Posterior hybrid approach in surgery of cervical spondylotic myelopathy: a new technique (short-segment stabilization and laminoplasty)

Abstract Objective Posterior decompressive surgeries are frequently preferred in patients with multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. Long-segment stabilization and laminectomy procedures performed for this purpose cause the impairment of cervical ROM, problems are experienced related to the instruments, and quality of life is adversely affected. We aimed to define the combined posterior hybrid approach, which involved short-segment stabilization on the unstable segment alone and laminoplasty to other segments with stenosis, and to report early results. Methods We analyzed the data of 22 patients (8F, 14 M) who had undergone surgery due to cervical spondylotic myelopathy between 2019 and 2022. MRIs and CTs of the patients were examined. Their Range of Motions (ROMs) were measured. In particular, the mobility of the segment with the prominent myelopathic signal was examined on direct radiography and dynamic MRI. Open-door laminoplasty was performed on all segments with narrow canals. Short-segment stabilization was performed only on the unstable segment with a bilateral lateral mass screw. Results The ages of the patients were between 42 and 83 (mean 58.4), and the mean follow-up period was 20 months. Only two patients were observed to have postoperative neck pain lasting longer than two weeks (VAS 3 and 4) and required medical treatment. While the mean preoperative JOA was 11.8, the mean JOA score increased to 15.7 in the 1st postoperative year. No impairment was observed in cervical lordosis angles. Conclusion Hybrid surgery, which involves the combination of laminoplasty and short-segment stabilization on the problematic segment, should be considered in patients with CSM and OPLL. The advantages of this new technique are the partial preservation of mobility, the reduction of instrument problems, the lack of neck pain only due to the stabilization of the unstable segment, and the elimination of the loss of lordosis.