Expansive open-door laminoplasty and selective anterior cervical decompression and fusion for treatment of multilevel cervical spondylotic myelopathy.

Objective: To evaluate the clinical results of combined expansive open-door laminoplasty by splitting of spinous processes and selective anterior cervical decompression and fusion in treatment of multilevel severe cervical spondylotic myelopathy (CSM).

Methods: Twenty-eight patients (16 men and 12 women) underwent one-stage combined expansive open-door laminoplasty and selective anterior decompression and fusion for severe CSM; the average patient age was 51.3 years (range, 32-63 years). Clinical results were assessed by Japanese Orthopaedic Association (JOA) scores, number of finger grip and releases (G and R) in ten seconds, hand-grip strength, visual analog scale (VAS) of axial pain, and C2-C7 angle.

Results:   There was no worsening of neurological symptoms due to cord injury, cerebrospinal fluid leakage, or wound infection. All cases completed one-year follow-up. The JOA scores, number of G and R in ten seconds, and hand-grip strength were all significantly improved (P < 0.05). Satisfactory decompression was shown by MRI or CT to have been achieved in all cases. The C2-C7 angle did not differ significantly from that found pre-operatively. The axial neck pain score was 2.0 ± 0.1 on VAS.

Conclusion: Combined expansive open-door laminoplasty by splitting of spinous processes and selective anterior decompression and fusion achieves complete spinal canal decompression with minimal morbidity; this strategy is effective in improving the surgical outcomes of CSM in one-year follow-up.