2026 Volume 17 Issue 2 Pages 87-94
Introduction: Various posterior decompression procedures exist for cervical spondylotic myelopathy (CSM), each with advantages and disadvantages. We introduced macroscopic muscle-preserving selective laminectomy (MMSL) and compared its outcomes with the conventional spinous process-splitting laminoplasty (SPSL).
Methods: MMSL uses a 4-5 cm midline incision performed under headlight-guided direct vision, followed by spinous process splitting to expose the paraspinal muscles and allow for a 13 mm laminectomy. We analyzed 219 patients who underwent posterior decompression for CSM at our institution from June 2016 to September 2023 (MMSL: 119 cases; SPSL: 100 cases). Patients with ossification of the posterior longitudinal ligament (OPLL), radiculopathy, or a history of spinal or lower limb orthopedic surgery were excluded. Surgical time, blood loss, radiographic parameters, and clinical outcomes (JOA score, neck VAS, NDI, and JOACMEQ) were compared at one year postoperatively.
Results: There were no significant differences between the two groups in terms of blood loss, complications, JOA recovery rate, neck VAS, NDI, or JOACMEQ. However, the MMSL group had a significantly shorter operative time and better preservation of postoperative cervical lordosis.
Conclusions: MMSL reduces operative time while maintaining clinical outcomes comparable to SPSL. It is a minimally invasive and stable surgical option for posterior decompression in CSM.
