BACKGROUND: In open-door cervical laminoplasty, gutter position sets the bone-cutting width and canal expansion. Whether a wider opening adds benefit, or a conservative opening with residual dural contact suffices, remains unclear.
PURPOSE: To evaluate whether the laminoplasty width-to-facet distance ratio (LP/Facet percentage) is associated with neurological recovery.
PATIENT SAMPLE: 108 patients who underwent open-door laminoplasty for cervical myelopathy (2017-2024); 75 with preoperative JOA <15 formed the recovery cohort.
OUTCOME MEASURES: JOA recovery rate at postoperative one year.
METHODS: LP/Facet percentage, open-door angle, and canal area were measured. Associations were examined with Spearman correlation, group comparisons with Benjamini-Hochberg FDR adjustment, and multivariable linear regression of the 1-year postoperative JOA score. The authors report no study-specific funding or conflicts of interest.
RESULTS: The LP/Facet percentage was not associated with JOA recovery (ρ = -0.017, P = 0.888) and this remained unchanged after adjustment for the preoperative JOA score, age, OPLL, operated levels, and cervical alignment (B = -0.031, P = 0.260). Greater width correlated with canal enlargement (ρ = +0.305, P = 0.008), but the canal area did not predict recovery (ρ = -0.056, P = 0.632). Patients with dural contact (32/103) showed similar recovery to those without contact (P = 0.387). Patients with neurological worsening had a higher LP/Facet percentage in unadjusted comparison (P = 0.013), although this did not persist after FDR correction (adjusted P = 0.079).
CONCLUSION: Within the range of decompression achieved in this cohort, relative bone-cutting width was not associated with neurological recovery. Wider cutting enlarged the canal but did not improve JOA recovery, and dural contact was not associated with worse recovery. Although these findings do not establish equivalence between narrower and wider decompression, they suggest that routinely maximizing bone-cutting width may offer limited additional neurological benefit.
STUDY DESIGN: Retrospective cohort study.
Read the article: PubMed · Publisher (DOI)