Abbreviations used in this paper:ACDF = anterior cervical discectomy and fusion; CDH = cervical disc herniation; ESCP = evoked spinal cord potential; JOA = Japanese Orthopaedic Association; MTDL = microsurgical transdural discectomy with laminoplasty; RR = recovery rate.
Address correspondence to: Nobuhiro Tanaka, M.D., Department of Orthopaedic Surgery, Institute of Biomedical & Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551, Japan. email: nobut@hiroshima-u.ac.jp.
Please include this information when citing this paper: published online April 5, 2013; DOI: 10.3171/2013.3.SPINE12673.
The dorsal dura mater after a left, open, and expansive laminoplasty. The upper portion of each photograph shows the lifted laminae; the medial and lower portions show the articular facets of the cervical spine; the lateral side and left view show the cephalad side; and the right portion shows the caudal side. Upper: The dorsal dura mater at the level of the cervical disc herniation was longitudinally incised, while the arachnoid membrane was preserved. Lower: The surgical procedure proceeded within the space between the subdural and the extraarachnoid space, and the dentate ligament (arrow) was transected.
Discectomy procedure. A: The cervical cord and rootlets were slowly retracted to the medial aspect using a small spatula, and the ventral dura mater was then incised vertically about 1 cm. B: The disc fragments were milked through the hole of the ventral dura mater with a blunt hook and spatula. C: The fragments were removed using a small pituitary rongeur.
Repair of the dura mater. Upper: After the discectomy, the ventral dura mater was repaired using 6-0 nylon sutures. Lower: The dorsal dura mater was repaired in a watertight fashion using 6-0 nylon sutures.
Graph showing JOA scores at preoperative, midterm, and final follow-up examinations. The scores were significantly improved after surgery and were maintained without statistical differences between midterm and final follow-up evaluations. *p < 0.05.
Magnetic resonance images obtained in a 51-year-old man. Preoperative sagittal T1- (A) and T2-weighted (B) images show disc herniation at C5–6 (arrow) with multilevel canal stenosis, especially at C4–5 and C6–7 (arrowheads). Axial T1- (C) and T2-weighted (D) images demonstrate a paracentral disc herniation.
Follow-up MR images acquired 14.2 years after surgery in the same patient in Fig. 5. Postoperative sagittal T1- (A) and T2-weighted (B) images show a well-decompressed spinal cord after C3–6 laminoplasty with transdural discectomy. Axial T1- (C) and T2-weighted (D) images demonstrate no significant recurrences of the disc herniation.
Postoperative flexion (left) and extension (right) radiographs acquired in the same patient in Figs. 5 and 6. The postoperative range of motion of the cervical spine was 45° without any axial pain.