Cervical laminoplasty for subaxial lesion in rheumatoid arthritis.

Expansive laminoplasty of the cervical spine was performed for 15 patients with subaxial lesion (SAL) in rheumatoid arthritis (RA) with or without symptomatic occipitocervical pathology. Clinical results were satisfactory, and radiographic evaluation revealed that the range of movement of the cervical spine decreased to 56.3%, spinal alignment was well preserved, and intervertebral slipping advanced only slightly. Therefore, expansive laminoplasty is shown to be clinically effective in decompressing the subaxial spinal cord without the need for fusion of this region, yet it avoids exacerbating or creating significant instability. We found that it can serve as a useful procedure for treating spinal cord compression caused by SAL in RA. For patients with upper cervical instability, laminoplasty with upper cervical fusion appears to be an effective option. In a case in which kyphosis was observed preoperatively, its deformity became worse after laminoplasty. Thus, it may be advisable to consider subaxial fusion in such cases.