Unilateral Open-Door Laminoplasty: Impact of the Opening Side on Spinal Cord Space and Arm Pain Improvement

Francisco Cini^*
*Correspondence: Francisco Cini, Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA, Email:

Introduction

Unilateral open-door laminoplasty is a well-established surgical technique used in the treatment of cervical spondylotic myelopathy, a condition caused by compression of the spinal cord due to degenerative changes in the cervical spine. CSM can result in a wide range of neurological symptoms, including arm pain, weakness, numbness, and gait disturbances. In cases where conservative treatments fail, surgical decompression via laminoplasty is considered to relieve spinal cord compression and improve patient outcomes. The "open-door" laminoplasty technique involves creating a hinge on one side of the lamina (the bony plate forming part of the spinal canal) and lifting or "opening" the lamina on the opposite side to create additional space for the spinal cord. The unilateral version of this technique, in which the door (the opening) is created on one side only, has gained popularity because it reduces operative complexity and the associated risks of bilateral decompression. While laminoplasty has been shown to improve spinal canal space and relieve symptoms like arm pain, questions remain regarding whether the side of the opening (left or right) affects the ultimate outcome, particularly in terms of improving spinal cord space and reducing arm pain. This article explores the available evidence and discusses whether the side of the opening in unilateral open-door laminoplasty has any significant impact on these clinical outcomes [1,2].

Description

The effectiveness of the procedure is largely due to the overall restoration of spinal canal space, which benefits the spinal cord and nerve roots bilaterally, even when only one side of the lamina is opened. Patients typically experience improvements in both spinal cord function and radicular pain, regardless of the side of the door. As a result, surgeons can perform unilateral laminoplasty with confidence, knowing that the side of the opening is unlikely to influence the ultimate success of the surgery. This finding provides important reassurance for patients and surgeons alike, ensuring that the decision on which side to open does not significantly alter the expected clinical outcomes. Further studies are needed to explore other aspects of the procedure, such as the long-term outcomes and potential complications, but for now, unilateral open-door laminoplasty remains a reliable and effective option for treating cervical spondylotic conditions. In mild cases, scoliosis may not cause significant symptoms and may not require immediate intervention. However, in moderate to severe cases, the curvature can worsen over time, leading to symptoms such as back pain, difficulty breathing, nerve compression, and functional impairments.

Conclusion

Unilateral open-door laminoplasty is a highly effective and minimally invasive procedure for treating cervical spondylotic myelopathy and radiculopathy. The goal of the surgery is to relieve spinal cord compression and improve symptoms such as arm pain, weakness, and numbness. Although it seems logical that the side of the door might influence the degree of decompression and pain relief, research has shown that the side of the opening does not significantly impact spinal cord space improvement or arm pain relief.

References

1. Ruetten, Sebastian, Martin Komp, Harry Merk and Georgios Godolias. "Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: A prospective, randomized, controlled study." (2008): 940-948.

Google Scholar, Crossref, Indexed at

2. Wirth, Fernanda, Esthael Cristina Querido Avelar Bergamaschi, Fabio da Silva Forti and João Paulo Machado Bergamaschi. "Development of Indications for Endoscopic Spine Surgery: An Overview." J Int Med Res 3 (2023): 321-333.

Google Scholar, Crossref