Expansive open-door laminoplasty and selective anterior cervical decompression and fusion for treatment of multilevel cervical spondylotic myelopathy.
OBJECTIVE
To evaluate the clinical results of combined expansive open-door laminoplasty by splitting of spinous processes and selective anterior cervical decompression and fusion in treatment of multilevel severe cervical spondylotic myelopathy (CSM).


METHODS
Twenty-eight patients (16 men and 12 women) underwent one-stage combined expansive open-door laminoplasty and selective anterior decompression and fusion for severe CSM; the average patient age was 51.3 years (range, 32-63 years). Clinical results were assessed by Japanese Orthopaedic Association (JOA) scores, number of finger grip and releases (G and R) in ten seconds, hand-grip strength, visual analog scale (VAS) of axial pain, and C2-C7 angle.


RESULTS
There was no worsening of neurological symptoms due to cord injury, cerebrospinal fluid leakage, or wound infection. All cases completed one-year follow-up. The JOA scores, number of G and R in ten seconds, and hand-grip strength were all significantly improved (P < 0.05). Satisfactory decompression was shown by MRI or CT to have been achieved in all cases. The C2-C7 angle did not differ significantly from that found pre-operatively. The axial neck pain score was 2.0 ± 0.1 on VAS.


CONCLUSIONS
Combined expansive open-door laminoplasty by splitting of spinous processes and selective anterior decompression and fusion achieves complete spinal canal decompression with minimal morbidity; this strategy is effective in improving the surgical outcomes of CSM in one-year follow-up.
Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, China. newyuliu@yahoo.com.cn
Xin-yu
XY
Liu
Suo-mao
SM
Yuan
Yong-hao
YH
Tian
Yan-ping
YP
Zheng
Jian-min
JM
Li
D000328:Adult; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013117:Spinal Cord Compression / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D055009:Spondylosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome