Comparison of Ipsilateral and Contralateral Unilateral Open-door Laminoplasty for Cervical Myelopathy

Objective : To compare the clinical and radiographic outcomes of ipsilateral and contralateral unilateral open-door laminoplasty (UODL) in treating cervical myelopathy. Methods : Retrospective analysis of patients who received UODL treatment at Xi'an Honghui Hospital from January 2023 to June 2024. A total of 76 patients with cervical myelopathy (42 who underwent ipsilateralopen-door laminoplasty) and 34 who underwent contralateral open-door laminoplasty) were included. All surgical procedures were carried out by experienced surgeons under general anesthesia via a standardized posterior midline approach. Clinical outcomes were evaluated via the visual analog scale (VAS), Japanese Orthopedic Association (JOA) score, and Oswestry Disability Index (ODI). Radiographic parameters, such as the spinal canal area and spinal cord area of the narrowest segment, were measured by two independent radiologists who were blinded to the clinical outcomes. Results : The two groups were comparable in terms of baseline characteristics. For sex distribution, ​ χ² =0.071 (​ P= 0.790); for age, ​ T= 0.195 (​ P= 0.846); for surgical duration, ​ T= −0.277 (​ P= 0.782); for blood loss, ​ T= 0.727 (​ P= 0.470); for hospitalization duration, ​ T= 1.536 (​ P= 0.129); for diagnostic categories, ​ χ² =0.071 (​ P= 0.790); for stenosis levels, ​ χ² =2.090 (​ P= 0.148); for surgical segments, χ² =1.543 ( P= 0.485); and for complication rates, χ² =0.04 ( P= 0.953).​Postoperatively, both groups showed significant decreases in VAS scores and improvements in the ODI. However, there were no significant intergroup differences in the VAS score (preoperative: T= 0.321, P= 0.749; postoperative: T= 0.456, P= 0.649), JOA score (preoperative: T= 0.512, P= 0.610; postoperative: T= 0.638, P= 0.525), or ODI (preoperative: T= 0.289, P= 0.774; postoperative: T= 0.378, P= 0.707).​ In terms of radiographic outcomes, there were no significant differences in the spinal canal area (preoperative: T= 0.789, P= 0.433; postoperative: T= 0.892, P= 0.376) or spinal cord area (preoperative: T= 0.654, P= 0.515; postoperative: T= 0.721, P= 0.474) between the two groups before and after surgery. Notably, both groups had an approximately 80 mm² increase in the spinal canal area and a 30 mm² increase in the spinal cord area postoperatively compared with the preoperative values.​ Conclusion : Ipsilateral and contralateral UODL achieved similar clinical and radiographic results in treating cervical myelopathy. Surgeons can choose the surgical side flexibly on the basis of specific cases.