Review Question - QID 214056

Combined laminoplasty and fusion for the treatment of cervical myelopathy has the theoretical benefit of preserved paraspinal muscle attachments and decrease muscular atrophy.

Cervical myelopathy is the chronic compression of the spinal cord which leads to gait instability, decreased dexterity, numbness, and loss of bladder function. Treatment is dependent on the cervical sagittal alignment and extent of cord compression across cervical motion segments. Cervical kyphosis greater than 10 degrees should be addressed with anterior cervical discectomy and fusion (ACDF) to restore cervical lordosis and decreased cord compression over the posterior vertebral bodies. When there is multilevel involvement or persistent stenosis posteriorly despite successful anterior decompression, posterior decompression can be performed. Laminoplasty combined with fusion has the added benefit of preserved muscular attachments and decreased muscular atrophy compared to laminectomy and fusion.

Ashana et al. performed a retrospective study of paraspinal muscular atrophy following cervical laminoplasty and laminectomy with fusion. They reported mean cross-sectional atrophy of 6% following laminoplasty and 13.1% following laminectomy with fusion. The authors concluded that laminoplasty is associated with lower rates of paraspinal muscular atrophy, and can contribute to preserved cervical lordosis.

Kurokawa and Kim reviewed the history of cervical laminoplasty and described various techniques. They reported the literature has not supported the superiority of laminoplasty over laminectomy for the treatment of cervical myelopathy. The authors speculated the new development of myoarchitectonic spinolaminoplasty with active postoperative range of motion may provide an added benefit for the treatment of cervical myelopathy.

Bridges et al. performed a literature review of combined laminoplasty and fusion for the treatment of cervical myelopathy. They reported that combined laminoplasty and fusion has equivalent, if not superior, neurological improvements compared to laminectomy and fusion. They concluded that laminoplasty and fusion can be used effectively for cervical myelopathy in the setting of local kyphotic deformity, associated ossification of the posterior longitudinal ligament, and associated segmental instability.

Illustration A is a diagram of the myoarchitectonic spinolaminoplasty procedure. Illustration B is a diagram of an open-door laminoplasty. Illustration C is a diagram of a french door laminoplasty.

Incorrect Answers:
Answer 1: Laminoplasty has not been shown to have an infection benefit over laminectomy.
Answer 2: Neurologic complications are similar between laminoplasty and laminectomy, with C5 palsy being the most common.
Answer 3: Postoperative hospital stay has not been shown to differ between combined laminoplasty and fusion compared to laminectomy and fusion.
Answer 5: Adjacent segment disease would not be affected since the patient has already undergone and anterior cervical discectomy and fusion. Laminoplasty alone would decrease the risk of adjacent segment disease.