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CC BY-NC-ND 4.0 · J Neurol Surg A Cent Eur Neurosurg 2022; 83(05): 494-501
DOI: 10.1055/s-0041-1739224
Surgical Technique

Surgical Treatment of Multilevel Degenerative Cervical Myelopathy: Open-Door Laminoplasty and Fixation via Unilateral Approach. A Feasibility Study

Gregor Schmeiser 
1   Department of Spine Surgery, Schoen-Klinik Hamburg-Eilbek, Hamburg, Germany
,
Janina Isabel Bergmann
1   Department of Spine Surgery, Schoen-Klinik Hamburg-Eilbek, Hamburg, Germany
,
Luca Papavero 
1   Department of Spine Surgery, Schoen-Klinik Hamburg-Eilbek, Hamburg, Germany
,
Ralph Kothe
2   Clinic for Spine Surgery, Schoen Clinic Hamburg Eilbek, Academic Hospital of the Eppendorf University Medical Center, Hamburg, Germany
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Abstract

Objective We compared open-door laminoplasty via a unilateral approach and additional unilateral lateral mass screw fixation (uLP) with laminectomy and bilateral lateral mass screw fixation (LC) in the surgical treatment of multilevel degenerative cervical myelopathy (mDCM).

Methods A retrospective cohort analysis of 46 prospectively enrolled patients (23 uLP and 23 LC). The minimum follow-up was 1 year. Neck and arm pains were evaluated with visual analog scales and disability with the Neck Disability Index (NDI). Myelopathy was rated with the modified Japanese Orthopaedic Association (mJOA) score. Cervical sagittal parameters were measured on plain and functional X-ray films with a specific software. The statistical significance was set at p < 0.05. Fusion was defined as <2 degrees of intersegmental motion on flexion/extension radiographs.

Results The two groups were similar in age and comorbidities. The mean operation time and the mean hospital stay were shorter in the uLP group (p = 0.015). The intraoperative blood loss did not exceed 200 mL in both groups. At follow-up, the groups showed comparable clinical outcome data. The sagittal profile did not deteriorate in either group. Fusion rates were 67% in the uLP group and 92% in the LC group. No infections occurred in either group. In the LC group, one patient developed a transient C5 palsy. Revision surgery was required for a malpositioned screw (LC) and for one implant failure (uLP).

Conclusion Laminoplasty and unilateral fixation via a unilateral approach achieved comparable clinical and radiologic results with laminectomy and bilateral fixation, despite a lower fusion rate. However, the surgical traumatization was less.

Keywords

cervical myelopathy - laminoplasty - laminectomy - Lateral mass screws


Publication History

Received: 21 December 2020

Accepted: 23 April 2021

Article published online:
15 December 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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