Posterior pedicle screw fixation and expansive open-door laminoplasty for cervical spinal cord injury with spondylostenosis and without radiological abnormality

Objective To investigate the clinical efficacy of posterior pedicle screw fixation and C3 ~7 expansive open-door laminoplasty for cervical spinal cord injury without fracture and dislocation in patients with cervical stenosis. Methods Between June 2006 and March 2011, 44 patients with cervical spinal cord injury with cervical stenosis, but without fracture or dislocation in plain films were included to receive posterior pedicle screw fixation and C3~7 expansive open-door laminoplasty. The spinal cord in all patients was incompletely injured with central cord syndrome in 26 patients, anterior spinal cord syndrome in 12, Brown-Sequard syndrome in 4 and another in 2. Results All patients were successfully managed with this technique. The 40 patients were followed up for an average of(25.2±17.8) months(range 12 to 60 months). But for 5 patients who still sustained a poor functional improvement of upper extremities, the JOA improvement rate was 68.5% at last followup. Postoperative radiography demonstrated that cervical alignment was maintained in all patients and no implant failure and spinal instability developed. CT scan showed screws were in place and the patency of spinal canal was maintained. No re-closure of the canal and fracture of hinge occurred during follow-up. Conclusion posterior pedicle screw fixation and C3~7 expansive open-door laminoplasty is an effective procedure for cervical spinal cord injury without fracture and dislocation in patients with cervical stenosis.