Laminoplasty for the Treatment of Multi-Level Cervical Spondylosis with Myelopathy

บทคัดย่อ

From Sep 1992 to Jan 1997, 12 patients with multi-level cervical spondylotic myelopathy were treated by open-door Iaminoplasty with segmental bone graft without intersegmental fusion or internal Hxation. There were 6 males and 6 females, age between 43-64, average 54.83 years. Pre-operative neurologic condition of the patients were 9 Nurick grade 3 and 3 Nurick grade 4. The average CN ratio (Pavlov ratio) was 0.86 pre-operatively and 1.17 post-operatively, averagely increased 37%. 4 patients had persistent radiculopathy after the operation. 2 patients refused further surgery and other 2 underwent Robinson anterior fusion of C4-5 and C4-5, C5-6.

The patients were follow-up for 12-64 months, average 35.08 months. Neurologic condition of the patients were, 1 Nurick grade 2, 2 Nurick grade 1 and 1 Nurick grade 0. There was one patient, who had neck pain without myelopathy or radiculopathy, still had to take some medicine intermittently. The average follow-up C/V ratio was 1.13, 4% decreased from the immediate post-op. C/V ratio. The patients with post-op. radiculopathy, 2 patients underwent anterior fusion were doing well, the other 2 patients still had to take some medicine intermittently.

According to the patients’feeling, 8 had no difference in the range of neck motion, 3 had increased and the only one that had decreased the range of motion was the patient who underwent anterior fusion C4-5 and C5-6. However, all satisfied with the results. Thus, the open-door laminoplasty with segmental bone graft without intersegmental fusion or internal fixation is a good surgical procedure to treat the patients with multi-level cervical spondylotic myelopathy.