Modified laminoplasty for multilevel cervical myelopathy

To investigate the effectiveness of combined C3 laminectomy preserving the semispinalis cervicis into axis and modified C4-C7 open-door laminoplasty in the treatment of multilevel cervical myelopathy. 57 out of 74 patients who underwent combined C3 laminectomy preserving the semispinalis cervicis into axis and modified C4-C7 open-door laminoplasty were followed. Pre- and postoperative Japanese Orthopaedic Association (JOA) score, cervical Range of Motion (ROM) and Cervical Curvature Index (CCI) were measured. The mean operative time was 70 min and the mean intraoperaitve blood loss was 230 ml. Early postoperative neck pain occurred in 41 patients (71.9%), wound infection occurred in 2 patients (3.5%), obvious axial symptoms occurred in 9 patients (15.8%) and C5 nerve root palsy occurred in 6 patients (10.5%). There were no severe complications, such as spinal cord injury, and cerebrospinal fluid leakage. JOA score significantly increased from preoperative 8.5 ± 2.0 points to postoperative 13.8 ± 2.3 points (P<0.05). Cervical ROM decreased from 37.4° ± 10.3° to 28.2° ± 10.8° with a mean loss of 8.2° ± 5.1°. CCI decreased from 13.9 ± 7.4% to 11.3 ± 8.1% with a mean loss of 2.9 ± 2.4%. The rate of neurological function improvement was 57.0 ± 1 9.7%. Combined C3 laminectomy preserving the semispinalis cervicis into axis and modified C4-C7 open-door laminoplasty can significantly improve the neurological function of patients with multilevel cervical myelopathy and the surgical procedure is relatively simple. Therefore, this technique might be widely used in the clinical practice