Tension-Band Laminoplasty: A Laminoplasty with Minimal Surgical Intervention to the Spinoligamentous Complex for Better Postoperative Neck Function
The development of surgical techniques for cervical laminoplasty in Japan has shown that the key issue in obtaining better postoperative function of the neck is preserving the integrity of the spinoligamentous (SL) complex in lamina-enlarging procedures . The characteristic structural changes after laminoplasty, namely, loss of lordosis with a mild anterior tilt of the cervical spine accompanied by neck stiffness , result from damage to the SL complex. These structural changes produce fatigue in the neck with axial pain, a reduction in the range of motion (ROM) of the neck, and a loss of smoothness in neck movements. All of these dysfunctions cause considerable inconvenience in the activities of daily living [3,4]. The loss of a posterior supporting force by cutting the spinous processes and/or spinous ligaments causes a forward inclination of the neck and the outflow of osteoblastic substances from inside the bone through the exposed bone marrow of the spinous processes and laminae. This might be a major cause of both the stiffness of the healed soft tissue and the posterior segmental fusion between laminae or spinous processes . All these facts indicate that surgical intervention in the SL complex should be minimal for the best possible postoperative neck function. In 1989 , we developed a tension-band laminoplasty (TBL) which allowed sufficient spinal cord decompression while maintaining the maximal integrity of the SL complex. In TBL, the tension-band effect of the preserved ligaments allowed early postoperative neck mobilization, facilitated the union of spacers, and prevented postoperative soft tissue contracture. The operative procedures and results are described below.
KeywordsSpinous Process Cervical Myelopathy Japanese Orthopaedic Association Neck Movement Axial Symptom
Unable to display preview. Download preview PDF.
- 1.Tsuzuki N (2000) Problems related to the posterior decompression of the cervical spinal cord for cervical myelopathy, mainly from the results of cervical laminoplasty. J Jpn Orthop Assoc 74:1–10Google Scholar
- 2.Ishihara H, Matsui T, Kawaguchi Z, et al.(1998) Kyphotic change of the cervical spine alignment after en bloc laminoplasty. An analysis of the factors involved. Cent Jpn J Orthop Traumatol 41:1075–1076Google Scholar
- Takeuchi N, Osawa Y, Itoh H, et al. Long-term results of expansive open-door laminoplasty. A follow-up study over seven years. J Jpn Orthop Assoc 70;3:S604Google Scholar
- 7.Saiki K, Horie T, Ishizuka K, et al. (2000) Relationship between the postoperative neurological outcome and the postoperative spinal alignment in patients who underwent tension-band laminoplasties for cervical myelopathy. J East Jpn Orthop Traumatol 12:233Google Scholar
- 8.Takahashi K, Suyama T, Tsuzuki N (1999) Postoperative activities of daily living and cervical symptoms in tension-band cervical laminoplasty. J Jpn Orthop Assoc 73:S727Google Scholar
- 9.Aida I, Yabuki T, Hayashi K, et al. (1995) Long-term results of cervical laminoplasty using spinous processes as bone blocks. Seikeigeka 46:1161–1166Google Scholar