Expansive laminoplasty for cervical radiculomyelopathy due to soft disc herniation - A comparative study of laminoplasty and anterior arthrodesis

Study Design. A comparative study was performed in patients with cervical radiculomeylopathy due to soft disc herniation to compare surgical results of laminoplasty with anterior discectomy and arthrodesis. Objectives. To determine whether posterior decompression without discectomy can be selected for cervical myelopathy due to cervical soft disc herniation. Summary of Background Data. Anterior cervical discectomy and arthrodesis has had acceptable surgical results, but a significant number of complications have been reported, especially those related to bone grafting. Methods. Sixteen patients who received expansive laminoplasty and 17 patients who received anterior arthrodesis were studied. The mean value of the anteroposterior diameter of the spinal canal was 12.4 mm in the former and 12.9 mm in the latter. The mean follow-up was 3.1 years in the laminoplasty group, and 8.8 years in the anterior arthrodesis group. There was no statistical difference between the two groups in prognostic factors believed to affect surgical results. Neurologic results were evaluated with postoperative scores and recovery rates by methods previously described, and assessed by the Japanese Orthopaedic Association scoring system. Results. The difference between the two groups in the recovery rate and final Japanese Orthopaedic Association score was not statistically significant. Surgical complications were more frequent in the anterior arthrodesis group than in the laminoplasty group. Additional surgeries were performed in three cases (18%) in the anterior arthrodesis group: posterior wiring for delayed union and kyphotic deformity in two cases, and laminoplasty for deterioration of myelopathy in one case. Regression of herniated cervical disc after laminoplasty was confirmed by computed tomography or magnetic resonance imaging in six of eight cases (75%). Conclusions. When the incidence of complications and the possibility of regression of herniated disc are taken into consideration, expansive laminoplasty can be selected for radiculomyelopathy due to cervical disc herniation.