Technique-Related Factors (25%):
- Laminoplasty Closure: This is a common complication. In the study, 3 patients (25%) required revision due to closure of the laminoplasty, specifically when suture anchors were used to hold the hinge open. No closures were observed when laminoplasty plates were used.
- Cord Compression from Lamina Subsidence or Hinge Fracture: Cases have been reported where laminectomy was needed due to spinal cord compression from a fractured laminoplasty hinge or lamina intrusion.
- Poor Head Control: Patients with uncontrolled head movement (e.g., due to cerebral palsy or Down syndrome) may have poor laminoplasty results.
Inadequate Symptomatic Relief After Treatment (8.3%):
- Persistent Preoperative Symptoms: This can occur if the initial procedure does not fully resolve the symptoms.
- Residual Foraminal Stenosis: Significant foraminal stenosis may persist, requiring further anterior decompression.
- Large Anterior Cord Compression: Laminoplasty may not be sufficient if there is a large retrovertebral or osteo-discogenic anterior spinal cord compression (e.g., OPLL thicker than 7 mm or >50% spinal canal intrusion).
- Kyphotic Spine: Laminoplasty is contraindicated in a kyphotic spine as it can lead to poor neurologic recovery. Poor results have been reported with ≥10° global kyphosis, ≥13° local segmental kyphosis, or an S-shaped spine.
- Intractable Preoperative Neck Pain/Spinal Instability: Patients with intractable preoperative neck pain from cervical spondylosis or spinal instability might be better candidates for spinal decompression with fusion rather than motion-preserving laminoplasty.
Recurrence of Symptoms Due to Disease Progression (66.7%): This was the largest group of patients requiring revision surgery.
- Progression of OPLL: OPLL can progress after cervical laminoplasty, with reported worsening in 73% of patients with OPLL 10 years post-op, potentially leading to late neurologic deterioration and spinal cord compromise. Younger patients and those with continuous types of OPLL have a higher risk of progression.
- Worsening Spondylosis: This was observed in a majority of patients requiring revision for disease progression (7 of 12 patients, 58.3%). Changes like facet arthrosis, disc degeneration, and disc herniation may be induced by postsurgical changes in spinal biomechanics, ongoing aging, or both.
- Adjacent Segment Disease: Disease progression is often most extensive at segments immediately cephalad or caudal to the laminoplasty levels.
- Worsening Cervical Alignment/Postlaminoplasty Cervical Kyphosis: The reported incidence of post-laminoplasty cervical kyphosis ranges from 0% to 22%. This can lead to poor postoperative neurologic recovery and late neurologic deterioration. It is believed to be caused by paraspinal muscle damage during the procedure, particularly the detachment of the semispinalis cervicis from its C2 spinous process insertion.
- Junctional Kyphosis: Development of post-laminoplasty kyphosis combined with adjacent level degeneration can result in proximal junctional kyphosis.
- Increased Degenerative Segmental Spondylolisthesis: This was observed in some patients before revision surgery, with C2–C3, C3–C4, and C6–C7 levels most commonly affected.
- Risk of Revision Due to Disease Progression: The risk was 4% at 1 year and 21% at 4 years following laminoplasty, comparable to rates following fusion operations.
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