1552. Dome Laminotomies at Adjacent Segments in Cervical Laminoplasty
Authors: Jeffrey Hale Zimering, MD; Konstantinos Margetis, MD, PhD (New York, NY)
Cervical spondylotic myelopathy causes decreased hand dexterity, urinary incontinence, and/or gait instability. Cervical laminoplasty is a common neurosurgical approach for the treatment of patients having cervical stenosis and cervical spondylotic myelopathy. We undertook to evaluate whether the technique of performing dome laminotomies at adjacent segments is associated with satisfactory decompression and prevents kinking of the spinal cord after its dorsal migration post-decompression. The technique's advantages are: limited number of levels used, smaller exposure and incision, preservation of muscular attachments at the top of C2 and C7.
C3-6 laminoplasty, C2-C7 dome laminotomies-bilateral laminotomies, the caudal/trailing edge of C2, the cranial/leading edge of C7. Seventeen patients, (12 men and 5 women) mean age of 62 years, chart review of 2015-2018 at Mount Sinai Hospital. Post-operative clinical evaluation findings based on the one or two month post-operative visit.
Among twelve patients who reported having experienced significant neck pain pre-operatively, one-third reported no pain, one-third had persistent mild pain and one-third still experienced moderate persistent pain post-operatively. Range of neck motion was reported to have improved significantly, post-operatively, in two patients. Of nine patients who had hand dysfunction pre-operatively, eight reported post-operative improvement in hand function. Of eight patients who reported balance problems pre-operatively, five patients reported improvement in balance post-operatively. Among those patients whose balance did not improve post-operatively, there was a trend toward older age (69.3 vs 58.6 years; P = 0.13) compared to the mean age in patients experiencing post-operative balance improvement. Of four patients who reported urinary incontinence pre-operatively, three reported improvement in urinary incontinence post-operatively.
In summary, C3-6 laminoplasty that includes C2 and C7 undercuts was associated with improved neurological function in the majority of patients with one-third of patients experiencing complete resolution of neck pain.