Cervical Laminoplasty: Spinal Decompression with Preservation of Stability and Mobility

1. The Genesis of a Motion-Preserving Solution: A Historical Perspective on Cervical Laminoplasty

The history of cervical laminoplasty is not one of a single invention, but of a necessary evolution driven by the clinical shortcomings of its predecessor. To appreciate its significance, it is essential to first examine the procedure it sought to improve: the laminectomy.

1.1 The Post-Laminectomy Problem: A Legacy of Instability

For decades, cervical laminectomy was the standard treatment for posterior decompression of the spinal cord in patients with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL). The procedure is conceptually simple: it involves the surgical removal of the lamina (the bony “roof” of the spinal canal) and the spinous process to relieve pressure on the spinal cord. However, this simplicity concealed a fundamental biomechanical flaw. By removing these posterior structures, laminectomy dismantled the “posterior tension band” of the cervical spine, a complex of bones and ligaments crucial for stability and alignment.

The consequences of this biomechanical disruption were well documented and often severe. Patients could develop postoperative segmental instability, where the vertebrae moved abnormally. Even more concerning was the tendency to develop progressive kyphosis, an abnormal forward curvature of the neck that could lead to new spinal cord compression and late neurological deterioration. Furthermore, removal of the lamina left the dura mater (the spinal cord covering) exposed to the formation of a “post-laminectomy membrane,” an epidural scar tissue that could adhere to the cord and cause late compression. These unsatisfactory outcomes created an urgent clinical need for a posterior decompression approach that was more sophisticated and less destructive.

1.2 The Japanese Pioneers: The Birth of Expansive Laminoplasty

The answer to this clinical challenge emerged in Japan during the 1970s. Japanese orthopedic spine surgeons, who faced a high prevalence of OPLL in the Asian population, dedicated themselves to developing a superior procedure. Their idea was revolutionary: instead of removing the posterior elements, they sought to reconstruct or reposition them to expand the spinal canal. This concept, termed “laminoplasty” (literally, “molding the lamina”), aimed to achieve adequate spinal cord decompression while preserving a protective bony roof over the dura and maintaining the anchor points for the crucial posterior neck musculature.

This conceptual innovation did not occur in a vacuum; it was made possible by a key technological advance: the development of the high-speed surgical burr. This tool allowed surgeons to perform the precise bone cuts (osteotomies) needed to reshape the lamina with a safety and efficacy previously unattainable, transforming laminoplasty from a theoretical idea into a practical clinical reality. The relationship between surgical technique and available tools is co-evolutionary; clinical need drove the concept, but it was technology that enabled its execution.

1.3 Key Innovators and Foundational Techniques

Three principal figures laid the groundwork for modern laminoplasty:

• Oyama’s “Z-Plasty” (1973): Considered the first true expansive laminoplasty, this technique was a direct evolution of Kirita’s earlier method, which simply thinned and removed the lamina. In Oyama’s procedure, after thinning the laminae, Z-shaped cuts were made at each level. This allowed the laminar segments to be lifted and sutured to reconstruct an enlarged spinal canal.
• Hirabayashi’s “Open-Door” Expansive Laminoplasty (1977-1981): This landmark technique, which would become one of the two dominant methods, greatly simplified the procedure. It involves making a complete bone cut on one side of the lamina and creating a “hinge” on the opposite side. This allows the entire posterior arch (laminae and spinous processes from C3 to C7) to open like a single door. Its key advantages were the ability to decompress multiple levels simultaneously and, crucially, to preserve posterior muscular structures to help prevent postoperative kyphosis.
• Kurokawa’s Spinous Process-Splitting Laminoplasty (“French Door”) (1982): Almost simultaneously, Kurokawa developed the second dominant technique. This method involves splitting the spinous processes along the midline and creating bilateral bony hinges at the lamina-facet junction. The canal then opens symmetrically, like a pair of French doors. The theoretical advantage of this approach was a more balanced and symmetrical decompression of the spinal cord.

