Cervical laminoplasty with unilateral C4-5 foraminotomy: Technical note and case series

Objective: The open-door laminoplasty technique is widely used in the treatment of multilevel cervical myelopathy. Despite the satisfactory functional and radiological results of this technique, postoperative C5 palsy is still a severe and disabling complication with a variable incidence in the literature. The objective of this article is to describe and demonstrate the surgical technique step by step with the addition of unilateral C4-5 foraminotomy and to evaluate the results obtained to date, with special emphasis on C5 palsy. Material and methods: Retrospective study of 20 patients operated on for cervical myelopathy using the extended laminoplasty technique, which is described step by step. Results: Between January 2013 and April 2019, 20 patients were operated on using the extended laminoplasty technique. Only one patient (5%) presented postoperative C5 palsy. The postoperative recovery rate of the modified JOA (Japanese Orthopaedic Association) score was 54.5%, similar to that observed in other series. Conclusion: The extended cervical laminoplasty technique with unilateral C4-5 foraminotomy was developed and demonstrated for the prevention of C5 palsy. The results were analysed and an incidence of C5 palsy coinciding with the lowest percentage reported in the literature was obtained. A prospective randomised study would be useful to assess the role of preventive unilateral C4-5 foraminotomy. (C) 2020 Sociedad Espanola de Neurocirugia. Published by Elsevier Espana, S.L.U. All rights reserved.

Automated summary

The open-door laminoplasty technique is used in the treatment of multilevel cervical myelopathy. This article describes the surgical technique step by step, with the addition of unilateral C4-5 foraminotomy, and evaluates the results obtained so far, focusing on C5 palsy. Out of 20 patients operated on with this technique, only 1 (5%) had postoperative C5 palsy, with a postoperative recovery rate of 54.5%.