Expansive Laminoplasty

Abstract

Laminoplasty has been performed throughout Japan since the early 1980s as a posterior approach for the treatment of cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament (OPLL), and it has generally been considered to provide a good postoperative outcome. However, a thorough evaluation of the long-term follow-up data over more than 10 years has revealed a considerable number of cases in which the patient has deteriorated, indicating the limitations of surgical improvement even with laminoplasty [1]. To achieve longer-term stability of the spine, we first need to understand fully the mechanism of decompression associated with posterior approaches and associated problems [2], and second we must determine precisely which cases are suitable for posterior or anterior approaches based on the condition of the lesions. In addition, when posterior approaches are selected, we should further select either standard laminoplasty involving the range from the C3 to C7 laminae, or expansive laminoplasty involving the extended range from the C2 to T1 laminae. We should also note that approaches to surgical treatment differ between cervical spondylotic myelopathy and OPLL. In this chapter, we outline (i) the types of laminoplasty that we currently adopt, especially the surgical technique of expansive laminoplasty, (ii) the decompression mechanism of laminoplasty, and (iii) the selection criteria for anterior and posterior approaches.