Introduction: Multilevel cervical compressive myelopathy can be treated by posterior decompressive techniques. The aim of this study was to compare the outcome and complications of three different posterior operative techniques viz: double door laminoplasty (DDL), open door laminoplasty (ODL) and laminectomy with lateral mass fusion (LMF) for multilevel compressive cervical myelopathy due to cervical spondylosis (CSM) and/or OPLL.

Methods: Patients with multilevel CSM and OPLL were treated with DDL or ODL or LMF. All patients underwent neurological evaluation, plain radiographs, MRI preoperatively and plain radiographs and CT postoperatively. Axial neck pain was graded as mild, moderate & severe. Postoperative neurological improvement was assessed using Nurick’s grading and mJOA score. Complications were recorded. Mean follow up was 9 months.

Results: 15 patients underwent DDL, 18 underwent ODL and 20 underwent LMF. In the DDL group all patients improved by atleast one Nurick’s grade, inadequate radiological decompression was seen in 3 of 57 operated levels and there was two cases of postop C5 palsy. In the ODL group, all patients improved by atleast one Nurick’s grade, there was inadequate radiological decompression in 6 of 72 levels and there was no postop C5 palsy. 50% of patients in both groups had significant axial neck pain postoperatively. In the LMF group, all patients improved by atleast one Nurick’s grade, fracture of the lateral masses occurred in 4 of the140 lateral masses, there was no C5 palsy, screw pull out or breakage. Axial neck pain was not disabling in any patient.

Conclusions: All the three posterior approaches lead to equal neurological improvement. ODL results in greater increase in canal diameter than DDL. Overall,laminoplasty has a higher incidence of axial neck pain than LMF. Laminectomy with lateral mass fusion is associated with lesser complications and lesser incidence of axial neck pain.

Patient Care: 1. Indications for posterior procedures will be clearly defined, 2. the limitations as well as the advantages of two different laminoplasty techniques will be clearly defined, 3. the pros and cons of laminoplasty versus laminectomy with lateral mass fusion will be clearly defined. All these will help surgeons dealing with cervical spondylotic myelopathy or myelopathy due to OPLL choose their options correctly.

Learning Objectives: By the conclusion of this session, participants should be able to 1)determine the role of different posterior decompressive techniques for multilevel compressive cervical myelopathy, 2) determine the advantages and limitations of open door laminoplasty versus double door laminoplasty, 3) determine the advantages and limitations of laminoplasty versus laminectomy with lateral mass fusion.

References: 1.Highsmith JM, Dhall SS, Haid RW Jr, Rodts GE Jr, Mummaneni PV.:Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion.J Neurosurg Spine. 2011 May;14(5):619-25 2.Chen Y, Guo Y, Lu X, Chen D, Song D, Shi J, Yuan W.:Surgical strategy for multilevel severe ossification of posterior longitudinal ligament in the cervical spine.J Spinal Disord Tech. 2011 Feb;24(1):24-30.