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Vol. 32. Issue 5.
Pages 224-230 (September - October 2021)
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Vol. 32. Issue 5.
Pages 224-230 (September - October 2021)
Special article
DOI: 10.1016/j.neucie.2021.06.001
Cervical laminoplasty with unilateral C4-5 foraminotomy: Technical note and case series
Laminoplastia cervical con foraminotomía unilateral C4-C5: nota técnica y serie de casos
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Francisco Marcó del Pont
Corresponding author
fmarcodelpont@gmail.com

Corresponding author.
, Sebastián Juan María Giovannini, Tomás Ries Centeno, Guido Caffaratti, Emiliano Lorefice, Andres Cervio
Departamento de Neurocirugía, FLENI, Buenos Aires, Argentina
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Abstract
Objective

The open-door laminoplasty technique is widely used in the treatment of multilevel cervical myelopathy. Despite the satisfactory functional and radiological results of this technique, postoperative C5 palsy is still a severe and disabling complication with a variable incidence in the literature. The objective of this article is to describe and demonstrate the surgical technique step by step with the addition of unilateral C4-5 foraminotomy and to evaluate the results obtained to date, with special emphasis on C5 palsy.

Material and methods

Retrospective study of 20 patients operated on for cervical myelopathy using the “extended” laminoplasty technique, which is described step by step.

Results

Between January 2013 and April 2019, 20 patients were operated on using the extended laminoplasty technique. Only one patient (5%) presented postoperative C5 palsy. The postoperative recovery rate of the modified JOA (Japanese Orthopaedic Association) score was 54.5%, similar to that observed in other series.

Conclusion

The extended cervical laminoplasty technique with unilateral C4-5 foraminotomy was developed and demonstrated for the prevention of C5 palsy. The results were analysed and an incidence of C5 palsy coinciding with the lowest percentage reported in the literature was obtained. A prospective randomised study would be useful to assess the role of preventive unilateral C4-5 foraminotomy.

Keywords:
Laminoplasty
C5 palsy
Laminectomy
Cervical myelopathy
Surgery complications
Resumen
Objetivo

La laminoplastia “open door” es una técnica ampliamente utilizada para el tratamiento de la mielopatía cervical multinivel. A pesar de presentar resultados funcionales y radiológicos satisfactorios a largo plazo, la parálisis de C5 posoperatoria continúa siendo una complicación severa e invalidante con una incidencia variable en la literatura. El objetivo del presente trabajo es describir e ilustrar la técnica quirúrgica paso a paso con el agregado de la foraminotomía unilateral C4-5 y evaluar los resultados obtenidos hasta el momento, haciendo especial énfasis en la parálisis de C5.

Material y métodos

Estudio retrospectivo de 20 pacientes intervenidos por mielopatía cervical mediante la técnica de laminoplastia cervical “extendida” con foraminotomía unilateral, para la cual se detallan los pasos.

Resultados

Entre enero de 2013 y abril de 2019 se trataron 20 pacientes con “laminoplastia cervical extendida”. Un solo paciente agregó déficit de C5 postoperatorio (5%). El porcentaje de recuperación del JOA modificado (Japanese orthopaedic association score) postoperatorio fue de 54,5%, siendo similar a lo observado en otras series.

Conclusión

Se desarrolló e ilustró la técnica de laminoplastia cervical “extendida” con foraminotomía unilateral de C4-5 para la prevención de la parálisis de C5. Se analizaron los resultados y se obtuvo una incidencia de parálisis de C5 coincidente con el menor porcentaje reportado en la literatura. Sería de utilidad un estudio prospectivo y aleatorizado para valorar el rol de la foraminotomía preventiva C4-5 unilateral.

Palabras clave:
Laminoplastia
Parálisis de C5
Laminectomía
Mielopatía cervical
Complicaciones postoperatorias

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