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Better results seen with wedge-shaped resection, open-door laminoplasty vs laminoplasty alone
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Investigators found patients who underwent wedge-shaped resection of the cranial portion of the posterior bony arch in open-door laminoplasty had better outcomes for cervical range of motion, posterior bony impingement prevention and pain intensity of the neck compared with patients who underwent open-door laminoplasty alone.
In a prospective, double-arm comparative study, researchers randomly grouped 75 patients to undergo either a wedge-shaped resection of the cranial portion of the posterior bony arch during open-door laminoplasty (ODLP, n=38) or ODLP alone (n=37). The range of motion of the cervical spine was the primary outcome. Other outcomes included pain intensity, SF-12 scores, modified Japanese Orthopaedic Association scale scores, bony impingement presence on dynamic lateral radiograph, surgical outcomes and surgery-related complications.
Results showed at 6-months and 1-year postoperatively, the range of motion of the cervical spine was significantly greater in patients who underwent wedge-shaped resection during ODLOP compared with patients who underwent ODLP alone. After 1-year postoperatively, patients who underwent wedge-shaped resection during ODLP had significantly lower pain intensity at the posterior neck. Patients who underwent wedge-resection had 0% posterior bony impingement, whereas, those who underwent ODLP alone had 32.4% bony impingement. Groups had comparable clinical outcomes and surgery-related complications. ‒ by Monica Jaramillo
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Ahmad Nassr, MD
Suh and colleagues performed a prospective study of a modified open door laminoplasty involving the resection of the cephalad portion of the lamina vs. traditional open door laminoplasty. Their results suggested that resection resulted in better ROM and did not affect clinical outcome. These results seem to be intuitive as this resection would result in less bony impingement between lamina during range of motion (ROM). This may, however, weaken the lamina and predispose it to hinge fracture. Another alternative to doing this routinely at all levels would be to check the ROM after laminoplasty and before closure and resect only the portions of the lamina that cause impingement. This can be achieved by use of Gardner-Wells tongs with traction rather than traditional Mayfield skull tongs (SM USA). This allows for ROM to be examined at the end of each procedure and then for selectively resecting any areas of bony impingement. This study is certainly convincing that laminar impingement does likely occur and limit ROM in some patients after laminoplasty.
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