Single-Door Cervical Laminoplasty Using Titanium Miniplates Alone

Abstract

Purpose. To review outcome of 29 patients who underwent single-door cervical laminoplasty for myelopathy using titanium miniplates alone. Methods. Records of 20 men and 9 women aged 35 to 79 (mean, 64.3) years who underwent single-door cervical laminoplasty for myelopathy using titanium miniplates alone were reviewed. A total of 125 laminae were opened; 97 of them were fixed with a titanium miniplate. In 19 patients, a 20-hole titanium miniplate bent to the contour of a lamina was used and fixed into 3 laminae at alternate levels. In the remaining 10 patients, the pre-contoured ARCH Laminoplasty System was used and fixed into all laminae. In most patients, screw fixation was unicortical, and no spacer or bone graft was used. Results. The mean follow-up duration was 4 (range, 2-9) years. At one-year follow-up, the mean Japanese Orthopaedic Association (JOA) score improved from 9.2 to 13.2 (p<0.001). The mean JOA recovery rate was 64%. No patient had neurological deterioration. The mean anteroposterior diameter increased from 14.3Single-door cervical laminoplasty using titanium miniplates alone mm to 19.7 mm; the mean increase was 6.1 mm in the plated laminae and 5.3 mm in the unplated laminae (p=0.11). Out of the 125 laminae, there were 2 hinge non-unions in the unplated laminae, and 2 screw pullouts (not associated with plate loosening). No patient had penetration into the vertebral foramen or neuroforamen. Spring-back closure occurred in 5 (18%) of the 28 unplated laminae, with a mean of <3 mm loss of the initial expansion. Two patients developed transient C5 palsy presenting as shoulder abduction weakness. One patient had a delayed dural tear due to a sharp spike at the edge of the opened C6 lamina. Conclusion. Single-door cervical laminoplasty using miniplates alone is a safe technique and achieves a high hinge union rate, good canal expansion, and neurological recovery.

Cervical Spondylotic Myelopathy Release by Unilateral Open-Door Laminoplasty with Miniplate Alone: Three Years Follow-up

“…The normal cervical aging process, congenital narrowing aggravated by acute trauma and bony malformations were identified as the primary causes of cervical stenosis that result in myelopathy. [1][2][3][4][5] Titanium miniplates fixation can be used to instantly reconstruct the spinal canal to restore its integrity. A relatively stable mechanical environment is conducive to bone slot healing on the door axial side and is also conducive to left and right muscle strength balance in the neck.…”

“…The remaining ventral cortex and the ligamentum flavum were removed using a diamond burr and Kerrison rongeur. 1,5 The precontoured laminoplasty system was used and fixed into 3, 4, 5 laminae. Care was taken to avoid breaking the hinge.…”

“…A common treatment for cervical spondylotic myelopathy particularly for multilevel disk disease and ossification of the posterior longitudinal ligament without instability is expansive open-door laminoplasty. 1,2 Posterior decompression with laminectomy is an effective method in patients with OPLL or multisegmental cervical spondylotic myelopathy (CSM). With these methods, decompression is achieved and the biomechanical integrity is maintained.…”

Recent Surgical Methods of Double-door Laminoplasty of the Cervical Spine (Kurokawa's Method)

“…Various materials are used to maintain the enlarged spinal canal such as thread 3) , autogeneous bone (spinous process 4,5) , iliac bone 2,6) ), hydroxyapatite spacer [7][8][9][10][11][12][13][14][15][16][17] , and titanium plate and screw 18,19) . Double-door type was first developed by Kurokawa in the late 1970s and reported in 1982 2) .…”

Preoperative Factors Affecting Postoperative Axial Symptoms After Single-Door Cervical Laminoplasty for Cervical Spondylotic Myelopathy: A Prospective Comparative Study

“…However, it has been modified because of complications such as postoperative axial symptoms (post-AS) [4,5], laminar reclosure [6], reduced range of neck motion [7], and C5 palsy [8]. Titanium miniplate fixation is a modified laminoplasty (ML) that provides immediate and rigid fixation with satisfactory clinical outcomes [9]. Yeh et a.l [10] also demonstrated that laminoplasty using titanium miniplates is a safe and effective surgical alternative to CSM.…”