Laminoplasty instead of laminectomy as a decompression method in posterior instrumented fusion for degenerative cervical kyphosis with stenosis.
BACKGROUND
Posterior laminectomy with instrumented fusion is a standard procedure for treating degenerative cervical kyphosis with stenosis (DCKS). Two major disadvantages of the surgery are adhesion of the dural membrane with significant disfiguring of cervical spine and a small fusion bed around the lateral mass. One of the advantages of laminoplasty over laminectomy is the protection of the dural membrane from adhesion through preservation of posterior bony elements. This study presents the surgical outcomes of laminoplasty, instead of laminectomy, as a decompression method applied in posterior instrumented fusion for DCKS.


METHODS
A consecutive single center series of twenty cases between 2008 and 2011 were retrospectively reviewed. They were diagnosed as DCKS and received anterior cervical fusion followed by expansive open door laminoplasty and lateral mass or pedicle screw instrumented fusion. We collected the functional scores and changes of cervical curvature on the basis of dynamic lateral films preoperatively and postoperatively. We used computed tomography scans and magnetic resonance imaging (MRI) to evaluate the status of fusion and decompression.


RESULTS
The mean age at the time of surgery was 67.6 ± 15.2 years. Half of the patients were older than 75 years. All functional scores and cervical lordotic curvatures markedly improved. No recurrence of spinal cord compression was caused by closure of opened laminae, according to MRI study that was conducted 12 months postoperatively. No pseudarthrosis or hardware loosening was observed 24 months postoperatively.


CONCLUSIONS
The surgical aims for DCKS are adequate decompression, correction of kyphosis, and solid instrumented fusion. Laminoplasty applied in cervical fusion as a decompression method seems to lead to a favorable functional recovery and reduces the complications of perineural adhesion that typically occur after laminectomy. In addition, laminoplasty affords an additional fusion bed at the hinge side and this advantage benefits solid fusion mass formation for the patients who suffered from DCKS.
Institute of Medical Sciences, Tzu Chi University, No. 701, Zhongyang Rd., Sec. 3, Hualien, 97004, Taiwan. micrograft@gmail.com.|Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97002, Taiwan. micrograft@gmail.com.
Kuang-Ting
KT
Yeh
Institute of Medical Sciences, Tzu Chi University, No. 701, Zhongyang Rd., Sec. 3, Hualien, 97004, Taiwan. fish@mail.tcu.edu.tw.
Ru-Ping
RP
Lee
Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97002, Taiwan. ihchen@tzuchi.com.tw.|School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan. ihchen@tzuchi.com.tw.
Ing-Ho
IH
Chen
Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97002, Taiwan. FEYU@tzuchi.com.tw.|School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan. FEYU@tzuchi.com.tw.
Tzai-Chiu
TC
Yu
Institute of Medical Sciences, Tzu Chi University, No. 701, Zhongyang Rd., Sec. 3, Hualien, 97004, Taiwan. 102353105@stmail.tcu.edu.tw.|Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97002, Taiwan. 102353105@stmail.tcu.edu.tw.
Kuan-Lin
KL
Liu
Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97002, Taiwan. 100353105@stmail.tcu.edu.tw.
Cheng-Huan
CH
Peng
Department of Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97002, Taiwan. paulwang@tzuchi.com.tw.
Jen-Hung
JH
Wang
Institute of Medical Sciences, Tzu Chi University, No. 701, Zhongyang Rd., Sec. 3, Hualien, 97004, Taiwan. wentien2003@yahoo.com.tw.|Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97002, Taiwan. wentien2003@yahoo.com.tw.|School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan. wentien2003@yahoo.com.tw.
Wen-Tien
WT
Wu
D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery*; D007796:Laminectomy / Q000379:methods* / Q000592:standards; D065406:Laminoplasty / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods* / Q000592:standards; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome