Effect of Repairing Versus Preserving Muscles During LaminoplastySurgery to take pressure off the spinal cord in the cervical spine(neck) can cause problems. In order to reach the bone over the spinal cord, the muscles are first stripped away. Even though the muscles are reattached, patients lose the natural lordosis (curve) of the neck.
In this study, surgeons from Japan compare two different methods of doing a laminoplasty for cervical myelopathy. Laminoplasty refers to the removal of part of the lamina. The lamina is a bridge of bone that forms a protective covering around the spinal cord. Myelopathy refers to any damage or disease to the spinal cord.
Two groups of patients with cervical myelopathy were surgically treated with cervical laminoplasty. Group A had the standard operation with stripping of the extensor neck muscles, removal of part of the bone, and repair of the muscles.
Group B had a dome laminotomy or a laminectomy. In the dome laminotomy, the lower half of the lamina is removed. The entire lamina is taken out during laminectomy. The muscles are not cut or disrupted.
Results were measured using X-rays of the cervical lordosis before and after the operation. Differences between men and women were noted. Loss of nerve function and neurologic recovery were also reported.
The authors report loss of cervical lordosis only in the Group A women. They saw that the extensor muscles were atrophied (wasted away) at the time of the operation. They could not be repaired successfully. It appears that preserving these muscles (even when atrophied) prevents loss of cervical lordosis in men and women.
The dome laminoplasty can improve outcomes for patients with cervical myelopathy. The procedure is not recommended for anyone with ossification of the posterior ligament (OPLL). OPLL is a hardening of the ligament along the back of the spine.
Haku Iizuka, MD, et al. Cervical Malalignment After Laminoplasty: Relationship to Deep Extensor Musculature of the Cervical Spine and Neurological Outcome. In Journal of Neurosurgery: Spine. December 2007. Vol. 7. No. 6. Pp. 610-614.
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