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Abstract
Expansive laminoplasty of several types has been proposed for patients with cervical
multisegmental stenotic myelopathy to reduce postlaminectomy complications. Its effectiveness
has not been fully explored by evaluating long-term results and magnetic resonance
imaging (MRI) findings before and after surgery.
We conducted a 5-year follow-up study of 22 patients with cervical spondylotic myelopathy
and/or ossification of the posterior longitudinal ligament surgically treated with
expansive laminoplasty. The operative results were examined using the Japanese Orthopedic
Association (JOA) disability scale, with reference to the findings of MRI, computed
tomography, and radiography.
Postoperative improvement was observed in 18 (81.8%) of the 22 patients. In 11 patients
the percentage recovery of the JOA score was higher than 50% (average: 83.1%), while
in the remaining 11 patients it was lower than 50% (average: 20.1%). Factors contributing
to incomplete recovery appear to be related mainly to cord degeneration with atrophy
(depicted as a T2-high intensity area) and to specific factors such as long symptom
duration, age higher than 70 years, deterioration due to trauma, severe cord compression,
radiculopathy, and kyphotic cervical curvature.
In cervical myelopathy, patients with multisegmental stenosis, expansive laminoplasty
can be expected to provide a favorable outcome by providing sufficient cord decompression
and stabilization of the cervical spine, when the stenotic cervical canal is enlarged
to the normal range (over 12 mm residual anteroposterior diameter and 200 mm2 residual
canal area). The efficacy can be restricted by various factors, especially irreparable
cord degeneration.