Efficacy of Cervical Expansive Laminoplasty for Quadriplegic Patients Without Cervical Bony Injury

ABSTRACT

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the efficacy of cervical expansive laminoplasty for patients with quadriplegia due to traumatic cervical spinal cord injury (SCI) without skeletal injury. SUMMARY OF LITERATURE REVIEW There are a few studies on the surgical results for acute cervical SCI without bony injury. MATERIALS AND METHODS: From 2003 to 2010, among the patients who visited emergency room with post-traumatic quadriplegia, 12 patients who had underwent cervical expansive laminoplasty for acute cervical SCI without body injury and cord compression on MR images were included in this study. We evaluate the pre-operative swelling on MRI, the change of neurologic symptoms at pre-, post operative state, respiration state, complication and survival period. RESULTS: The average of motor index scores at the time of admission to the emergency room was 23 (4–30), and the average was changed to 29(4–43) during the follow-up period. No significant neurological improvement was observed in 11 cases except 1 case. The average time for operation after the injury was 26 hours(9–72). 4 patients showed paradoxical respiration when they first visited emergency room and the symptom continued after the operation and during follow-up periods. Another 4 patients showed paradoxical respiration after the operation. In all 8 cases who showed paradoxical respiration, tracheostomy and occasional ventilation were needed. In the follow-up period, 6 patients died due to respiratory failure within 1 year after the surgery. All these patients presented severe spinal cord edema on preoperative MRI with paradoxical respiration. CONCLUSIONS: Efficacy of expansive laminoplasty for quadriplegic patients due to acute cervical SCI without bony injury may be limited. In many patients, no significant neurological recovery was observed but it was clearly identified that prognosis was related to the grades of spinal cord edema and paradoxical respiration.