27. Open door versus double door laminoplasty in the treatment of cervical OPLL: a 10-year retrospective analysis

Abstract

BACKGROUND CONTEXT

Cervical ossification of the posterior longitudinal ligament (OPLL) is a common cause of cervical myelopathy, often requiring surgical intervention. Laminoplasty, with two main approaches—open-door (OD) and double-door (DD)—is widely performed. However, while previous studies have reported on the clinical and radiological outcomes of these techniques, none have examined a 10-year follow-up with a significant number of patients.

PURPOSE

This study aims to compare the long-term outcomes of open-door and double-door laminoplasties in patients with cervical OPLL over a 10-year follow-up period.

STUDY DESIGN/SETTING

A 10-year retrospective cohort analysis conducted at a single institution.

PATIENT SAMPLE

A total of 109 patients with cervical OPLL, comprising 63 patients in the open-door laminoplasty group and 46 patients in the double-door laminoplasty group.

OUTCOME MEASURES

The clinical outcomes assessed in this study included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, and recovery rates. Radiological outcomes evaluated were the C2-7 Cobb angle, range of motion (ROM), occupying ratio, and K-line type.

METHODS

For cervical myelopathy caused by OPLL, we performed OD and double-door DD laminopasties at a single institution. A total of 63 patients in the OD group and 46 patients in the DD group were evaluated for 10 years’ follow-up. The following criteria were evaluated: demographic information, range of operation, occupying ratio, K-line, type of OPLL, Cobb angle of C2-C7, and range of motion. Clinical outcomes were assessed using the VAS, JOA score and recovery rate.

RESULTS

Age, sex, symptom duration, and comorbidities were not significantly different between the groups. No significant differences in K-line type, canal occupying ratio were found. There were 6 patients in each group who underwent reoperation. Between the two groups, there was no difference in the change in the C2-7 cobb angle preoperative, immediate after surgery, and 2 years after surgery. However, at 10 years after surgery, the angle during extension decreased in the DD group, and the ROM also decreased statistically significantly (12.61 vs 8.4, p=0.02; 18.87 vs 13.62, p=0.016). However, the ROM decreased in both groups from before surgery to the last follow-up, with no significant difference (-14.43 vs -18.07, p=0.221). The VAS scores for neck and arm were significantly lower in the DD group immediately after surgery (p=0.044, 0.022), but no difference was observed between the groups 10 years post-surgery. JOA scores showed a similar improvement 10 years postoperatively.

CONCLUSIONS

Both laminoplasty methods are effective for treating cervical OPLL over a 10-year period. However, the ROM decreased significantly more in the DD group. Despite this, both groups showed similar long-term clinical outcomes and improvement in JOA scores.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.