Abstract
Introduction
It is generally accepted that laminoplasty is a safe and reliable surgical treatment for cervical spine myelopathy (CSM) because of the spinal canal stenosis. There are multiple techniques of laminoplasty for spinal cord decompression and most of them require expensive instruments or spacers to stabilize the lamina. In the Hospital for Traumatology and Orthopaedics at Ho Chi Minh city, Vietnam, we performed the Z-plasty operation (Sakou technique) since 2004 to present for patients with CSM with an effort to reduce the cost of treatment.
Patients and Methods
It is a retrospective study. Patients suffered from CSM treated by Z-plasty technique are selected. We performed the Sakou technique, which open one lamina to the left, then the next lamina to the right and the next one to the left, consecutively and respectively. To keep the lamina opened, we tight them in pairs with unabsorbable sutures. Patients were instructed to wear hard collar for 1 week, and then started to follow our rehabilitation program. We use JOA score system and recovery ratio of Hirabayashi to evaluate the neurologic outcome. For functional outcome of cervical spine evaluation, we use the Neck Disability Index (NDI).
Results
There were 36 patients with a mean follow-up of 5 years (range, 1–10 years), sex ratio approximately 3:1, and a mean age of 61 years. The mean operating time and blood loss per lamina were 40 minutes and 55 mL, respectively. The final canal expanding ratio was 25%. For surgical complications, there were only three cases of C5 palsy with full recovery after 1 year. There was no case of dura tear or infection. The mean pre- and postoperative JOA score were 11.1 and 14.7, respectively. The recovery ratio was 68%, with 71% of cases considered as good and excellent. For clinical outcome, the mean NDI was 0.18 with 88% of cases considered as good and excellent. The mean preoperative and final lordotic angle of cervical spine were 21.1 and 19.3 degrees, respectively, with no statistical significance.
Conclusion
The Z-plasty is a safe and reliable technique with a good outcome on neurological, anatomical, and clinical aspect which can be compared with other techniques. The absence of foreign bodies such as titanium plates or spacers reduces considerably the risk of infection and the cost of treatment. Considering the risk–benefit and cost–benefit ratio, this operation is particularly suitable for low-income patients in the developing countries.