Motion Preservation at All Costs? Multilevel Hinge Nonunion, and Intradural Plate Migration After Cervical Laminoplasty: A Case Report and Literature Review

Rosinski A, Odeh K, Leasure J, Kondrashov D.

Mar 1, 2020

World Neurosurg. 2020 Mar;135:80-86. doi: 10.1016/j.wneu.2019.11.074. Epub 2019 Nov 20.

Abstract:

Background: Cervical laminoplasty is a motion-preserving procedure that addresses spinal cord compression and avoids postlaminectomy kyphosis associated with cervical laminectomy. The most common complications include C5 nerve palsy, axial neck pain, hinge nonunion, and premature closure. Plating is a relatively newer method of laminoplasty fixation that may provide greater stabilization postoperatively and reduce the risk of laminoplasty closure compared with less rigid (e.g., suture) fixation techniques. Although prior studies have reported low rates of laminar/lateral mass screw back out, plate breakage and migration have not been previously described in the literature. The purpose of this paper is to present a case of multilevel hinge nonunion, plate breakage, and plate fragment migration. Although rare, plate failure may result in a dural tear and spinal cord injury/compression.

Case description: In this case, a 61-year-old man with a history of cervical spondylotic myelopathy treated with C3-7 laminoplasty 7 years prior presented to our hospital with severe headaches and electrical-type pain through the left upper and lower extremities. Imaging studies revealed several broken laminoplasty plates and intradural migration of a fragment of the C7 plate.

Conclusions: We provide recommendations for preventing hinge nonunion because resultant micromotion likely contributed to the plate breakages observed in this patient.

Keywords: Cervical spondylotic myelopathy; Laminoplasty; Nonunion.