The Rare Occurrence of Reoperation after Cervical Laminoplasty

Study Design: Retrospective cohort study. Objective: To determine the rate of recurrent or adjacent-level stenosis requiring reoperation after single-door cervical laminoplasty for spondylotic myelopathy at our institution. Summary of Background Data: Adjacent-level stenosis requiring reoperation is a commonly evaluated condition for anterior or posterior arthrodesis, however, there are few studies that evaluate adjacent-level stenosis in the case of cervical laminoplasty. Methods: Retrospective review of adults undergoing cervical laminoplasty for spondylotic myelopathy between January 2005 and May 2018 at our institution. Demographics, symptom duration, stenotic levels, preoperative and postoperative Medical Research Council motor, American Spinal Injury Association, modified Japanese Orthopaedic Association scores, and Nurick grade were obtained. Postoperative data included presence of C5 palsy, infection rate, alleviation or persistence of symptoms, and rate of recurrent or adjacent-level stenosis. Results: A total of 102 patients underwent cervical laminoplasty; mean age was 56.7 years (±12.96). Most were men (n=76, 74.5%), with myelopathy (n=64, 63.4%), C4 (n=94, 93.1%), and C5 (n=92, 91.1%) cervical stenosis; mean symptom duration was 55 days (7 d to 2.8 y). Average follow-up was 6.4 months (±3.4). After surgery, there was statistically significant improvement in Nurick grade (3.1±2.2 vs. 2.7±2.4, P=0.002) and modified Japanese Orthopaedic Association score (11.4±3.7 vs. 13.9±3.6, P<0.001); American Spinal Injury Association scores also improved (P<0.001). Rate of postoperative C5 palsy was 7.8% (n=8); postoperative infection rate was 1.96% (n=2). Reoperation rate was 4.9% (n=5); reoperation for recurrent or adjacent-level stenosis was 1.96% (n=2). Conclusions: Recurrent or adjacent-level stenosis requiring reoperation after cervical laminoplasty is rare. Longitudinal studies are needed to verify correlation between motion preservation and incidence of adjacent or recurrent stenosis. Level of Evidence: Level III—treatment benefits: nonrandomized controlled cohort/follow-up study.