En bloc laminoplasty without dissection of paraspinal muscles.
OBJECTIVE
Although conducting cervical laminoplasty in patients with multisegmental cord compression provides good neurological results, it is not without shortcomings, including C-5 palsy, axial neck pain, and undesirable radiologically detectable changes. Postoperative kyphosis and segmental instability can cause neurological problems and are believed mainly to result from neck muscle disruption. The authors developed a new laminoplasty technique, with the aim of preserving optimal muscle function.


METHODS
The present technique is a modification of unilateral open-door laminoplasty. By using an ultrasonic osteotome in small gaps of muscle bellies, a gutter is made without disrupting muscles, spinous processes, or their connections on the hinged side. Ceramic spacers are then positioned between elevated laminae and lateral masses at C-3, C-5, and C-7 on the opened side, which is exposed in a conventional manner. This new procedure was used to treat 37 consecutive patients with compression myelopathy. Postoperative computerized tomography (CT) scanning revealed a significant difference in a cross-sectional area of muscles between the hinged and opened side. The mean follow-up period was 40.2 months (range 24-54 months). Changes in alignment were observed in only one patient, and vertebral slippage developed in two. Performed at regular intervals, CT scanning demonstrated that the elevated laminae remained in situ throughout the study period.


CONCLUSIONS
In using the present unilateral open-door laminoplasty technique, deep extensor muscles are left intact along with their junctions to spinous processes on the hinged side. Radiologically documented changes were minimal because the preserved muscles functioned normally immediately after the operation.
Hosono
Noboru
N
Department of Orthopedics, Osaka University Graduate School of Medicine, Osaka, Japan. hosono-n@umin.ac.jp
Sakaura
Hironobu
H
Mukai
Yoshihiro
Y
Ishii
Takahiro
T
Yoshikawa
Hideki
H
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009334:Neck Muscles / Q000503:physiopathology; D019635:Neurosurgical Procedures / Q000379:methods*; D010027:Osteotomy / Q000295:instrumentation*; D011859:Radiography; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014465:Ultrasonics