Cervical laminoplasty in patients with spinal canal stenosis and myelopathy A case series.

Abstract

Introduction: Cervical spinal stenosis causes spinal cord compression and, in the long term, degenerative changes, which are clinically manifested by neurological dysfunction of the upper limbs and impaired walking. MRI shows this degeneration as white marrow at one or more levels. Open-door laminoplasty is a surgical technique for multilevel stenosis with neurological symptoms in patients who retain cervical lordosis. This study aims to determine the incidence of degenerative myelopathy due to cervical stenosis in our Hospital, to carry out the functional assessment of patients operated on for myelopathy and treated with open-door laminoplasty.

Methods: In a descriptive, cross-sectional study in the Traumatology and Orthopedics Service of the Alcívar Hospital in the period 2021 - 2024, 5 patients with cervical myelopathy were treated, of which four were operated on with the open-door laminoplasty procedure, being analyzed with the mJOA and Nurick functional scales.

Results: The incidence of myelopathy in our hospital was 7%. Of the 4 patients operated on, 3 underwent surgery in 2 stages due to mild instability or mild loss of cervical lordosis; only one patient underwent open-door laminoplasty directly. Favorable mJOA functional results were obtained from 9 pre-surgical to 14 post-surgical, recovering up to 50% of the spinal canal.

Discussion: Performing anterior cervical fusion first ensures increased cervical lordosis and a stable spine when appropriate. Titanium mini plates are very useful to keep the door open. When spinal cord degeneration has been developing for a long time, there may be immediate improvement and then worsening of neurological symptoms, as we saw in a patient who had been developing for 2 years. Whenever there is cervical stenosis, we also find lumbar stenosis; in 3 of our patients, there were both, but the lumbar stenosis was still asymptomatic.

Conclusions: Cervical laminoplasty represents a safe and effective posterior approach to achieve an adequate canal opening with multilevel stenosis and decompress the spinal cord.