Hybrid Procedure of Laminoplasty Combined with Foraminotomy for Multilevel Cervical Spondylotic Myelopathy Accompany with Nerve Root Canal Stenosis

Abstract

Abstract Purpose: The purpose of this study was to investigate the clinical efficacy and security of laminoplasty combined with foraminotomy (which is called hybrid procedure, HP) for multilevel cervical spondylotic myelopathy accompany with nerve root canal stenosis. Methods: The first 37 patients underwent the traditional C3-6 or C3-7 laminoplasty (TL). The subsequent 35 patients were performed with laminoplasty and foraminotomy (HP). The clinical evaluation was based on modified Japanese Orthopaedic Association Scores (mJOA) and Neck Disability Index (NDI) and visual analogue scale (VAS) score for brachialgia. The cervical physiological curvature (CCP) and range of cervical movement (ROM) were observed for imaging evaluation. Results: At the last follow-up, the NDI and mJOA scores in HP group were significantly superior to those in TL group (P<0.001). Foraminotomy could effectively alleviate the brachialgia, in spite of aggravating the first day after operation Axial symptoms were aggravated or new emerged after surgery in 3 patients in HP group and 5 patients in TL group. The incidence of C5 nerve root palsyin HP group and TL group were 2.8% and 10.8% respectively. Conclusions: HP is considerable for multilevel cervical spondylotic myelopathy accompany with nerve root canal stenosis, however, considering the aggravation of postoperative brachialgia, it should be carefully adopted and performed.