Impact of wedge-shaped resection of the posterior bony arch on postoperative outcomes after open door laminoplasty in the cervical spine: a 2-year follow-up study

• Published in: The spine journal 2017-09, Vol.17 (9), p.1230-1237
• Main Authors: Lee, Gun Woo, Suh, Bo-Gun, Yeom, Jin S., Ryu, Seung-Min, Ahn, Myun-Whan
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cervical spine; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - surgery; clinical outcomes; complication; Female; Follow-Up Studies; Humans; Laminectomy - adverse effects; Laminectomy - methods; Laminoplasty - adverse effects; Laminoplasty - methods; Male; Middle Aged; motion restriction; Neck Pain - diagnostic imaging; Neck Pain - etiology; open-door laminoplasty; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; range of motion; Range of Motion, Articular; surgical modification; wedge-shaped resection
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2017.04.033

Open door laminoplasty (ODLP) can also lead to significant postoperative motion restriction that further increases over time, for which one of the possible factors is the bony impingement between neighboring posterior bony arches. Previously, we reported this phenomenon and modified technique of ODLP, wedge-shaped resection of the posterior bony arch that produced greater range of motion (ROM) of the cervical spine and less posterior neck pain compared with conventional ODLP (cODLP) in 1-year follow-up time, but no longer follow-up outcomes of the surgical technique has been reported. The study aimed to thoroughly evaluate the impact of posterior bony impingement following ODLP on postoperative cervical motion and related outcomes, and to compare postoperative outcomes of conventional ODLP (cODLP with those of modified ODLP (mODLP) in 2-year follow-up times. This is a retrospective comparative study. A total of 145 patients who underwent cODLP or mODLP and were followed up for at least 2 years were classified into two groups: Group A (cODLP, 79 patients) and Group B (mODLP, 66 patients). The primary outcome measure was ROM of the cervical spine. Secondary outcome measures included (1) patient satisfaction, (2) radiological outcomes, including the rate of bony impingement and spontaneous fusion, and bone regrowth of the resection site, (3) clinical outcomes based on pain intensity and scores on the 12-item short-form health survey (SF-12) and neck disability index (NDI), (4) surgical outcomes, and (5) surgery-related complications. We compared baseline data in both groups. To evaluate the impact of our surgical modification on postoperative outcome after ODLP, we compared the outcome measures in 2-year follow-up times. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. The ROM of the cervical spine was significantly greater in Group B 2 years after surgery than in Group A (p=.001). Patient satisfaction (p=.02) at 2 years after surgery and pain intensity of the posterior neck at 1 (p=.01) and 2 years (p