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Original papers

Open-door laminoplasty for multilevel cervical spon-dylotic myelopathy: Good outcome in 12 patients using suture anchor fixation

, , , &
Pages 62-66 | Received 03 Nov 2006, Accepted 30 Jul 2007, Published online: 08 Jul 2009
 

Abstract

Background and purpose In the classic Hirabayashi procedure, the lamina door is tethered open by sutures between the spinous process and facet capsule or para-vertebral muscle. Our early experiences showed, however, that the loosened sutures result in dislodgement and reclosure of the lifted lamina. We present a modified method to ensure secure fixation and prevent restenosis due to hinge closure.

Patients and methods 12 patients with cervical spon-dylotic myelopathy underwent unilateral open-door laminoplasty using suture anchor fixation between 2000 and 2004. The sutures were tied and fixed onto the holed lateral mass screws, instead of using the conventional suture technique. We used radiography, MRI, and CT for imaging studies. The Nurick score was used to assess severity of myelopathy, and the Japanese Orthopedic Association (JOA) score was used to evaluate clinical outcomes before surgery and at the last follow-up visit.

Results All patients experienced functional improvement of at least 1 Nurick score after surgery. The JOA score for the 12 patients increased significantly from 6.9 (SD 3.0) before surgery to 13 (SD 1.6) at final follow-up. Postoperative radiography and CT showed increased sagittal diameter and canal expansion. Average preoper-ative and postoperative ranges of motion for the cervical spine were 48 (SD 4.6) and 36 (SD 2.7), respectively. No neurological deterioration due to hinge reclosure and no major surgery-related complications were observed during the follow-up period.

Interpretation Open-door laminoplasty using suture anchor fixation effectively maintains expansion of the spinal canal and resists closure while preserving alignment and flexibility. This modified technique is easy to use, has a low complication rate, and provides marked functional improvement for patients with cervical spon-dylolytic myelopathy.

Contributions of authors

SCY examined all patients, collected the data, and prepared the manuscript. CCN and WJC performed the surgery and revised the article for intellectual content. CHW and SWY supervised the statistical analyses and proofread the manuscript.

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