term Surgical Outcomes

Abstract

Study Design Prospective cohort study. Objective To clarify long-term surgical outcomes of C3–6 laminoplasty preserving muscles attached to the C2 and C7 spinous processes in patients with cervical spondylotic myelopathy (CSM). Methods Twenty patients who underwent C3–6 open-door laminoplasty for CSM and who were followed for 8 to 10 years were included in this study. Myelopathic symptoms were assessed using Japanese Orthopaedic Association (JOA) score. Axial neck pain was graded as severe, moderate, or mild. C2–7 angle was measured using lateral radiographs of the cervical spine before surgery and at final follow-up. Results Mean JOA score before surgery (11.7) was significantly improved to 15.2 at the time of maximum recovery (1 year after surgery), declining slightly to 14.9 by the latest follow-up. Late deterioration of JOA score developed in eight patients, but was unrelated to the cervical spine lesions in each case. No patient suffered from prolonged postoperative axial neck pain at final follow-up. The mean C2–7 angle before surgery (13.8 degrees) significantly increased to 19.2 degrees at final follow-up. Conclusions C3–6 laminoplasty preserving muscles attached to the C2 and C7 spinous processes in patients with CSM maintained satisfactory long-term neurologic improvement with significantly reduced frequencies of prolonged postoperative axial neck pain and loss of C2–7 angle after surgery.

Cervical Spondylotic Myelopathy: Pathophysiology and Surgical Approaches

“…However, they did not describe the preservation of the muscle attachment at the C2 level in the technique. Conversely, Cho [37] and Sakaura et al [40] preserved the C2 muscle attachment in their technique, and this resulted in lesser loss of cervical lordosis than that reported by Uehara et al [34]. Interestingly, Su et al [36] reported lesser loss of cervical lordosis after performing C3-C6 laminoplasty without preserving the C2 muscle attachment.…”

“…They reported that laminoplasty provided significant enhancement of the JOA score in the short-term, mid-term, and long-term follow-up [34][35][36][37][38][39]. However, Sakaura et al [40] reported that the average JOA score was at its highest point in 12 months of follow-up and decreased slightly to 14.9 in the final follow-up. In this paper [40], they explained that this was due to the non-CSM diseases including lumbar spine canal stenosis, osteoarthritis of knee, carpal tunnel syndrome, and stress urine incontinence.…”

“…However, Sakaura et al [40] reported that the average JOA score was at its highest point in 12 months of follow-up and decreased slightly to 14.9 in the final follow-up. In this paper [40], they explained that this was due to the non-CSM diseases including lumbar spine canal stenosis, osteoarthritis of knee, carpal tunnel syndrome, and stress urine incontinence. Moreover, Son et al [41] reported that laminoplasty resulted in good clinical outcomes in the elderly (65 years old), which were the same as in the non-elderly subjects.…”

“…Similarly, Heller et al [42] reported that both laminoplasty approaches exhibited similar good clinical outcomes. Furthermore, the recovery rate (RR) of laminoplasty was greater than 50% in the short-term, mid-term, and long-term follow-up [35,[38][39][40][41]. On the other hand, Uehara et al [34] reported that RR was 47.1% in the final follow-up, but 55.9% immediately after operation.…”

“…These studies used different laminoplasty methods to provide decompression of the spinal cord. It is suggested that the preservation of the C2 muscle attachment can maintain the post operation cervical lordosis angle [40]. Uehara et al [34] used open door laminoplasty, and 84.6% of their cases involved the C3 level.…”