Open Door Laminoplasty: Creation Of A New Vertebral Arch

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Fig. 1
(a) Stenosis of the spinal canal and compressed spinal cord. (b) Creation of open side, hinged side and extraction of spinous processes. (c) Insertion of bony graft cut as a strut or column in the open side of the laminoplasty (d) Stabilization of the construction with titanium plates and screws. Original drawings carried out by the senior author (JHV).
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Fig. 2
Preoperative T2-weighted MRI. (a) Sagittal MRI that shows multiple discal involvements and a decrease in the diameter of the spinal canal (<12 mm). (b) Axial MRI at the C4-C5 level that illustrates the important compression of the spinal cord with an anterior posterior diameter of the canal of 2.60mm.
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Fig. 3
Neuroimaging tests at 24 months after the surgical intervention (a), (b) Sagittal T2-weighted MRI and axial T2-weighted MRI (level C4-C5), that show an adequate spinal cord decompression with a medullary shift of > 3 mm. (c), (d) Sagittal CT scan (reconstruction) and axial CT scan (level C3-C4) where we can see a more physiological cervical curvature and the fusion of the cervical neo-arch.

Table 1

Clinical evaluation and improvement at follow-up.

	Results (x̅ ± SD)	Improvement (%)	Wilcoxon's Z	p^*
JOA score Preoperatory 6 months postop 12 months postop 24 months postop Nurick Scale Preoperatory 6 months postop 12 months postop 24 months postop VAS Preoperatory 6 months postop 12 months postop 24 months postop	8.9 ± 1.8 14 ± 0.8 14.8 ± 0.8 14.9 ± 0.5 3.5 ± 0.6 1.6 ± 0.5 1.5 ± 0.5 1.5 ± 0.5 6.9 ± 0.8 0.06 ± 0.2 0.2 ± 0.5 0.6 ± 0.7	-- 62.8 72.8 75 -- 53.9 57.8 57.8 -- 99.1 96.3 90.1	-- -3.52 -3.53 -3.53 -- -3.75 -3.75 -3.75 -- -3.56 -3.56 -3.57	-- p < 0.05 p < 0.05 p < 0.05 -- p < 0.05 p < 0.05 p < 0.05 -- p < 0.05 p < 0.05 p < 0.05

↵* Wilcoxon´s test was used to calculate the differences between the preoperatory and postoperatory periods. Significant differences were found (p < 0.05).