Open-door laminoplasty : What can the unilateral approach offer?

Objective: Multilevel posterior decompression of subaxial cervical spinal canal stenosis through a less-invasive unilateral approach.

Indications: Degenerative cervical myelopathy due to multilevel subaxial spinal canal stenosis.

Contraindications: Cervical kyphosis or instability, bilateral radiculopathy due to foraminal stenosis, involvement of C2 or C7.

Surgical Technique: Unilateral subaxial approach with detachment of muscles only on one side. The ipsilateral laminae C6 to C3 are cut at the laminofacet junction and opened up. The loss of resistance is usually due to a greenstick fracture in the proximity of the contralateral laminofacet junction. The opened laminae are fixed with Z‑shaped thin titanium plates. If necessary, the laminoplasty can be combined with a unilateral fixation and fusion by the same approach.

Postoperative Management: Early mobilization 4-6 h postoperatively. No orthosis necessary.

Results: A total of 131 patients (77 men, mean age 67 years) with a multilevel cervical spondylotic myelopathy (CSM) underwent surgery using a posterior approach. In 52 patients (40%), a unilateral approach was performed (laminoplasty: n = 30; laminoplasty/fusion: n = 22). In this group, the mean operation time was less compared with two other techniques (unilateral approach: 110 min; laminectomy/fusion: 150 min; 360° approach: 210 min). The postoperative European myelopathy score (EMS) improved from 12.8 to 15.2. The overall complication rate was 17% (unilateral approach: 9%; laminectomy/fusion: 18%; 360° approach: 27%).