1.4 Evolution of Fixation: From Sutures to Spacers and Plates

One of the critical challenges of early procedures was how to reliably keep the “door” open. Fixation failure could lead to “spring-back” of the lamina, causing canal restenosis and procedure failure. The evolution of fixation methods reflects the maturation of the technique:

1. Sutures: Initial methods used simple non-absorbable sutures passed through the facet joint capsule or interspinous ligaments to hold the lamina in its new open position. However, these sutures offered limited stability.
2. Spacers: To provide more robust support, surgeons began interposing “spacers” in the created space. These could be bone autografts (often carved from the patient’s own resected spinous processes), hydroxyapatite blocks (a ceramic material similar to bone), or allografts (donor bone).
3. Titanium Miniplates: The modern era of laminoplasty fixation began in the late 1990s with the adaptation of titanium miniplates and screws, originally developed for maxillofacial surgery. These implants provided much more rigid and durable fixation, effectively solving the door-closure problem and significantly improving procedural reliability.

The geographical development of laminoplasty in Japan was no coincidence. The higher prevalence of OPLL, a disease that often causes multilevel stenosis, in East Asian populations provided a strong clinical and research impetus to find more effective treatments than in Western countries, where the pathology is less common. This explains not only why Japanese surgeons pioneered these techniques, but also why laminoplasty remains performed by the majority of spine surgeons in Japan, while it is less common in other parts of the world.

2. The Architectural Principles of Spinal Decompression: Fundamental Laminoplasty Techniques

Although numerous variations exist, nearly all modern laminoplasty techniques are based on two fundamental architectural principles: the unilateral “open door” or the bilateral “French door.” The goal of both is the same: to expand the spinal canal diameter so that the spinal cord can shift posteriorly (“drift-back”) and move away from anterior compressive structures (such as disc herniations or osteophytes), thereby achieving indirect decompression.

2.1 The “Open Door” Technique (Hirabayashi): A Unilateral Hinge

This method, the most common, uses the analogy of creating a “hinged door” in the posterior arch of the spine. The idea is to open the laminae and spinous processes of several vertebral levels as a single cohesive unit.

Procedure (Simplified):

1. Exposure: The surgeon makes an incision at the back of the neck and carefully separates the muscles to expose the bony laminae, typically from the C3 to C7 vertebra.
2. Creating the Opening: On one side (the “opening” side), the surgeon uses a high-speed burr to cut a groove through the full thickness of the bone at the lamina-facet junction. The choice of this side may depend on which of the patient’s arms has worse radicular symptoms (radiating pain), as this approach facilitates additional procedures.
3. Creating the Hinge: On the opposite side, a similar groove is cut. However, on this side, the surgeon carefully preserves the inner (cortical) layer of bone. This thin, flexible bone layer will act as a living hinge.
4. Expansion: The surgeon gently pushes the spinous processes, causing the bony “door” to open by pivoting on its hinge. This increases the spinal canal diameter by 30% to 50%, creating vital space for the compressed spinal cord to shift posteriorly and decompress.
5. Fixation: The door is securely held open using small titanium plates and screws that bridge the created space, or by other fixation techniques such as suture anchors or bone grafts.

2.2 The “French Door” Technique (Kurokawa): Symmetrical Expansion

This method uses the analogy of a “French door” or “double door” that opens from the center, aiming to achieve a perfectly symmetrical canal expansion.

Procedure (Simplified):

1. Exposure: As with the open-door technique, the posterior spine is exposed.
2. Midline Division: The surgeon splits the spinous processes through the center and continues this cut through the midline of the laminae.
3. Bilateral Hinge Creation: On both left and right sides, the surgeon creates bony hinges at the lamina-facet junction, similar to the hinge side of the open-door technique.
4. Expansion: The two halves of the lamina (the “hemilaminae”) are gently separated, opening the canal from the midline.
5. Fixation: Spacers are placed in the midline space to hold the “doors” open. These spacers may be bone graft (often from the patient’s own resected spinous process bone), hydroxyapatite, or other synthetic materials, and are secured with sutures, wires, or plates.

The choice between these two techniques is not merely a matter of surgeon preference. It has direct implications for additional procedures. For example, if a patient suffers from both myelopathy (cord compression) and severe radiculopathy (nerve root compression causing arm pain), the surgeon may need to perform a foraminotomy to widen the foramen where the nerve root exits. The “open-door” technique greatly facilitates this step on the open side, as the lamina has been fully moved aside, providing unobstructed access to the foramen. In contrast, performing a foraminotomy with the “French door” technique is more difficult, as it requires working around or through the hinge, which could compromise its integrity.

