Tension-band laminoplasty of the cervical spine

Abstract

A new laminoplasty of the cervical spine has been developed using preserved ligaments as a tension-band. The laminae were enlarged in an open-door fashion and spacers inserted to maintain the spinolaminoligamentous complex intact. The stretched ligaments exerted a tension-band effect on the spacers and stabilised them so that neck movements could be started as soon as bleeding stopped. The spacers were iliac grafts, or were made of a bioactive ceramic which proved more satisfactory. The results of 102 cases with ceramic spacers showed an average preservation of preoperative movement between C2 and C7 to be 79% in cervical spondylotic myelopathy and 67% in ossification of the posterior longitudinal ligament at 3 years after operation. No spacer became displaced. CT showed new bone formation in the lamina-ceramic gap in 59% of the spacers used in cervical spondylotic myelopathy by sixth months and in 63% in cases of ossification of the posterior longitudinal ligament by the third month. Neurological recovery was comparable to that after other types of laminoplasty, but the new method allows better function of the neck and more new bone formation around the spacers.

Biomechanics of open-door laminoplasty with and without preservation of posterior structures

“…Historically, many authors describe a laminoplasty performed with resection of the spinous processes to prevent "crowding" in extension, to provide room for bone graft spacers, and to prevent a loss in cervical ROM. 12,19,20,24 Conversely, others describe the importance of maintaining this dorsal tension band, 28 and a recent clinical trial showed that retention of these dorsal elements may prevent loss of sagittal alignment at 1-year follow-up.…”

“…7,8,13,22,25,27 Others suggest that the muscular attachments to C-7 do not influence long-term outcomes, 5 and that facet joint disruption may be more important in the development of postlaminoplasty neck pain and deformity. 20 There are few reports that address the preservation 26,28 or partial preservation 29 of the ISLs. Unfortunately, however, unless clearly stated, it is often difficult to determine if the terminal ligaments are spared in a given study.…”

“…5,15 Despite the limited clinical data on ligament-sparing techniques, their potential importance has been suggested. 26,28,29 Recently, a retrospective cohort study demonstrated superior clinical outcomes with regard to sagittal balance at 2-year follow-up using a ligament-sparing ODL. 1 Despite the paucity of prospective clinical data, the impact of the C2-3 and C7-T1 ligaments and the kinematic changes following their transection that was observed herein cannot be understated, and should be considered moving forward when investigating clinical outcomes.…”

“…In contrast to a standard laminectomy, which leads to postlaminectomy kyphosis in 15%-43% of cases, ODL is purported to reduce this adverse outcome. 2,3,5,16,28 Despite these advantages, reports have shown that ODL may lead to persistent neck and shoulder pain, progressive loss of ROM, and progressive cervical kyphosis. [6][7][8]11,29 There are various approaches used to perform cervical laminoplasty, many of which involve spinous process resection and disruption of intervening interspinales musculature and supraspinous ligaments (intraspinous and supraspinous ligaments [ISLs]).…”

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) .…”