Comparative Five-Year Surgical Outcomes of Open-Door versus French-Door Laminoplasty in Multilevel Cervical Spondylotic Myelopathy

Abstract

Objective. To compare the five-year surgical outcomes between Open-Door laminoplasty (ODL) and French-Door laminoplasty (FDL) in the management of multilevel cervical spondylotic myelopathy (MCSM). Methods. Sixty patients with MCSM, who were operated by ODL or FDL, were included in this study and followed up for at least 5 years. The average follow-up period was $69.2\pm 3.2$ months. The modified Japanese Orthopaedic Association (mJOA) score and radiological assessments including the Cobb angle and cervical range of motion (ROM) were evaluated and compared before surgery and at the final follow-up. The incidence of postoperative complications and medical costs were also compared. Results. Both ODL and FDL groups achieved significant improvements of the mJOA score in postoperative 5 years; the average recovery rate (RR) of the mJOA score in the ODL and FDL groups was $72.14\pm 6.97\%$ and $69.53\pm 7.51\%$ , respectively. No statistically significant differences regarding the pre- and postoperative mJOA score, the RR of the mJOA score, the loss and the loss rate of the Cobb angle, and the incidence of postoperative complications existed between ODL and FDL. The mean loss and the loss rate of cervical ROM in the FDL group ( $18.70\pm {8.91}^{°}$ , $41.08\pm 11.17\%$ ) were significantly higher than those of the ODL group ( $13.81\pm {8.62}^{°}$ , $31.47\pm 12.43\%$ ) ( $P<0.05$ ). FDL reduced medical costs more greatly than ODL ( $33014.37\pm 3424.12$ China Yuan versus $82096.62\pm 7093.07$ China Yuan, $P<0.001$ ). Conclusions. Both ODL and FDL are effective for MCSM. The 5-year neurological results are similar between the two groups. ODL trends to be superior to FDL in postoperative preservation of cervical ROM while FDL reduced medical costs more greatly.