title: Risk factors for closure of lamina after open-door laminoplasty.
abstract: OBJECTIVE
  This retrospective study was conducted to evaluate the prevalence and clinical consequences of postoperative lamina closure after open-door laminoplasty and to identify the risk factors.
  
  
  METHODS
  Eighty-two consecutive patients with cervical myelopathy who underwent open-door laminoplasty without plates or spacers in the open side (Hirabayashi's original method) were included (62 men and 20 women with a mean age of 62 years and a mean follow-up of 1.8 years). In 67 patients the cause of cervical myelopathy was spondylotic myelopathy, and in 15 it was caused by ossification of posterior longitudinal ligament. Radiographic measurements were made of the anteroposterior diameters of the spinal canal and vertebral bodies from C3-6, and the presence of kyphosis were assessed. Lamina closure was defined as > or = 10% decrease in the canal-to-body ratio at the final follow-up compared with that immediately after surgery at > or = 1 vertebral level. The impact of lamina closure on neck pain, patient satisfaction, Japanese Orthopaedic Association scores, and recovery rates were also evaluated.
  
  
  RESULTS
  The mean canal-to-body ratio at C3-6 was 0.69-0.72 preoperatively, 1.25-1.28 immediately after surgery, and 1.18-1.24 at the final follow-up examination. Lamina closure was observed in 34% of patients and was not associated with sex, age, or cause of myelopathy, but was significantly associated with the presence of preoperative kyphosis (p = 0.014). Between patients with and without lamina closure, there was no significant difference in preoperative (9.7 +/- 3.1 vs 10.6 +/- 2.5) and postoperative (13.7 +/- 2.4 vs 13.1 +/- 2.7) Japanese Orthopaedic Association scores, recovery rates (53.9 +/- 29.9% vs 44.3 +/- 29.5%), neck pain scores (3.5 +/- 0.7 vs 3.3 +/- 1.0), or patient satisfaction level (4.0 +/- 1.4 vs 4.8 +/- 1.0).
  
  
  CONCLUSIONS
  Lamina closure at > or = 1 vertebral level occurred in 34% of patients. Although patients with lamina closure obtained equivalent recovery from myelopathy in a short-term follow-up, they tended to be less satisfied with surgery compared with those who did not have closure. The only significant risk factor identified was the presence of preoperative cervical kyphosis, and preventative methods for lamina closure, therefore, should be considered for patients with preoperative kyphosis.
authors.affiliation: Department of Advanced Therapy for Spine & Spinal Cord Disorders, School of Medicine, Keio University, Tokyo, Japan. morio@sc.itc.keio.ac.jp
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Kota
authors.initials: K
authors.lastname: Watanabe
authors.forename: Takashi
authors.initials: T
authors.lastname: Tsuji
authors.forename: Ken
authors.initials: K
authors.lastname: Ishii
authors.forename: Hironari
authors.initials: H
authors.lastname: Takaishi
authors.forename: Masaya
authors.initials: M
authors.lastname: Nakamura
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Toyama
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Chiba
mesh_terms: D002574:Cervical Vertebrae; D015331:Cohort Studies; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D007796:Laminectomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D017887:Ossification of Posterior Longitudinal Ligament / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013115:Spinal Canal; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D055009:Spondylosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery