Treatment of cervical compressive myelopathy with a new dorsolateral decompressive procedure

Object. A new dorsolateral decompressive procedure involving a unilateral a pproach has been devised for the treatment of cervical compressive myelopat hy. In this operation, the posterior spinal elements of the contralateral s ide are not disturbed, and thus, postoperative deformity of the cervical sp ine can be avoided. Following decompressive surgery via the unilateral appr oach, the cervical spine was kept more stable compared with the results obt ained after wide laminectomy or other expansive laminoplasty procedures. Methods. Twenty-six patients underwent dorsolateral decompressive surgery, and the patients' clinical and radiological results were examined during th e follow-up period to evaluate neurological function and postoperative defo rmities of the cervical spine. The underlying conditions for myelopathy wer e cervical spondylosis (19 patients), ossification of posterior longitudina l ligament (three patients), and ossification of yellow ligament (four pati ents). The follow up period ranged from 6 to 110 months (average 35.5 month s). Functional recovery, which was rated by using the Japanese Orthopaedic Association scoring system, was an average of 56% in all patients (100% bei ng equal to full recovery). The recovery rate was compatible with those att ained after other expansive laminoplasty procedures. Radiographically, prog ression to swan-neck or kyphotic deformity was not observed in any patient. No postoperative spinal instability was noted. Based on computerized tomog raphy myelograph evaluation, the average transectional area of the dural tu be at the C4-5 level was expanded from 122 mm(2) to 169 mm(2), and the tran sectional area of the spinal cord at the C4-5 level was expanded from 39.6 mm(2) to 52.9 mm(2) after surgery. Conclusions. The authors conclude that this operative procedure could be us ed as a new option for the treatment of cervical compressive myelopathy.