title: A unilateral open door laminoplasty technique: prospective analysis of the relationship between midline extensor muscle preservation and postoperative neck pain.
abstract: Since laminoplasty was first introduced, several techniques have been developed to reduce postoperative neck pain and progressive kyphosis following this procedure. We describe the importance of deep muscle preservation to prevent postoperative neck pain following cervical posterior surgery, using the inter-muscular plane. We performed cervical laminoplasty on 10 patients from March to July 2012. The mean follow-up duration was 14.6 (range 12-18) months, and the mean age was 58.8 (48-68) years. There were eight men and two women in the study cohort, which consisted of eight cases of cervical spondylotic myelopathy and two cases of ossification of the posterior longitudinal ligament. The Japanese Orthopaedic Association (JOA) score and neck disability index (NDI) score were assessed before and at 6 and 12 months after surgery. The numeric rating scale (NRS) for neck pain was evaluated at 1, 3, 6, and 12 months after surgery. CT scan was performed immediately after the operation, and a radiograph was performed preoperatively and during the follow-up evaluation at 1, 3, 6, and 12 months after surgery. The preoperative JOA and NDI scores improved in all patients. Although there were two patients who complained of moderate postoperative neck pain (NRS 4 and 5), their condition gradually improved. Seven patients had mild or no neck pain (below NRS 3) at the 12 month follow-up. In addition, the cervical alignment was well maintained in all but one patient. Although larger prospective cohorts, longer follow-up periods, and comparative analyses are still needed, the clinical and radiological outcomes observed in the short 12 month period in this small cohort are promising.
authors.affiliation: Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
authors.forename: Jin Hoon
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Anesthesiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
authors.forename: Eui-Kyun
authors.initials: EK
authors.lastname: Jeong
authors.affiliation: Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
authors.forename: Moon Kyu
authors.initials: MK
authors.lastname: Lee
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Seung
authors.initials: S
authors.lastname: Chul Rhim
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Sung Woo
authors.initials: SW
authors.lastname: Roh
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Jeoung Hee
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Republic of Korea. Electronic address: srjeon@amc.seoul.kr.
authors.forename: Sang Ryong
authors.initials: SR
authors.lastname: Jeon
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D065406:Laminoplasty / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology* / Q000517:prevention & control*; D017887:Ossification of Posterior Longitudinal Ligament / Q000601:surgery; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D013118:Spinal Cord Diseases / Q000601:surgery
keywords: Cervical laminoplasty; Inter-muscular plane; Kyphosis; Muscle preservation; Neck pain