Furthermore, although the “French door” technique offers theoretically more symmetrical decompression, it may carry a greater intrinsic risk of direct spinal cord injury. The midline osteotomy is performed directly over the spinal cord, often in a canal that is already severely narrowed. Using a high-speed burr or saw in this confined space creates an inherent risk of the instrument plunging and injuring the cord. The “open-door” technique, by contrast, performs the main cuts more laterally, where the ligamentum flavum may offer some protection, making it potentially safer in cases of extreme stenosis.

2.3 The Original “Z-Plasty” (Oyama): The Foundational Concept

Although it has been largely superseded by more modern methods, it is important to mention the historic Z-plasty technique for context. This method involved making Z-shaped cuts in the laminae of each vertebra individually, which were then lifted and sutured. Its importance lies in establishing the fundamental principle of canal expansion and reconstruction rather than simple removal.

3. Evolution and Refinement: Modern Variations and the Pursuit of Better Outcomes

The basic laminoplasty techniques have continued to evolve to address their shortcomings, primarily postoperative neck pain and loss of mobility. This evolution reflects a fundamental philosophical shift in spine surgery, moving from a purely bony procedure to an integrated neuro-musculoskeletal reconstruction.

3.1 The “Axial Pain” Problem and the Rise of Muscle-Preserving Techniques

One of the most significant drawbacks of early laminoplasties was the high incidence of persistent axial neck pain after surgery. Surgeons soon identified the cause: the extensive dissection and detachment of the posterior cervical muscles from their anchor points on the spinous processes, especially the semispinalis cervicis muscle at the C2 and C7 processes. These muscles are vital for maintaining lordosis (the normal backward curvature of the neck) and dynamic stability.

Understanding this problem led to a paradigm shift. Initially, surgeons attempted to separate and then reattach the muscles. However, they soon realized that preserving the original muscle attachments was far superior. This culminated in the development of Myoarchitectonic Spinolaminoplasty. In this refined technique, the spinous processes are separated from the laminae, but the crucial muscle attachments to the spinous processes are left intact. This allows canal expansion while preserving the entire posterior musculoskeletal complex. Studies have shown that this approach leads to less muscle atrophy, minimal lordosis loss, and a very low incidence of axial pain, addressing one of the main weaknesses of the original procedure.

3.2 Targeted Decompression and Motion Preservation

In addition to muscle preservation, other variations have been developed to optimize outcomes:

• Laminoplasty with C3 Laminectomy: Surgeons observed that spontaneous bone fusion between the C2-C3 and/or C3-C4 levels could occur after laminoplasty, limiting neck mobility. To counteract this, a hybrid technique was developed in which the C3 lamina is completely removed (laminectomy) while laminoplasty is performed at the other levels. This can help preserve greater range of motion and, in some cases, reduce surgical time.
• “Alternate Side” and “Double Open-Door” Techniques: These are creative solutions to specific problems. The “double open-door” technique (not to be confused with the French door), for example, involves opening the C3 and C4 laminae on one side and the C5 and C6 laminae on the opposite side. This can facilitate bilateral foraminotomy at the C4-C5 level, which is believed to help prevent C5 nerve palsy. The “alternate side” technique may offer a more flexible approach to decompression when radiculopathy is present on different sides and at different levels.

4. A Comparative Clinical Analysis: Laminoplasty Versus Alternative Surgical Approaches

The decision to perform laminoplasty is not made in isolation. It must be weighed against other established surgical options, primarily laminectomy with posterior fusion (LF) and anterior cervical discectomy and fusion (ACDF). Meta-analyses and systematic reviews provide a high level of evidence for comparing these procedures across multiple metrics.

4.1 The Posterior Debate: Laminoplasty (LP) vs. Laminectomy with Fusion (LF)

These two procedures are performed from the back of the neck but with opposing philosophies. LP seeks to decompress the spinal cord while preserving motion, while LF seeks to decompress and then eliminate motion through fusion to ensure stability.

