New laminoplasty technique for preserving paravertebral muscles: technical note

Abstract

AIM: To develop a new laminoplasty technique for preserving paravertebral muscles. MATERIAL and METHODS: In this technique, semispinalis and splenius muscles are cut approximately 1 cm laterally to the muscle insertion point to the spinous process at the laminotomy side. Then, multifidus and rotatory muscles are dissected subperiosteally and retracted laterally. The posterior part of the spinous process is cut horizontally below the insertion point of the semispinalis and splenius muscles. At this point, all the contralateral paravertebral muscles with the cut head of the spinous process are dissected subperiosteally and retracted laterally in the same manner as the laminotomy side. After the open-door laminoplasty for reconstruction of the anatomical formation, we fixed the head of the spinous process on the opening side laminae close to the inferior part of the spinous process with a titanium wire. RESULTS: This technique is unique in that it reconstructs the spine similar to its normal anatomical form by preserving the posterior paravertebral muscles' attachments to the bones and tension ligaments. CONCLUSION: This technique can reduce the risk of axial pain and kyphotic deformity, and prevent the reduction of ROM.

Relationship Between C2 Semispinalis Cervicis Preservation and C2 Spinous Process Morphology During Cervical Laminoplasty Involving C3

“…Despite the development of various laminoplasty methods, such as a muscle preserving laminoplasty to resolve this problem, it is a more complex procedure than a conventional unilateral open-door laminoplasty at the C3 level. [12][13][14] Furthermore, high tension is applied to the tendinous portion in the intraoperative neck flexion position during surgery, which causes the C2 semispinalis cervicis to be highly vulnerable to thermal injury in the operative field. In a prior study by Lee et al, preservation of the C2 semispinalis cervicis was achieved in only 67% of patients after conventional laminoplasty.…”

Evaluation of Haplo-Paraspinal-Muscle-Preserving Technique to Prevent Postoperative Axial Pain in Cervical Laminoplasty

“…17 Many muscle-sparing laminoplasty techniques have been developed based on this thesis for opendoor laminoplasty. 7,9,10,18 Many studies have focused on preserving the muscle attachment to the C2 or C7 spinous process, following demonstrations that muscle detachment at these levels greatly affect the incidence and severity of axial pain after laminoplasty. 19 The decompression of the C2 and C7 levels will be accompanied by the sacrifice of the cervical deep extensor, especially the semispinalis cervicis, which plays an important role in maintaining the lordosis and alignment of the cervical vertebrae.…”

“…23 And interestingly, reports of different posterior element-sparing techniques or restriction of the laminoplasty from C3 to C6 instead of C7 are shown to reduce kyphosis. 7,25,26 These studies have shown that when less of the posterior element is compromised, it may improve the lordosis of laminoplasty-treated patients and thus affect the overall clinical outcome. In our data, we found that HMP laminoplasty-treated patients showed slightly improved cervical lordosis even after 6 months of follow-ups, while the cervical lordosis was slightly reduced at the 6-months follow-up in the open-door laminoplasty group, with continued loss of lordosis at the 1-year follow-up (Table 3).…”

“…4,5 Since postoperative axial neck pain is more frequently observed in laminoplasty-treated patients, different surgical techniques were developed to protect the spinal muscles, thus reducing postoperative axial pain and lordosis loss after laminoplasty surgery. [5][6][7][8] Studies have shown that protecting either C2, C6, and C7 spinous muscle and ligament attachment was effective in lowering the incidence of postoperative axial pain. 9,10 However, such techniques may cause insufficient decompression of the spinal canal as both sides of the paraspinal muscles are prevented from complete dissection, and the force of the muscle strain could limit the expansion distance.…”