Motion preservation at all cost? Multilevel hinge non-union, plate breakage, and intra-dural plate migration following cervical laminoplasty: a case report and literature review.

Cervical laminoplasty is a motion-preserving procedure that addresses spinal cord compression and avoids post-laminectomy kyphosis associated with cervical laminectomy. The most common complications include C5 nerve palsy, axial neck pain, hinge non-union, and premature closure. Plating is a relatively newer method of laminoplasty fixation that may provide greater stabilization postoperatively and reduce the risk laminoplasty closure compared to less rigid (e.g., suture) fixation techniques. While 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 article is to present a case of multilevel hinge non-union, plate breakage, and plate fragment migration. Although rare, plate failure may result in a dural tear and spinal cord injury/compression. In this case, a 61-year-old male with a history of cervical spondylotic myelopathy treated with C3-C7 laminoplasty seven 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 intra-dural migration of a fragment of the C7 plate. We provide recommendations for preventing hinge non-union since resultant micro-motion likely contributed to the plate breakages observed in this patient.