• Neurological Outcomes: A crucial and consistent finding across multiple meta-analyses is that there is no significant difference in neurological improvement between LP and LF. Scores on scales such as the Japanese Orthopaedic Association (JOA) and the Nurick scale are comparable between both groups. This suggests that the more extensive fusion procedure does not confer an additional neurological benefit.
• Operative Metrics: LP is consistently superior in this regard. Meta-analyses demonstrate that LP has a shorter operative time and lower estimated blood loss (EBL) compared to LF.
• Complication Profile: LP demonstrates a significantly better safety profile. The rate of overall complications and, specifically, the rate of C5 nerve palsy (a debilitating shoulder and biceps weakness) are significantly lower with LP than with LF.
• Patient-Reported Outcomes: LP is associated with better (lower) scores on the Neck Disability Index (NDI), indicating less postoperative disability.
• Radiographic Outcomes: LF is superior in maintaining or correcting cervical lordosis. LP, by contrast, may be associated with some lordosis loss over time. However, LP preserves greater range of motion (ROM), although this may also decrease over time.

4.2 Anterior vs. Posterior: Laminoplasty (LP) vs. Anterior Cervical Discectomy and Fusion (ACDF)

This is a comparison between two entirely different surgical philosophies. ACDF is approached from the front of the neck, directly removes the discs and osteophytes causing compression, and fuses the vertebrae. LP is approached from the back and achieves indirect decompression.

• Neurological Outcomes: Most meta-analyses find no significant difference in neurological improvement (JOA scores) between the two approaches, especially at final follow-up. Some studies suggest that ACDF may have slightly better JOA scores at 2 years.
• The Central Dilemma: Lordosis vs. Motion: This is the key decision point.
  • ACDF is superior for restoring or maintaining cervical lordosis.
  • LP is superior for preserving cervical range of motion (ROM).
• Operative Metrics: Data are mixed, but recent meta-analyses suggest that ACDF is associated with shorter operative time and lower blood loss, likely because the posterior muscle dissection of LP is more extensive.
• Complication Profile: The procedures have statistically similar overall complication rates, but the types of complications differ.
  • ACDF has a higher risk of dysphagia (difficulty swallowing) and pseudarthrosis (fusion failure).
  • LP has a higher risk of wound complications/infections (due to the extensive posterior approach) and C5 palsy.
• Cost-Effectiveness: Studies suggest that ACDF is more expensive, both for the initial procedure and in total payments up to 2 years later, despite LP having higher readmission rates.

The following table summarizes the comparative evidence, providing an overview of the strengths and weaknesses of each procedure.

Table 1: Comparative Analysis of Cervical Decompression Techniques

Feature	Laminoplasty (LP)	Laminectomy and Fusion (LF)	Anterior Discectomy and Fusion (ACDF)
Primary Goal	Indirect decompression, Motion preservation	Posterior decompression, Stabilization	Direct decompression, Stabilization
Neurological Outcome (JOA)	Equivalent to LF and ACDF	Equivalent to LP and ACDF	Equivalent to LP and LF
Range of Motion (ROM)	Preserved (though decreasing)	Eliminated at fused levels	Eliminated at fused levels
Cervical Lordosis	Potential for loss	Maintained / Improved	Maintained / Improved
Operative Time	Shorter than LF	Longer than LP	Shorter than LP
Blood Loss	Less than LF	More than LP	Less than LP
Characteristic Complication	C5 palsy, Axial pain	C5 palsy, Implant failure	Dysphagia, Pseudarthrosis
Cost	Lower	Intermediate	Higher

5. The Surgeon’s Dilemma: Comparing Laminoplasty Techniques

Even within the world of laminoplasty, there is an ongoing debate about which main technique—open door or French door—offers the best outcomes. The literature on this topic is often contradictory, suggesting that no technique is universally superior and that the choice may depend on patient-specific factors and the surgeon’s experience.

5.1 Open Door vs. French Door: A Review of the Evidence

• Neurological Outcomes (JOA Score / Recovery Rate): The evidence is contradictory and inconclusive. Some meta-analyses find that the open-door technique (ODL) has higher postoperative JOA scores and recovery rates. However, other meta-analyses and a randomized controlled trial find no statistically significant differences between the two techniques. This lack of consensus is a key finding in itself.
• Operative Metrics: Most studies find no significant differences in operative time. However, there is some evidence suggesting that the French door technique (FDL) is associated with lower intraoperative blood loss.
• Radiographic Outcomes: This is where a clearer difference emerges. Multiple studies, including a randomized controlled trial, show that the French door technique is superior for preserving postoperative cervical lordosis and range of motion compared to the open-door technique. Conversely, the open-door technique may achieve greater spinal canal diameter expansion.
• Complications: Overall complication rates are usually similar. However, some evidence suggests that the French door technique results in a lower incidence of postoperative axial symptoms (pain).

