Cervical laminoplasty in patients with canal stenosis and myelopathy.

Abstract

Introduction: Cervical spinal stenosis leads to spinal cord compression, ischemia, and degenerative changes, clinically manifesting as upper and lower extremity neurological dysfunction with impaired gait. MRI shows this degeneration as hyperintensity at one or more cervical levels. Open-door laminoplasty is a surgical technique for multilevel stenosis (3 or more levels) with signs of myelopathy and axial pain in patients who maintain cervical lordosis.

Case Report: A 52-year-old man presented with a 2-month history of cervicalgia following a fall with direct impact on the posterior cervical region. Accompanying symptoms included paresthesia and muscle weakness in the upper extremities (3/5 in the left C5 and C6 distribution) and lower extremities (left patellar hyperreflexia). At the time of presentation, he had urinary retention, a Nurick score of 4, a modified Japanese Orthopaedic Association (mJOA) score of 9, a positive Hoffmann's sign, and a positive Trommer's sign. Cervical spine X-rays showed advanced arthritic changes. CT demonstrated osteophytes and a narrowed spinal canal. MRI revealed spinal cord compression at three levels: C3-C4, C4-C5, and C6-C7. The patient underwent a laminectomy. The incidence of myelopathy in the study was 7%. Favorable functional outcomes were observed, with the mJOA score improving from 9 preoperatively to 14 postoperatively and a 50% recovery of the spinal canal.

Conclusion: Open-door laminoplasty is an effective and safe option for the treatment of multilevel cervical spinal stenosis, offering significant benefits in terms of spinal cord decompression, improved cervical function, and minimized complications.