Cervical Endoscopic Laminoplasty for Cervical Myelopathy

STUDY DESIGN: Prospective clinical series. OBJECTIVE: The aim of this study was to evaluate the safety, feasibility, and efficacy of a new minimally invasive laminoplasty technique for patients with cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA: Posterior decompression is one of the most common surgical interventions for CSM. Conservative posterior approaches require extensive release and extensive retraction of paraspinal muscles and/or treatment of bone (lamina), which leads to postoperative axial neck pain and a decrease in lordosis and range of motion (ROM). METHODS: A total of 45 patients with CSM received cervical microendoscopic laminoplasty (CMEL). Surgery included endoscopy-assisted bilateral laminoplasty with spinous process-ligament complex and deep extensor muscle retroposition. Bilateral titanium mini-screws and plates were used for fixation. Effects and axial symptoms were evaluated according to the Japanese Orthopedic Association (JOA) scores for neurological condition and visual analog scales (VAS) for axial neck pain, respectively. Cervical curvature index (CCI) and ROM were evaluated by X-ray. Computerized tomography and magnetic resonance imaging scans evaluated laminar healing and spinal cord decompression. RESULTS: Follow-up ranged from 18 to 48 months (average 28 months). The duration of surgery averaged 119 minutes (range 62-147 min). Average blood loss was 360 mL (range 250-700 mL). Mean JOA scores improved from 8.0 ± 1.72 preoperatively to 13.29 ± 1.85 postoperatively. The effects were excellent in 13 cases, good in 25 cases, and fair in 7 cases. Axial symptoms were excellent in 16 cases, good in 18 cases, and fair in 11 cases. The VAS scores of axial pain significantly improved to 2.3 ± 2.0 at the final follow-up compared with 4.3 ± 2.1 preoperatively (P < 0.05). The CMEL procedure provided stable reconstruction of expanded laminar arches with no postoperative collapse or door-close. Sagittal spinal canal diameter increased by 1 to 3 mm. There were no differences in the pre- and postoperative CCI and ROM. CONCLUSION: The new CMEL provides stable reconstruction of an expanded laminar arch and causes less damage to the spinous process-ligament complex and the deep extensor muscles than conventional surgical approaches. The CMEL procedure can be used efficiently and safely to treat CSM. LEVEL OF EVIDENCE: N/A.