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"Spring-back" closure associated with open-door cervical laminoplasty.

Hai-Qiang Wang1, Kin-Cheung Mak, Dino Samartzis

  • 1Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, 15 Changle Western Rd, Xi'an, Shaanxi Province, China 710032.

The Spine Journal : Official Journal of the North American Spine Society
|September 6, 2011
PubMed
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Spring-back closure, a complication of open-door laminoplasty, occurred in 10% of patients within six months. This complication, often affecting the lower cervical spine, was linked to postoperative neurologic deterioration, necessitating preventative surgical strategies.

Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Spinal Surgery

Background:

  • Spring-back, a known risk after open-door laminoplasty, lacks clear definition, incidence data, and understanding of its neurologic impact.
  • This study addresses the ambiguity surrounding spring-back complications following Hirabayashi's open-door laminoplasty technique.

Purpose of the Study:

  • To determine the incidence of spring-back closure after open-door laminoplasty.
  • To evaluate the neurologic consequences associated with spring-back closure.

Main Methods:

  • Retrospective review of radiographic and clinical data from 30 patients undergoing open-door laminoplasty.
  • Measurement of anteroposterior diameters (APD) of the cervical vertebral canal (C3-C7) on serial X-rays.
  • Definition of spring-back as loss of APD post-surgery; assessment of lamina silhouette changes and Japanese Orthopaedic Association (JOA) scores for neurologic status.

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Main Results:

  • Spring-back closure was observed in 10% of patients (3/30) and 6% of laminae (7/117) within six months, primarily in the lower cervical spine (C5-C6).
  • All closures were partial and segmental. No significant association was found with patient gender or age.
  • Patients experiencing spring-back closure showed postoperative neurologic deterioration, with a mean JOA score of 12.5 (40% recovery rate).

Conclusions:

  • Spring-back closure is a significant complication occurring in 10% of patients within six months post-open-door laminoplasty.
  • The incidence of spring-back at the laminar level is 6%, predominantly affecting C5 and C6.
  • Given the association with neurologic deficit, preemptive surgical measures are recommended to prevent spring-back closure.