Multi-level posterior foraminotomy with laminoplasty versus laminoplasty alone for cervical spondylotic myelopathy with radiculopathy: a comparative study

Publication date: Available online 4 September 2017
Source:The Spine Journal
Author(s): Dong-Ho Lee, Jae Hwan Cho, Chang Ju Hwang, Choon Sung Lee, Chunghwan Kim, Jung-Ki Ha
Background ContextConventional laminoplasty is useful for expanding a stenotic spinal canal. However, it has limited use for the decompression of accompanying neural foraminal stenosis. As such, an additional posterior foraminotomy could be simultaneously applied, although this procedure carries a risk of segmental kyphosis and instability.PurposeThe aim was to elucidate the long-term surgical outcomes of additional posterior foraminotomy with a laminoplasty for cervical spondylotic myelopathy (CSM) with radiculopathy.Study Design/SettingRetrospective comparative study.Patient SampleNinety-eight consecutive patients who underwent laminoplasty for CSM with radiculopathy between January 2006 and December 2012 were screened for eligibility. This study included 66 patients, who were treated with a laminoplasty of two or more levels and followed more than two years after surgery.Outcome MeasuresThe Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) scores, JOA recovery rates, and Visual Analog Scale (VAS) were used to evaluate clinical outcomes. The C2–C7 sagittal vertical axis distance, cervical lordosis, range of motion (ROM), and angulation and vertebral slippage at the foraminotomy level were used to measure radiological outcomes using the whole spine anteroposterior/lateral and dynamic lateral radiographs.MethodsSixty-six patients with CSM with radiculopathy involving two or more levels were consecutively treated with laminoplasty and followed up for more than two years after surgery. The first 26 patients underwent laminoplasty alone (LA group), while the next 40 patients underwent an additional posterior foraminotomy at stenotic neural foramens with radiating symptoms in addition to laminoplasty (LF group). In the LF group, the foraminotomy with less resection than 50% of facet joint to avoid segmental kyphosis and instability was performed at 78 segments (unilateral:bilateral = 57:21) and 99 sites. Clinical and radiographic data were assessed preoperatively and at two-year follow-up and compared between the groups.ResultsNDI, JOA scores, JOA recovery rates, and VAS for neck/arm pain were improved significantly in both groups after surgery. The improvement in the VAS for arm pain was significantly greater in the LF group (from 5.55 ± 2.52 to 1.85 ± 2.39) than the LA group (from 5.48 ± 2.42 to 3.40 ± 2.68) (P < 0.001). Although cervical lordosis and ROM decreased postoperatively in both groups, there were no significant differences in the degree of reduction between the LF and LA groups. Although the postoperative focal angulation and slippage were slightly increased in the LF group, this was not to a significant degree. Furthermore, segmental kyphosis and instability were not observed in the LF group, regardless of whether the patient underwent a unilateral or bilateral foraminotomy.ConclusionsAdditional posterior foraminotomy with laminoplasty is likely to improve arm pain more significantly than laminoplasty alone by decompressing nerve roots. Also, performing posterior foraminotomy via multiple or bilateral did not significantly affect segmental malalignment and instability. Therefore, when a laminoplasty is performed for CSM with radiculopathy, an additional posterior foraminotomy could be an efficient and safe treatment that improves both myelopathy symptoms and radicular arm pain.



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