gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Clinical and imaging outcome in patients with cervical spondylotic myelopathy undergoing unilateral laminotomy and bilateral decompression in undercutting technique

Klinisches und bildgebendes Outcome bei Patienten mit spondylotischer zervikaler Myelopathie, welche mittels bilateraler Dekompression über eine unilaterale Laminotomie in undercutting-Technik behandelt wurden

Meeting Abstract

  • Silvia Hernández-Durán - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Noman Zafar - Klinikum Dresden, Neurochirurgie, Dresden, Deutschland
  • Daniel Behme - Universitätsmedizin Göttingen, Neuroradiologie, Göttingen, Deutschland
  • Matthias Momber - Klinikum Vest, Neurochirurgie, Recklinghausen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • presenting/speaker Ingo Fiss - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Dorothee Mielke - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV159

doi: 10.3205/19dgnc186, urn:nbn:de:0183-19dgnc1869

Published: May 8, 2019

© 2019 Hernández-Durán et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: The treatment for cervical spondylotic myelopathy (CSM) is realized by different surgical approaches to the spine. Over the decades, surgical procedures became more refined, incorporating techniques causing less trauma to the stabilizing structures of the cervical spine. In alternative to the overwhelming percentage of surgery via an anterior approach, dorsal approaches like laminoplasty or laminectomy plus fusion are also performed. We are presentig results of a novel approach to dorsal cervical decompression with unilateral hemi-laminectomy and bilateral decompression reducing muscle trauma.

Methods: In this prospective non randomized study, patients with cervical spinal canal stenosis undergoing surgery were evaluated preoperatively, postoperatively, 6 weeks, 6 and 12 month after surgery by analyzing step count for 25 meters, JOA and NDI score, neurological status. Pre-op MRI and pre- and postop computer tomography was performed and compared for volume of stenotic area. The surgical approach was performed by midline skin incision, ipsilateral muscle fascia incision and muscle detachement only from the hemi-lamina, followed by interlaminar fenestration or hemilaminectomy, depending on extension of CSM, completed by contralateral undercutting of spinous process and removal of yellow ligament (Figure 1 [Fig. 1], Figure 2 [Fig. 2]).

Results: In total 44 patients were included with a mean age of 66 (±9.9) years. The volume of stenotic area according to CT scan was 5.1 cm3 preoperatively and improved to 6.7 cm3 postoperatively (p<0.001). Preoperative MRI-based classification of myelopathy in CSM (Avadhani et al.) resulted in 25, 12, 7 patients matching grade I, II and III. Postoperatively, none of the patients presented with neurological worsening. The JOA score showed improvement postoperatively (p=0.001), after 6 weeks (p=0.002) and 6 months (p=0.034), but not after 1 year (p=0.083). NDI showed significant improvement 6 weeks postoperatively (p=0.02), but not postoperatively, after 6 and 12 months (p=0.54, p=0.13; p=0.15). No significant differences were found in step count postoperatively (p=0.33), after 6 weeks (p=0.73), 6 months (p=0.91) and 12 months (p=0.74)

Conclusion: This novel approach to cervical spine in cervical spondylotic myelopathy can be considereda safe procedure. Results are comparable to previous studies describing clinical outcome after laminectomy and laminoplasty but with less muscle trauma and deficits related to it.