Dome Laminotomies at Adjacent Segments in Cervical Laminoplasty

Background Cervical laminoplasty is an established and effective surgical treatment for neurologic dysfunction associated with cervical myelopathy. “Dome laminotomies” involve undercutting the laminae adjacent to the laminoplasty levels to decompress and prevent spinal cord kinking on the lamina edges. The technique allows for a decrease in the number of instrumented laminae, smaller surgical exposure, and preservation of muscular attachments at the top of C2 and C7. We investigated whether dome laminotomies are associated with satisfactory neurologic and pain outcome.

Methods This study involved a retrospective review of consecutive patients treated at a single institution between November 2015 and September 2018. The patients underwent a C3–C6 laminoplasty with dome laminotomies of the caudal edge of C2 and the cranial edge of C7 lamina. Postoperative evaluations of pain, myelopathy symptoms, and complications occurred at early (mean, ∼2 months) and late (mean, ∼15 months) time points.

Results Twenty-one patients were enrolled (mean age, 62 years). Mean axial pain score improved significantly at both the early (P = .02) and late (P = .045) postoperative evaluations compared with the mean baseline pain score. A total of 92% of patients experienced resolution of baseline hand dysfunction at the early postoperative follow-up, and 84% maintained it at the late follow-up. Two-thirds of patients experienced (late) significant improvement (P < 0.05) in baseline balance impairment. Postoperative response rates for urinary dysfunction were 58% (early) and 42% (late). There were no wound complications, late neurologic deterioration, kyphosis, or C5 palsy.

Conclusions C3–C6 laminoplasty with C2 and C7 dome laminotomies was safe, well tolerated, and associated with satisfactory early and late improved neurologic function and decreased pain.