gms | German Medical Science

Objective: In multilevel degenerative cervical spinal canal stenosis (CSCS), laminoplasty offers the perspective of maintaining the range of motion with a low risk of postoperative cervical deformation. Some techniques of laminoplasty are relatively cumbersome in handling and labor-intensive. Here we have evaluated different implants for "open door" laminoplasty technique.

Method: Between Oct 2011 and Oct 2014, 28 patients with multilevel CSCS were treated using laminoplasty. A retrospective analysis of epidemiological data, preoperative symptoms, intra- and perioperative complications, type and handling of implants, postoperative outcome and radiographic results was performed.

Results: Mean age of patients was 57 ± 7,6 years. 53% presented with ataxia only, 25% with tetraparesis, 21% with radiculopathy. Median follow-up was 6 ± 6.9 months. 13 patients were operated in prone position, 15 in sitting position. A total of 69 levels were instrumented. Six plating systems were used, two specifically designed for laminoplasty, four for general use in cranio-facial or trauma surgery. The systems significantly varied in implant costs. Mean operating time per level was 1 hour 28 min ± 36 min. In 7% wound infections occurred. Postoperatively,neurological symptoms improved in 50%, were unchanged or showed new or worsened deficits on last follow-up in 25% each. In 3 patients, new deficits regarded radicular sensory and in 3 patients motor deficits.In 50% of these, neurological deterioration was caused by C5 lesion. In one patient, ataxia worsened. Of 13 patients operated in prone position, 6 experienced transient or permanent neurological worsening whereas only two of 15 patients developed new or worsened deficits operated in sitting position (p=0,0957). The two systems specifically designed for laminoplasty were very convenient and fast handling with no need for plate bending and shaping and produced a uniformly optimal decompression of the spinal canal. However, these systems were also more expensive. There was no correlation between the use of the different implants and the duration of surgery, intra- or postoperative complications or neurological outcome.

Conclusions: Using specialized implants, open-door laminoplasty is a streamlined and safe procedure with the potential to maintain the range of motion. In our experience neurological outcome of laminoplasty seems to be better and faster when performed in sitting position.