Abstract
Background Context
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.
Purpose
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.
Study Design
This is a retrospective comparative study.
Patient Sample
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).
Outcome Measures
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.
Methods
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.
Results
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<.01) after surgery
were better in Group B than in Group A. Radiological evidence of posterior bony impingement
and spontaneous fusion between ODLPsegments were definitely fewer less in Group B
than in Group A (p<.001 and<0.001, respectively). The mean value of bone regrowth
was 1.2 mm (range, 0–3 mm). The NDI and SF-12 scores did not differ significantly
between groups. Surgical outcomes and postoperative complications were similar between
groups.
Conclusions
These results indicate that posterior bony impingement can be a factor in ROM restriction
after cODLP surgery and that wedge-shaped resection during ODLP can be a reliable
option for preserving cervical ROM and improving postoperative clinical and radiological
outcomes.
Keywords
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Article info
Publication history
Published online: April 27, 2017
Accepted:
April 24,
2017
Received in revised form:
December 6,
2016
Received:
October 24,
2016
Footnotes
FDA device/drug status: Approved (Centerpiece plate, Medtronic).
Author disclosures: GWL: Nothing to disclose. BGS: Nothing to disclose. JSY: Nothing to disclose. SMR: Nothing to disclose. MWA: Nothing to disclose.
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.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
