Ten‐Year Surgical Outcomes and Prognostic Factors for French‐Door Laminoplasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy

Abstract

Objective. To analyze the ten-year surgical outcomes and postoperative complications of French-Door laminoplasty (FDL) in the management of multilevel cervical spondylotic myelopathy (MCSM) and analyze the prognostic factors for FDL in treating MCSM. Methods. 64 patients with MCSM, who were operated by FDL, were included in this study and followed up for at least 10 years. Clinical assessments including modified Japanese Orthopaedic Association (mJOA) score, age at surgery, preoperative symptom duration, operative time, blood loss and postoperative complications, radiological assessments including Cobb angle, cervical range of motion (ROM), intramedullary signal intensity on T2W MRI, canal narrowing ratio (CNR), and maximum spinal cord compression (MSCC). mJOA score, Cobb angle, cervical ROM, intramedullary signal intensity on T2W MRI, and CNR were assessed before surgery and at the final follow-up. Results. The average mJOA score was significantly improved from preoperative 10.32±1.63 points to 15.10±0.62 points at the final follow-up (p<0.05). The average RR of the mJOA score at the final follow-up was 69.10±7.32%. The cervical Cobb angle and ROM decreased significantly at the final follow-up. Patients with high intramedullary signal intensity of T2W MRI or CNR more than 50% showed a lower RR of the mJOA score. Correlation analysis revealed that preoperative symptom duration and intramedullary signal intensity of T2W MRI, CNR, MSCC, and blood loss were significantly correlated with the RR of the mJOA score. Gender, operative method, and age at surgery were significantly correlated with the preservation rate of ROM. Operative time was significantly correlated with the incidence of axial symptoms. Conclusions. The ten-year clinical outcomes of FDL were satisfactory. Higher intramedullary signal intensity of T2W MRI and a greater CNR predicted poorer prognoses.

Comparative Five‐Year Surgical Outcomes of Open‐Door versus French‐Door Laminoplasty in Multilevel Cervical Spondylotic Myelopathy

“…The surgical procedures achieve improvement of neurological function by decompressing and increasing the perfusion of the spinal cord [ 14 ]. To our knowledge, laminoplasty which decompresses the spinal cord by enlarging the spinal canal has been recognized as one of the most important surgical practices to treat MCSM and achieved satisfactory clinical outcomes [ 2 , 8 ]. In this study, the average RR of the mJOA score in the ODL and FDL groups at the five-year follow-up was 72.14 ± 6.97% and 69.53 ± 7.51%, respectively, which were in accordance with that of previous studies about the short-term follow-up [ 8 , 15 ].…”

“…For the multilevel cervical spondylotic myelopathy (MCSM), posterior approaches such as laminoplasty and laminectomy have been recognized as effective methods [ 1 , 2 ]. However, according to previously published studies, operation-related complications such as cervical kyphosis, segmental instability, and neurological deterioration which were likely due to cervical instability after posterior structures being removed were not uncommon with patients treated with laminectomy [ 3 , 4 ].…”

Influence of preoperative depression on clinical outcomes after cervical laminoplasty: A retrospective study

“…At the same time, due to the preservation of vertebral lamina, laminoplasty can maintain the overall stability of cervical spine and reduce the incidence of postoperative complications such as axial pain and scar formation (8)(9)(10). The postoperative outcome of patients not only depends on the approach of operation, but also relates to many factors, including patient's age, duration of symptoms, neurological status and so on (11)(12)(13)(14)(15).…”

A Novel Method of Making Hinges Using a Newly Designed Sharp Rongeur to Enhance Radiological and Clinical Outcomes in French‐Door Cervical Expansive Laminoplasty

“…In this process, the lamina is sagittally split in a double door manner to produce sufficient canal expansion for better surgical outcomes 1,2 . However, there are some postoperative complications associated with FDL that may affect the clinical outcomes, such as C5 nerve root palsy, a decrease in the cervical dynamic range of motion, laminar fracture, spinal cord injury, and cerebrospinal fluid (CSF) leakage 3 . Amongst these, axial neck pain (ANP) and C5 nerve root palsy (C5‐NRP) are reportedly the most common complications, with an incidence rate of 45%–80% 3 and 4.7%, respectively 4,5 .…”

“… 1 , 2 However, there are some postoperative complications associated with FDL that may affect the clinical outcomes, such as C5 nerve root palsy, a decrease in the cervical dynamic range of motion, laminar fracture, spinal cord injury, and cerebrospinal fluid (CSF) leakage. 3 Amongst these, axial neck pain (ANP) and C5 nerve root palsy (C5‐NRP) are reportedly the most common complications, with an incidence rate of 45%–80% 3 and 4.7%, respectively. 4 , 5 Clinical investigations have suggested that the pathogenesis of both ANP and C5‐NRP could be linked to the post‐surgical posterior spinal cord movement.…”