Tension-band laminoplasty of the cervical spine.

A new laminoplasty of the cervical spine has been developed using preserved ligaments as a tension-band. The laminae were enlarged in an open-door fashion and spacers inserted to maintain the spinolaminoligamentous complex intact. The stretched ligaments exerted a tension-band effect on the spacers and stabilised them so that neck movements could be started as soon as bleeding stopped. The spacers were iliac grafts, or were made of a bioactive ceramic which proved more satisfactory. The results of 102 cases with ceramic spacers showed an average preservation of preoperative movement between C2 and C7 to be 79% in cervical spondylotic myelopathy and 67% in ossification of the posterior longitudinal ligament at 3 years after operation. No spacer became displaced. CT showed new bone formation in the lamina-ceramic gap in 59% of the spacers used in cervical spondylotic myelopathy by sixth months and in 63% in cases of ossification of the posterior longitudinal ligament by the third month. Neurological recovery was comparable to that after other types of laminoplasty, but the new method allows better function of the neck and more new bone formation around the spacers.