Novel lever-up laminoplasty for treating multilevel cervical spondylotic myelopathy: a prospective study of clinical and radiologic outcomes.

This prospective study aimed to evaluate the clinical and radiological outcomes of lever-up laminoplasty (LLP) using innovative hinged titanium plates for treating multilevel cervical spondylotic myelopathy (CSM). Ten patients diagnosed with multilevel CSM underwent LLP between June and October 2022 were enrolled. Intraoperative parameters, including operative time, blood loss, transfusion volume, and complications, were systematically recorded. Postoperative imaging evaluated spinal cord decompression by measuring the midsagittal diameter, transverse area, and osseous canal volume. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score, and axial symptoms (AS) assessed with the the Visual Analogue Scale (VAS). All procedures were successfully performed, with follow-up periods ranging from 12 to 15 months. Postoperative imaging confirmed complete neural decompression in the treated segments, without any signs of cervical instability. Significant increases in the mid-sagittal diameter (C3-C7) and cross-sectional area of the spinal canal were observed compared to preoperative values (P < 0.01). The osseous spinal canal volume increased by an average of 61.82% ± 18.50%. Both the JOA and VAS scores demonstrated significant improvements at the final follow-up (P< 0.01). One patient experienced transient C5 nerve root palsy, which was resolved with conservative treatment. No other complications or significant AS were reported. LLP using hinged titanium plates is a safe and effective surgical approach for the treatment of multilevel CSM. The technique achieves significant spinal canal expansion and a reduced incidence of postoperative AS, offering a promising alternative to conventional laminoplasty methods. Nevertheless, additional comparative research with extended follow-up is essential to confirm its long-term benefits and comparative advantages over conventional surgery.