Management of Cervical Spondylotic Myelopathy by Laminoplasty

Abstract

Cervical spondylotic myelopathy is a common spinal disorder that commonly results from the degenerative process of the vertebral column and associated soft tissue structures.(1) In the majority of patients, the cervical spondylotic myelopathy (CSM) occurs secondary to degenerative changes associated with the normal aging process. Progressive cervical spondylosis may lead to spinal cord compression, which may be exacerbated by spinal instability, kyphotic deformity, ossification of the posterior longitudinal ligament (OPLL), and large central disc herniation.(17) The diagnosis of the cervical spondylotic myelopathy include many symptoms and signs at both upper and lower extremities and many tests may be positive, also radiographic evaluation by plain x-ray,CT scan and MRI is needed to fulfill the diagnosis.(2) The treatment of cervical spondylotic myelopathy is by conservative treatment in the beginning which include medical treatment and physiotherapy and if there is no response surgical treatment is considered in the form of decompression procedures to relieve the cord compression.(120) Laminoplasty achieve posterior decompression of the cord and many techniques are used for this procedure such as Z-plasty laminoplasty, Hirabayashi expansive open door laminoplasty and French door laminoplasty. (120) Because laminectomy has been reported to cause post-operative instability, kyphotic deformity and post-laminectomy adhesions, it is preferable to use the laminoplasty techniques for the treatment of CSM.(120)