gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Comparison between open-door laminoplasty and bilateral spinal canal decompression via unilateral approach in patients with cervical spondylotic myelopathy

Meeting Abstract

  • Silvia Hernandez Duran - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
  • Noman Zafar - Krankenhaus Dresden-Friedrichstadt, Klinik für Neurochirurgie , Dresden, Deutschland
  • Matthias Momber - Klinikum Vest, Recklinghausen , Deutschland
  • Dorothee Mielke - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Ingo Fiss - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 132

doi: 10.3205/17dgnc695, urn:nbn:de:0183-17dgnc6957

Published: June 9, 2017

© 2017 Hernandez Duran et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: The majority of patients suffering from cervical spondylotic myelopathy (CSM) are treated by anterior cervical decompression and fusion (ACDF) or corpectomy. Laminectomy and laminoplasty are less frequently employed techniques. We propose an alternative bilateral dorsal compression technique via an unilateral approach. The present study was conceived to elucidate differences in the neurological outcome between the bilateral decompression and the laminoplasty approach.

Methods: Patients with symptomatic CSM with or without radiculopathy were included. In all patients, preoperative magnetic resonance (MR) imaging and pre- and postoperative computerized tomography (CT) were obtained. MRI was analyzed for cervical myelopathy. In the bilateral decompression group, either a laminotomy or hemilaminectomy was performed, depending on the number of involved segments. Bilateral decompression was achieved via undercutting technique. In the laminoplasty group, “an open-door”-technique with suture-muscle-fixation of the lamina without plates or implants was performed. Neurological status pre- and post- operatively was obtained regarding paresis and sensory deficits.

Results: A total of 145 patients was included, 85 in the laminoplasty and 60 in the bilateral decompression group. The mean age was 68 years (30-89). The median follow-up was six weeks. The neurological status significantly improved in each group in separate univariate analysis, in the laminoplasty group with p=0.045 and in the bilateral decompression group with p=0.001. Comparison of postoperative neurological status focused on sensory and motor deficits showed significant differences between both groups. Patients with unilateral radicular pain benefited from bilateral decompression rather than laminoplasty.

Conclusion: Unilateral laminotomy or laminectomy, followed by bilateral decompression via undercutting is a promising treatment in patients with cervical spondylotic myelopathy. We assume, that inter alia less muscle trauma and neck pain compared to laminoplasty leads to faster patient recovery.