gms | German Medical Science

Objective: To determine surgical indications for expansive open-door laminoplasty (EOLP) extended to the C1 level for multilevel cervical spine stenosis caused by ossification of the posterior longitudinal ligament (OPLL).

Method: 17 cases in whom C2/3-C7 laminoplasty required reoperation to decompress upward to C1, were reviewed to sum up the surgical indications for EOLP extended to C1. 30 cases with cervical spine stenosis caused by OPLL after screening were selected as a prospective case-control study to assess the validity of the surgical indications we had set.

Results: In the retrospective study (n = 17), 8 patients had undergone primary C3-C7 laminoplasty. In 3 of these patients, discontinuous cerebrospinal fluid around the spinal cord was observed on MRI T2, which necessitated reoperation to decompress upward for the C1-C2 canal stenosis. The other 5 patients were reoperated for a compression mass of diameter >7.0 mm in the C2-C4 segments. The remaining 9 patients in the retrospective study had undergone primary C2-C7 laminoplasty, and their preoperative radiological feature was a compression mass with a diameter >7.0 mm in the C2-C4 segments. All 17 patients were reoperated to extend the decompression range to the C1 level. The postoperative neurological improvement was excellent in 8 cases, good in 7, and fair in 2 at two years after reoperation. In the prospective study (n = 30), preoperative examination showed that all had a compression mass, whose anteroposterior diameter was >7.0 mm in the C2-C4 segments. C1-C7 expansive laminoplasty was performed as the initial surgery in 15 cases, C2-C7 expansive laminoplasty in another 15 cases. There were statistically significant differences in the postoperative neurological improvement between the case and the control group (P <0.05).

Conclusions: We provide the following surgical indications for EOLP extended to C1: (1) C1 canal stenosis diagnosed by the MRI finding of discontinuous cerebrospinal fluid around the spinal cord above the lower edge of the C1 posterior arch and with an actual anteroposterior diameter of the spinal canal <8.0 mm; or (2) a compression mass between C2 and the lower margin of the C4 vertebra, with a maximal sagittal diameter >7.0 mm, in patients where it is impossible or highly risky to relieve the pressure by cervical anterior approach surgery.