The following table breaks down these findings, illustrating the areas of debate and consensus in the literature.

Table 2: Direct Comparison: Open-Door vs. French-Door Laminoplasty

Outcome Metric	Open Door (ODL)	French Door (FDL)	Supporting Evidence
Postoperative JOA Score	Better / No difference	No difference / Worse	Contradictory
Recovery Rate	Better / No difference	Worse / No difference	Contradictory
Intraoperative Blood Loss	Higher	Lower	FDL appears superior
Cervical Lordosis Preservation	Worse (greater loss)	Better (less loss)	FDL is superior
Range of Motion Preservation	Worse (more restricted)	Better (less restricted)	FDL is superior
Axial Pain Incidence	Higher	Lower	FDL appears superior
Canal Expansion Diameter	Greater	Smaller	ODL is superior
Overall Complication Rate	No difference	No difference	Equivalent

6. Considerations and Complications: A Realistic Assessment

Despite its advantages, laminoplasty is not suitable for every patient with cervical stenosis. Careful candidate selection is paramount for success, and a clear understanding of potential risks is essential for both surgeon and patient.

6.1 Defining the Ideal Candidate

The success of a laminoplasty depends largely on the patient’s preoperative anatomy. The ideal candidate presents the following characteristics:

• Primary Indication: Multilevel cervical stenosis (typically 3 or more levels) with symptomatic myelopathy.
• Critical Prerequisite: Preserved Sagittal Alignment: The patient must have a lordotic (normal backward curve) or, at minimum, neutral cervical spine. Lordosis is fundamental because it allows the “posterior drift-back” of the spinal cord, which is the procedure’s indirect decompression mechanism. Surgery is relatively contraindicated in patients with significant kyphosis (forward curvature >13 degrees), as laminoplasty may worsen this deformity.
• Minimal Preoperative Axial Pain: Laminoplasty is designed to decompress the spinal cord, not to treat neck pain from degenerative arthritis. The extensive posterior muscle dissection can sometimes worsen axial pain, especially in the short term.
• Absence of Significant Instability: Patients with significant spondylolisthesis (slippage of one vertebra over another) are generally not candidates for isolated laminoplasty and would require a fusion procedure to stabilize the spine.

This “ideal candidate” profile creates a paradoxical clinical situation. The procedure works best in patients with “good” anatomy (lordosis, no instability), who tend to be younger and have less advanced degenerative disease. However, patients with “poor” anatomy (kyphosis, instability), who tend to be older and have more severe degeneration, are excluded and must undergo more extensive fusion procedures. This means that the procedure with a possibly better safety profile and motion preservation is reserved for less complex cases.

However, another rationale for laminoplasty is its use as a preliminary decompressive procedure in cases with severe anterior compression, especially if the displaced ligaments and discs are calcified, as their manipulation from the front can increase cord damage when there is no “escape” space for the cord posteriorly. Expanding that posterior space before anterior surgery can provide an extra margin of safety.

6.2 A Detailed Look at Complications

Like any major surgery, laminoplasty carries risks. The most discussed and procedure-specific complications include:

• C5 Nerve Palsy: This is the best-known complication. It manifests as postoperative weakness in the shoulder (deltoid muscle) and elbow flexion (biceps muscle). Its incidence varies but is reported in many studies. The exact cause is debated, but a leading theory is that the posterior shift of the spinal cord can cause a “tethering” or traction effect on the C5 nerve roots, which have a shorter course. Some surgeons perform a prophylactic foraminotomy at C4-C5 to reduce this risk.
• Axial Neck Pain: As discussed, this is a common problem related to disruption of the posterior musculature. It has been a major driver of the evolution toward muscle-preserving techniques.
• Loss of Range of Motion (ROM): Although considered a “motion-preserving” surgery, a significant decrease in ROM (an average of 50% in some studies) is a common and expected outcome. Some long-term studies have found that the final ROM is similar to that observed after laminectomy and fusion.
• Progressive Kyphosis / Lordosis Loss: This is a well-documented radiographic change that can occur postoperatively, especially if the integrity of the posterior musculature is compromised.

