Artificial lamina-assisted laminoplasty performed in seven cases.
OBJECTIVE
The authors attempted to simplify the operative approach to severe multilevel cervical spondylotic myelopathy. Seven patients with progressive and severe myelopathy underwent modified double-door laminoplasty during a 5-month period.


METHODS
The double-door laminoplasty procedure was modified by using two artificial titanium laminae obtained by simple surgical 0.5-mm Ti-mesh (rather than by bone graft or ceramic spacers). Preoperatively, gait disturbance was present in all patients with long-tract signs on neurological examination. In all cases the sagittal diameter of the cervical spinal canal was somewhat reduced (< 10 mm) by congenital stenosis, and further severe compression of the spinal cord resulted from osteophytic bars and calcified ligamenta flava at different levels. No abnormal alignment, pathological movements, or instability was present. Computerized tomography (CT) studies demonstrated severe multilevel cervical compression, and T2-weighted magnetic resonance (MR) imaging demonstrated pathological areas of hyperintensity within the spinal cord in all cases. In the initial follow-up study (range 8-12 months), the patients who underwent this procedure experienced marked improvement of gait disturbance without any significant incidence of morbidity or complications. Postoperative CT and MR imaging studies demonstrated complete spinal cord decompression and restoration of the patency of the subarachnoid spaces.


CONCLUSIONS
The proposed procedure has the advantage of achieving both an immediate stabilization of the open laminae by means of a bridgelike mechanism and protection from the possible compression of the dural sac by paravertebral muscles.
Department of Neurosurgery, Istituto Nazionale Neurologico C. Besta, Milan, Italy.
M
M
Fornari
G
G
Luccarelli
S
S
Giombini
L
L
Chiapparini
D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical; D004388:Dura Mater / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology; D017887:Ossification of Posterior Longitudinal Ligament / Q000150:complications; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D013128:Spinal Osteophytosis / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013130:Spinal Stenosis / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery; D013346:Subarachnoid Space / Q000473:pathology; D013526:Surgical Mesh; D014025:Titanium; D014057:Tomography, X-Ray Computed
D014025:Titanium