Objective To comparatively analyze the efficacy differences between unilateral open-door laminoplasty and combined foraminoplasty in treating mixed (myelopathic and radiculopathic) cervical spondylopathy. Methods Patients with mixed (myelopathic and radiculopathic) cervical spondylopathy who underwent the two surgical procedures at the Third People’s Hospital of Chengdu between January 2017 and December 2023 were retrospectively selected. According to the surgical method, patients were divided into the open-door surgery group and the combined surgery group. The basic information, surgical related indicators, clinical efficacy scores, and complications between the two groups were compared. Results A total of 65 patients were included. Among them, there were 38 males and 27 females; 30 cases in the open-door surgery group and 35 cases in the combined surgery group; The average follow-up period was (18.6±6.8) months. There were no statistically significant differences in age, gender, surgical stage, and disease duration among the groups (P>0.05). Except for the operation time (P<0.05), there was no statistically significant difference in incision length and intraoperative bleeding between the two groups (P>0.05). There was no statistically significant difference in preoperative Visual Analogue Scale and Japanese Orthopaedic Association Score between the two groups (P>0.05). The difference in Visual Analogue Scale and Japanese Orthopaedic Association Score between the two groups six months after surgery was statistically significant (P<0.05). No severe complications such as surgical failure, uncontrollable hemorrhage, or intraoperative nerve/spinal cord injury occurred. No significant cervical instability occurred in either group. Conclusions For treating mixed (myelopathic and radiculopathic) cervical spondylopathy, unilateral open-door laminoplasty combined foraminoplasty may reduce the incidence of nerve root palsy and yield superior clinical outcomes compared to laminoplasty alone. This combined approach does not increase surgical risk and may potentially avoid the need for revision anterior cervical surgery.
Objective To investigate the effect of the opening side selection in unilateral open-door laminoplasty (UODL) on postoperative outcomes for patients with cervical ossification of the posterior longitudinal ligament (OPLL) presenting with symptom-ossification mismatch. Methods A retrospective analysis was conducted on 89 patients with multilevel cervical OPLL presenting with symptom-ossification mismatch treated between January 2020 and January 2024. According to the opening side, 41 patients underwent laminoplasty with the opening toward the side with more severe ossification (ipsilateral group), and 48 patients toward the side with more severe symptoms and signs (contralateral group). There was no significant difference in the baseline data between groups (P>0.05), including gender, age, body mass index, disease duration, comorbidities, number and type of affected segment, and preoperative visual analogue scale (VAS) score, Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score, ossification length, ossification area, sagittal and coronal canal diameter, Pavlov ratio, C2-7 Cobb angle, and spinal cord diameter ratio. Perioperative parameters, changes in VAS score, NDI and JOA score, radiological parameters, and postoperative complications were analyzed. Results There was no significant difference between groups in operation time, intraoperative blood loss, or length of hospital stay (P>0.05). All patients were followed up 11-30 months (mean, 19.3 months). At last follow-up, VAS score and NDI significantly decreased and JOA score significantly increased when compared with preoperative values in both groups (P<0.05), while the changes in these clinical scores were not significantly different between the two groups (P>0.05). Radiological evaluation showed that there was no significant difference between groups in the changes of ossification length and C2-7 Cobb angle, nor in postoperative opening width and opening angle (P>0.05). However, the change in spinal cord diameter ratio differed significantly between groups (P<0.05). At last follow-up, the spinal cord posterior shift distance in the ipsilateral group was significantly more than that in the contralateral group (P<0.05). There was no significant difference between groups in the incidences of C5 nerve root palsy, axial symptoms, or the overall complications (P>0.05). Conclusion For patients with multilevel cervical OPLL with symptom-ossification mismatch, UODL provides similar improvement in clinical symptoms regardless of whether the opening side is directed toward the side with more severe ossification or toward the more symptomatic side. However, opening toward the side with more severe ossification may lead to more pronounced spinal cord morphological recovery and posterior shift, although the impact of this radiological advantage on long-term clinical outcomes requires further investigation.