These complications are not isolated events; they are biomechanically interconnected. Disruption of the posterior musculoskeletal tension band is the central problem. Dissection of the extensor muscles leads to their damage and atrophy, which in turn causes chronic axial pain. Weakened extensor muscles cannot counteract the natural tendency toward forward flexion, leading to lordosis loss and possible progression to kyphosis. Finally, postoperative scarring and muscle stiffness, combined with possible spontaneous interlaminar fusion, cause a reduction in ROM. These are not separate problems but clinical manifestations of a single central biomechanical problem.

• Other Surgical Risks: These include the standard risks of any spine surgery, such as infection, dural tear with cerebrospinal fluid (CSF) leak, hematoma, and fixation failure (loosening or breakage of plates and screws).

7. Evidence from Meta-Analyses and Systematic Reviews

This section serves as a curated bibliography, providing direct references to the highest level of scientific evidence (meta-analyses and systematic reviews) that support the comparisons and conclusions presented in this report.

7.1 Laminoplasty vs. Laminectomy with Fusion (LF)

• Key Conclusion: Laminoplasty has a superior safety profile (lower blood loss, shorter operative time, fewer complications and C5 palsy) for similar neurological outcomes.
• Key References: Comparative Effectiveness and Safety of Open-Door Laminoplasty, French-Door Laminoplasty, Laminectomy and Fusion, and Laminectomy Alone for Multilevel Degenerative Cervical Myelopathy: A Bayesian Network Analysis – Comparison of Laminoplasty vs. Laminectomy for Cervical Spondylotic Myelopathy: A Systematic Review and Meta-Analysis

7.2 Laminoplasty vs. Anterior Cervical Discectomy and Fusion (ACDF)

• Key Conclusion: A trade-off exists between motion preservation (laminoplasty advantage) and lordosis correction (ACDF advantage), with similar neurological outcomes but different complication profiles.
• Key References: Decompression and Fusion versus Laminoplasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy: A Meta-Analysis of Clinical and Radiological Outcomes – Anterior cervical discectomy and fusion versus posterior laminoplasty for multilevel cervical myelopathy: A meta-analysis

7.3 Open-Door vs. French-Door Laminoplasty

• Key Conclusion: Evidence on neurological outcomes is inconclusive. The French door technique may be better for preserving alignment and reducing axial pain.
• Key References: Open-door versus French-door laminoplasty for the treatment of cervical multilevel compressive myelopathy – Open-Door versus French-Door Laminoplasty for Patients with Multisegmental Cervical Spondylotic Myelopathy: A Systematic Review and Meta-analysis – Comparative Effectiveness and Functional Outcome of Open-Door versus French-Door Laminoplasty for Multilevel Cervical Myelopathy: A Meta-Analysis

7.4 General Reviews and Technique Analyses

• Key Conclusion: Reviews detailing the history, evolution, and various modifications of the procedure.
• Key References: Cervical laminoplasty – Cervical laminoplasty: a critical review – Cervical laminoplasty—review of surgical techniques, indications, methods of efficacy evaluation, and complications

8. Conclusions

Cervical laminoplasty represents a significant advance in spine surgery, born from the need to overcome the serious deficiencies of traditional laminectomy. Its history is a testament to surgical innovation, evolving from the pioneering concepts of Japanese surgeons to today’s refined muscle-preserving and minimally invasive techniques. The fundamental principle of the technique—expanding the spinal canal rather than removing it—allows effective spinal cord decompression while preserving, to the extent possible, the natural anatomy and biomechanics of the neck.

High-level comparative evidence, derived from numerous meta-analyses, paints a clear clinical picture. When compared to laminectomy and fusion, laminoplasty offers equivalent neurological outcomes with a markedly superior safety profile, including fewer complications, lower blood loss, and shorter operative time. Against anterior cervical fusion, laminoplasty presents a fundamental trade-off: it offers better motion preservation at the expense of less lordotic alignment control.

The choice of surgical procedure—and indeed, of the specific laminoplasty technique—remains a complex decision dependent on careful patient selection. Factors such as preoperative sagittal alignment, the presence of axial pain, and segmental stability are paramount. However, for the ideal candidate, cervical laminoplasty stands as an elegant and effective surgical option that successfully addresses multilevel cord compression while striving to maintain the functional integrity of the cervical spine.

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