Open Door Laminoplasty using Autogenous Spinous Process H-beam Grafts for Cervical Radiculomyelopathy

Jeong, Soon Taek; Cho, Se Hyun; Park, Hyung Bin; Hwang, Sun Chul; Kim, Byung Gi

Abstract

PURPOSE
To evaluate the results and effectiveness of laminoplasty in which autogenous spinous process grafts were used for the treatment of cervical spondylotic radiculomyelopathy.
MATERIALS AND METHODS
Sixteen patients with cervical spondylotic radiculomyelopathy were treated by laminoplasty from October 2001 to June 2004. The average follow-up period was 28 months (range, 14-47 months), the average age of the patients was 58 years old (range, 33-74 years old), and there were 14 men and 2 women. The operative procedure was a modified Itoh's laminoplasty with and H-beam shaped strut bone graft, which was harvested by sacrificing the spinous process. The results of the operative procedure were evaluated with a Pavlov ratio in a radiologic study and the JOA score and recovery rate by Hirabayashi in the clinical study.
RESULTS
At the final follow-up, the average JOA score increased from 7.8 to 13.2. The recovery rate was 58.7%. The Pavlov ratio improved from 0.58 to 0.93 post-operatively and to 0.92 at the final follow-up. The brace was removed at an average of 6 weeks and there was no change in the Pavlov ratio until union. There was neither evidence of instability in flexion and extension of the cervical spine nor neurologic aggravation and complications.
CONCLUSION
Laminoplasty using an autogenous spinous process in patients with cervical spondylotic radiculomyelopathy produced stability and could produce sufficient decompression. The advantages of an autogenous spinous process graft are: an early return to normal activity by shortening the period of the need for a brace, and no extra-cost and complications with the autogenous iliac graft, allograft, heterograft, or hydroxyapatite spacer. It can be considered as the optimal surgical procedure due to providing complete union at the last follow-up and no complications in the radiologic and clinical studies.