A prospective randomized study of clinical outcomes in patients with cervical compressive myelopathy treated with open-door or French-door laminoplasty.

STUDY

DESIGN

A prospective randomized clinical study.

OBJECTIVE

To compare the clinical outcomes of open-door and French-door laminoplasties.

SUMMARY OF BACKGROUND DATA: Expansive laminoplasty for cervical compressive myelopathy is well established and a variety of modifications procedures have been developed. The procedures are mainly classified into open-door and French-door. It has never been prospectively investigated as to which surgical procedure, open-door or French-door laminoplasty, results in a more favorable outcome.

METHODS

After informed consent was obtained from 40 patients, they were randomized into 2 surgical groups A and B. Patients in group A had open-door laminoplasty, and patients in group B underwent French-door laminoplasty with reattachment of the spinous process and extensor musculatures. The following criteria were evaluated: operation time, blood loss, perioperative complications, Japanese Orthopedic Association (JOA) scores, recovery rates, axial pain, and short-form 36 (SF-36). For radiographic evaluation, cervical lordosis was reviewed as lordotic angles, which were measured at C2-C7.

RESULTS

Although the operation time was significantly less in group A as compared with group B, the mean blood loss in group A was significantly more than group B. Perioperative complications occurred more frequently in group A than in group B. Although there were no significant differences in postoperative JOA scores and recovery rates between the 2 groups, axial pain was significantly decreased in group B at final follow-up. The scores of every subscale of the SF-36 were higher in group B than group A.

CONCLUSION

Perioperative complications occurred more frequently in open-door laminoplasty than in French-door laminoplasty. JOA scores and recovery rates suggested that both open-door and French-door laminoplasties could be similarly effective in decompressing the spinal cord. Axial pain was improved in French-door laminoplasty but became worse in open-door laminoplasty. SF-36 suggested that French-door laminoplasty could be more beneficial than open-door laminoplasty for patients with cervical compressive myelopathy.