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Expansive open-door laminoplasty versus laminectomy and instrumented fusion for cases with cervical ossification of the posterior longitudinal ligament and straight lordosis

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Abstract

Purpose

To identify whether expansive open-door laminoplasty (Lam) is more appropriate than laminectomy and instrumented fusion (LIF) for cases with ossification of the posterior longitudinal ligament (OPLL) and straight cervical lordosis.

Methods

A total of 67 cases were included and divided into Group Lam (n = 32) and Group LIF (n = 35), and the mean follow-up periods were 38 and 42 months, respectively. The cervical lordosis was elevated by C2–7 Cobb angle and cervical sagittal balance by C2–C7 sagittal vertical axis (SVA). Japanese Orthopedic Association (JOA), neurological recovery rate (RR) being calculated by the JOA, visual analog scale (VAS) and neck disability index (NDI) were used to assess clinical outcomes.

Results

Differences in general data between two groups were not significant. Total blood loss and operation duration in Group Lam were both significantly less than that in the Group LIF. By the final follow-up, the cervical lordosis significantly decreased in Group Lam and increased in Group LIF, the SVA significantly increased in Group Lam and kept unchanged in Group LIF, and the JOA, VAS, NDI significantly improved in both groups. Although there was no significant difference in RR between the two groups, cases in Group Lam had significantly larger incidence of postoperative kyphosis and kyphotic change rate, and less VAS, NDI and incidence of axial pain than cases in Group LIF.

Conclusions

When compared with the LIF, the Lam is recommended for cases with OPLL and straight cervical lordosis when taking comparable neurological recovery, less axial pain and better neck function improvement into consideration.

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Author notes

    Authors and Affiliations

    1. Department of Orthopedics, Jinling Hospital, Medicine College, Nanjing University, Nanjing, 210002, Jiangsu, China

      Xiaowei Liu & Bin Xu

    2. Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China

      Yu Chen, Haisong Yang, Tiefeng Li & Deyu Chen

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    1. Xiaowei Liu
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    2. Yu Chen
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    6. Deyu Chen
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    Correspondence to Deyu Chen.

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    None of the authors has any potential conflict of interest.

    The manuscript submitted does not contain information about medical device(s)/drug(s). And this study has been approved by the appropriate ethics committee and has, therefore, been performed in accordance with the Declaration of Helsinki’s ethical standards.

    Additional information

    B. Xu is a co-corresponding author for this submitted manuscript.

    X. Liu and Y. Chen have made equal contribution to this article, and should be regarded as co-first author.

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    Liu, X., Chen, Y., Yang, H. et al. Expansive open-door laminoplasty versus laminectomy and instrumented fusion for cases with cervical ossification of the posterior longitudinal ligament and straight lordosis. Eur Spine J 26, 1173–1180 (2017). https://doi.org/10.1007/s00586-016-4912-7

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