Background: In 1981, we developed a technique of expansive lumbar
laminoplasty to alleviate the problems of conventional laminectomy in the
treatment of spinal stenosis. The purposes of this study were to assess the
long-term outcome following expansive lumbar laminoplasty and to investigate
the postoperative problems.
Methods: Fifty-four patients underwent expansive lumbar laminoplasty
for the treatment of spinal stenosis. There were forty-three men and eleven
women with a mean age of 52.6 years. The average length of follow-up was 5.5
years. Preoperatively, twenty-five patients had degenerative stenosis;
thirteen, stenosis due to spondylolisthesis; twelve, combined stenosis (disc
herniation and stenosis); and six, hyperostotic stenosis. (Two patients with
hyperostotic stenosis and spondylolisthesis were included in both groups.) The
clinical results were assessed with use of the Japanese Orthopaedic
Association score, and the rate of recovery was calculated. Radiographic
findings were analyzed on the basis of the cross-sectional area of the spinal
canal, kyphosis, range of motion of the lumbar spine, and the rate of
Results: The average recovery rate at the time of the last follow-up
was 69.2% for patients with degenerative stenosis, 66.5% for patients with
combined stenosis, 65.2% for those with hyperostotic stenosis, and 54.7% for
those with spondylolisthesis. The factors resulting in a poor recovery were an
older age and insufficient decompression of the lateral stenosis. During the
follow-up period, the Japanese Orthopaedic Association score became worse for
seven patients, six patients had lesions develop at the level adjacent to the
laminoplasty, and five patients had spondylolisthesis develop. Interlaminar
fusion was observed in twenty-two patients (41%).
Conclusions: The satisfactory results of expansive lumbar
laminoplasty were maintained at an average of 5.5 years after surgery. The
best indications for the lumbar laminoplasty procedure were young and active
patients with central spinal stenosis.
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.