Does reconstruction of posterior ligamentous complex with extensor musculature decrease axial symptoms after cervical laminoplasty?
METHODS
The authors retrospectively determined the prevalence of neck and shoulder symptoms (axial symptoms) after expansive laminoplasty with reattachment of spinous process and extensor musculature in patients with cervical myelopathy.


OBJECTIVE
To determine the prevalence of both preoperative and postoperative axial symptoms of expansive laminoplasty when they occur after expansive laminoplasty.


BACKGROUND
Several clinical reports have noted that laminoplasty for cervical myelopathy produces positive clinical outcomes. However, recent reports have pointed out that complications from laminoplasty, such as axial symptoms, may be severe enough to interfere with daily activities.


METHODS
The authors used a modified spinous process-splitting laminoplasty, which involved reattaching the spinous process with extensor musculature after enlarging the spinal canal by use of the French window method. Postoperative axial symptoms were investigated in 173 of 214 patients (80.1%) who underwent expansive laminoplasty between January 1989 and December 1998. The patients included 121 men and 52 women, and their average age was 61.5 years. The presence or absence and grade of axial symptoms before and after laminoplasty were investigated. The severity and duration of complications were also recorded, along with differences between age, sex, spinal alignment, and cervical diseases.


RESULTS
Neck and/or shoulder stiffness worsened in 15% of the patients and declined in 21%. Neck pain worsened in 10% of the patients and improved in 11%. Neck and/or shoulder stiffness worse than moderate was recognized in 14.4% of the patients. Neck pain worse than moderate was recognized in 5% of the patients. In the 137 patients who had no axial pain before surgery, only 13 patients experienced such symptoms after surgery, and in most cases these symptoms were minimal. In only 1 case, significant postoperative neck pain arose de novo as a result of this surgery. In 88 patients who had no neck and/or shoulder stiffness before surgery, only 16 patients experienced such symptoms after surgery, and in most cases these were minimal. A similar pattern held true for each of the other grades of preoperative axial symptoms. The recovery rate score (Japanese Orthopedic Association) was 47.5 +/- 32.3 in the patients whose axial symptoms were worse than moderate and 60 +/- 28.9 in patients whose axial symptoms were less than mild. This difference was significant (P < 0.05).


CONCLUSIONS
Laminoplasty is an appropriate operation for cervical spondylotic myelopathy and did not, in this study, seem to have any significant influence on the development or resolution of axial symptoms.
Department of Orthopaedic Surgery, Wakayama Medical College, Wakayama, Japan. myoshida@wakayama-med.ac.jp
Munehito
M
Yoshida
Tetsuya
T
Tamaki
Mamoru
M
Kawakami
Naoki
N
Nakatani
Muneharu
M
Ando
Hiroshi
H
Yamada
Nobuhiro
N
Hayashi
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D017846:Longitudinal Ligaments / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D009333:Neck; D019547:Neck Pain / Q000209:etiology; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D010147:Pain Measurement; D015995:Prevalence; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D020069:Shoulder Pain / Q000209:etiology; D013118:Spinal Cord Diseases / Q000150:complications / Q000601:surgery*; D013169:Spondylolysis / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome