Modified open-door laminoplasty for treatment of neurological deficits in younger patients with congenital spinal stenosis: analysis of clinical and radiographic data

Object. Multilevel anterior cervical decompressive surgery and fusion effec tively treats cervical myeloradiculopathy that is caused by severe cervical spinal stenosis, but degenerative changes at adjacent vertebral levels fre quently result in long-term morbidity. The authors performed a modified open-door laminoplasty procedure in which allograft bone and titanium miniplates were used to treat cervical myelorad iculopathy in younger patients with congenital canal stenosis while maintai ning functional cervical motion segments. Pre- and postoperative magnetic r esonance imaging and/or computerized tomography myelography were performed to assess changes in cervical spinal canal dimensions. Pre- and postoperati ve flexion-extension radiographs were compared to determine the residual mo tion of the targeted operative segments. Methods. Twenty younger patients (average age 37.7 years) underwent modifie d open-door laminoplasty for treatment of myelopathy or myeloradiculopathy related to significant cervical spinal stenosis with or without. associated central or lateral disc herniation or foraminal stenosis. These surgeries were performed during a 2-year period and follow-up review remains ongoing (average follow-up period 21.6 months). Reconstructive procedures were perf ormed on an average of 4.1 levels (range three-six). Operative time average d 186 minutes (range 93-229 minutes). Average blood loss was 305 ml (range 100-650 ml). No cases were complicated by neurological deterioration, infec tion, wound breakdown, graft displacement, or hardware failure. The patient s' Nurick Scale grade improved from a preoperative average of 1.8 to a post operative average of 0.5. Pre- and postoperative sagittal spinal diameter averaged 11.2 mm (8-14 mm) and 16.6 mm (13-19 mm), respectively. The sagittal compression ratio (sagit tal/lateral x 100%) increased from 48% pre- to 72% postoperatively. The spi nal canal area increased an average of 55% (range 19-127%). In patients in whom pre- and postoperative flexion-extension radiographs were obtained, 72 .7% residual neck motion was maintained. No patient developed increased nec k or shoulder pain. Neurological symptoms improved in all patients, with to tal relief of myelopathy in 50% and partial improvement in 50%. Conclusions. Modified open-door laminoplasty with allograft bone and titani um miniplates effectively treats neurological deficits in younger patients with congenital and spinal stenosis. Although long term results are unknown , short-term results are good and there is a low incidence of complications .