Revision surgery after cervical laminoplasty: report of five cases and literature review.

Background Context: Revision surgery after laminoplasty is rarely performed, and there are few reports of this procedure in the English literature.

Purpose: To evaluate the reasons why patients underwent revision surgery after laminoplasty and to discuss methods of preventing the need for revision surgery. A literature review with a comparative analysis between previous reports and present cases was also performed.

Study Design: Case report and literature review.

Patient Sample: Five patients who underwent revision surgery after laminoplasty.

Outcome Measures: Diagnosis was based on the preoperative computed tomography and magnetic resonance imaging findings. Neurologic findings were evaluated using the Japanese Orthopedic Association score.

Methods: A total of 237 patients who underwent cervical laminoplasty for cervical spondylotic myelopathy from 1990 to 2010 were reviewed. Patients with ossification of the posterior longitudinal ligament, renal dialysis, infection, tumor, or rheumatoid arthritis were excluded. Five patients who underwent revision surgery for symptoms of recurrent myelopathy or radiculopathy were identified, and the clinical courses and radiological findings of these patients were retrospectively reviewed.

Results: The average interval from the initial surgery to revision surgery was 15.0 (range 9-19) years. The patients were four men and one woman with an average age at the time of the initial operation of 49.8 (range 34-65) years. Four patients developed symptoms of recurrent myelopathy after their initial surgery, for the following reasons: adjacent segment canal stenosis, restenosis after inadequate opening of the lamina with degenerative changes, and trauma after inadequate opening of the lamina. One patient developed new radiculopathy symptoms because of foraminal stenosis secondary to osteoarthritis at the Luschka and zygapophyseal joints. All patients experienced resolution of their symptoms after revision surgery.

Conclusions: Revision surgery after laminoplasty is rare. Inadequate opening of the lamina is one of the important reasons for needing revision surgery. Degenerative changes after laminoplasty may also result in a need for revision surgery. Surgeons should be aware of the degenerative changes that can cause neurologic deterioration after laminoplasty.