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Efficacy and results of expansive laminoplasty in patients with severe cervical myelopathy due to cervical canal

D Agrawal1, B S Sharma, A Gupta

  • 1Department of Neurosurgery, Neurosciences center, All India Institute of Medical Sciences, New Delhi-110 029, India.

Neurology India
|April 8, 2004
PubMed
Summary

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Expansive laminoplasty effectively decompressing the spinal cord improved neurological function in patients with advanced cervical myelopathy. Even a one-grade improvement significantly enhanced patients' quality of life.

Area of Science:

  • Neurosurgery
  • Spinal Surgery
  • Neurology

Background:

  • Cervical myelopathy, particularly advanced stages (Nurick's Grade III or greater), significantly impacts neurological function and quality of life.
  • Surgical intervention is crucial for managing severe cervical myelopathy.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of expansive laminoplasty for patients with advanced cervical myelopathy.
  • To assess the neurological improvement and patient satisfaction following the procedure.

Main Methods:

  • A retrospective review of 24 patients with advanced cervical myelopathy who underwent expansive laminoplasty between 1999 and 2002.
  • Neurological deficits were graded using Nurick's scale, and outcomes were analyzed using Odom's criteria.
  • A modified Hirabayashi's open-door laminoplasty was performed, utilizing titanium miniplates, autologous bone, or hydroxyapatite spacers.

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Main Results:

  • Patients with symptom duration under three years showed improvement in at least one Nurick's grade.
  • 50% of patients with symptom duration between three and six years also improved by at least one grade.
  • 87% of Grade IV patients improved to Grade III, and 95.8% of all patients achieved a good to fair outcome per Odom's criteria.

Conclusions:

  • Expansive laminoplasty with titanium miniplate fixation offers significant neurological improvement in advanced cervical myelopathy, even in late-presenting cases.
  • Even a single-grade improvement in Nurick's scale can lead to substantial benefits in patients' quality of life.
  • The procedure is a viable option for cord decompression and functional recovery in severe cervical myelopathy.