Canal expansive laminoplasty in the management of cervical spondylotic myelopathy.
BACKGROUND
Cervical spondylotic myelopathy is often progressive and leads to motor and sensory impairments in the arms and legs. Canal expansive laminoplasty was initially described in Japan as an alternative to the traditional laminectomy approach. The results of this approach have not previously been described in the Israeli population.


OBJECTIVE
To describe the technique of CEL and present our clinical results in the management of patients with CSM due to multilevel compressive disease.


METHODS
All patients undergoing CEL during the period 1984-2000 were identified. Of these, 24 of 25 patients had complete clinical information. Mean follow-up was 18 months (range 4-48). Mean age was 60 years (range 45-72). One patient underwent CEL at three levels, 22 patients at four to five levels and 1 patient at six levels The primary outcome measure was improvement in spinal cord function (according to the Nurick classification).


RESULTS
Twenty-three (96%) of the patients experienced relief of their symptoms. Of these, 11 patients showed improvement in their Nurick grade, 12 patients were unchanged and one had worsening. Intraoperative complications (epidural bleeding and dural tear) occurred in six patients. Two patients developed a late kyphosis.


CONCLUSIONS
Our treatment of choice for multilevel CSM is canal expansive laminoplasty as initially described by Hirabayashi. It provides the ability for posterior surgical decompression without compromising the mechanical stability of the spine. This approach has the benefit of not requiring internal fixation and fusion. Our clinical outcome and surgical complication rate are comparable to those in the literature.
Kaplan
Leon
L
Spine Surgery Unit, Department of Orthopedic Surgery, Hadassah University Hospital and Hebrew University-Hadassah Medical School, Jerusalem, Israel.
Bronstein
Yigal
Y
Barzilay
Yair
Y
Hasharoni
Amir
A
Finkelstein
Joel
J
D000368:Aged; D002574:Cervical Vertebrae; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013115:Spinal Canal / Q000601:surgery*; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013128:Spinal Osteophytosis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome