Operative Treatment of Cervical Myelopathy: Cervical Laminoplasty

Cervical spondylotic myelopathy (CSM) is a degenerative process which may result in clinical signs and symptoms which require surgical intervention. Many treatment options have been proposed with various degrees of technical difficulty and technique sensitive benefits. We review laminoplasty as a motion-sparing posterior decompressive method. Current literature supports the use of laminoplasty for indicated decompression. We also decribe our surgical technique for an open-door, or “hinged”, laminoplasty. 1. Introduction Cervical spondylotic myelopathy (CSM) is the natural result of degenerative compression on the cervical spinal cord. The result may be a progressive and stepwise deterioration of neurological function in patients. The chronic debilitating nature of this process justifies surgical decompression. Posterior decompression has been described as a treatment for CSM since the 1940s. Laminectomy was the initial surgical option used. The decompression was performed by rongeurs. However, the insertion of the rongeur in an already limited space available for the cord led often to a decrease in neurological function postoperatively [1–3]. Even with modern approaches to laminectomy using high speed burs, development of postoperative instability has led surgeons to explore more efficacious ways of decompression. In 1977, Hirabayashi and Satomi published their results on multisegment decompression by means of an open-door laminoplasty [4]. This technique allows for adequate posterior decompression of the spinal cord while retaining the posterior elements. This avoids the postoperative instability seen with laminectomy as well as the stiffness and risks of posterior cervical fusion. Additionally, motion is spared due to the absence of a fusion. There have since been multiple techniques for performing a cervical laminoplasty described with supporting literature [4–8]. These techniques include the expansive “open door,” a midline “French Door,” En Bloc resection, spinous process splitting, and Z-Plasty [4, 9]. Outcome studies have supported laminoplasty as a valid treatment for CSM however, no definitive literature shows its superiority to laminectomy in conjunction with a posterior cervical fusion. All surgical strategies appear to be equal in yielding neurologic outcomes, though differences are found in complication reports. Patient selection is crucial prior to proceeding with cervical laminoplasty. Special attention must be paid to sagittal alignment for optimal outcomes. Laminoplasty is ideal for multilevel stenosis (AP canal diameter < 13？mm) due to