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Suzuki H, Funaba M, Fujimoto K, Ichihara Y, Nishida N, Sakai T. Current Concepts of Cervical Spine Alignment, Sagittal Deformity, and Cervical Spine Surgery. J Clin Med 2024; 13:1196. [PMID: 38592040 PMCID: PMC10932435 DOI: 10.3390/jcm13051196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 04/10/2024] Open
Abstract
There are not many reports on cervical spine alignment, and only a few analyze ideal surgical approaches and optimal amounts of correction needed for the various types of deformity. We comprehensively reviewed the present literature on cervical spinal deformities (with or without myelopathy) and their surgical management to provide a framework for surgical planning. A general assessment of the parameters actually in use and correlations between cervical and thoracolumbar spine alignment are provided. We also analyzed posterior, anterior, and combined cervical surgical approaches and indications for the associated techniques of laminoplasty, laminectomy and fusion, and anterior cervical discectomy and fusion. Finally, on the basis of the NDI, SF-36, VAS, and mJOA questionnaires, we fully evaluated the outcomes and measures of postoperative health-related quality of life. We found the need for additional prospective studies to further enhance our understanding of the importance of cervical alignment when assessing and treating cervical deformities with or without myelopathy. Future studies need to focus on correlations between cervical alignment parameters, disability scores, and myelopathy outcomes. Through this comprehensive literature review, we offer guidance on practical and important points of surgical technique, cervical alignment, and goals surgeons can meet to improve symptoms in all patients.
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Affiliation(s)
- Hidenori Suzuki
- Department of Orthopedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan; (M.F.); (K.F.); (Y.I.); (N.N.); (T.S.)
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Cheng X, Chen Z, Sun X, Zhao C, Zhao J. Favorable cervical extension capacity preventing loss of cervical lordosis after laminoplasty due to spontaneous restoration of initial lordosis. Spine J 2024; 24:94-100. [PMID: 37774981 DOI: 10.1016/j.spinee.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND CONTEXT Cervical laminoplasty is a common approach for the treatment of multilevel cervical spondylotic myelopathy (CSM). Postoperative loss of cervical lordosis (LCL) was associated with lower extension motion of the cervical spine before laminoplasty. PURPOSE To analyze the possible causes of preoperative cervical extension capacity affecting LCL after laminoplasty by evaluating the changes in cervical lordosis (CL) at different stages. STUDY DESIGN/SETTING Retrospective study. PATIENT SAMPLE Seventy-two patients undergoing laminoplasty due to multilevel CSM. OUTCOME MEASURES Radiographic parameters included CL, extension CL (eCL), flexion CL (fCL), range of motion (ROM), extension ROM (eROM), flexion ROM (fROM) and LCL. Clinical outcomes were assessed using the Japanese Orthopedic Association (JOA) and neck disability index (NDI) score. METHODS The data were recorded before surgery and at 3- and 24-month follow-up. All patients completed a cervical extension test preoperatively. A receiver operating characteristic (ROC) curve of eROM was constructed to discriminate the patients with and without postoperative kyphotic deformity. RESULTS According to the optimal cut-off value of eROM, the patients were divided into two groups: extension group (eROM≥9.3°) and control group (eROM<9.3°). The radiographic outcomes demonstrated no significant differences in CL, eCL, fCL and ROM between the two groups. Both eROM and fROM were significantly different in the two groups. There was a significant change in CL in the extension group at 3-month follow-up and in the control group at 24-month follow-up. The extension group exhibited significantly lower LCL compared with the control group at follow-up. No significant difference between the two groups was noted in the JOA recovery rate, while the NDI score was significantly different at 24-month follow-up. The positivity ratio of the extension test was significantly greater in the extension group than that in the control group. CONCLUSIONS eROM in patients with favorable preoperative cervical extension capacity (eROM≥9.3°) consisted of the actual extension capacity and compensatory flexion. The cervical alignment would be spontaneously restored to its initial lordosis in the short term after laminoplasty. These patients had no substantial LCL at 24-month follow-up and would be good candidates for laminoplasty.
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Affiliation(s)
- Xiaofei Cheng
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Zhiqian Chen
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Xiaojiang Sun
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Changqing Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Jie Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China.
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Funaba M, Imajo Y, Suzuki H, Nishida N, Sakamoto T, Sakai T. The Deterioration of Cervical Kyphosis During Neck Flexion after Laminoplasty Affects the Surgical Outcome of Cervical Spondylotic Myelopathy. Global Spine J 2023; 13:2497-2507. [PMID: 35486847 PMCID: PMC10538317 DOI: 10.1177/21925682221088805] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN A retrospective single-center study. OBJECTIVE The present study investigated whether postoperative cervical alignment changes, in addition to preoperative patient backgrounds, imaging parameters, and disease severity, affect outcomes 1 year after laminoplasty. METHODS One hundred and three cervical spondylotic myelopathy (CSM) patients who underwent laminoplasty were enrolled. Preoperative and postoperative (1-year) Japanese Orthopedic Association (JOA) scores, cervical alignment, and balance on X-rays were assessed. Patients were classified into 2 groups for a univariate analysis according to the status of the recovery rate (RR) of the JOA score ≥50%. A multiple logistic regression analysis was performed to identify factors associated with good surgical outcomes a. RESULTS The mean RR of the JOA score was 47.5% and the loss of cervical lordosis in the neutral position was 5.5°. The univariate analysis revealed slight differences in age, sex, and the duration of disease. Preoperative C2-7 angles were not significantly different. The C2-7 angle during flexion after surgery was significantly smaller in Group F. In the multiple logistic regression analysis, significant factors associated with the status of RR≥50% were a younger age (OR: .75, 95%CI: .59-.96), shorter duration of disease (OR: .94, 95%CI: .89-.99), and a lordotic C2-7 angle during neck flexion after surgery (OR: 1.47, 95%CI: 1.1-1.95). CONCLUSION We retrospectively assessed the surgical outcomes of laminoplasty in 103 CSM cases. In addition to an older age and longer duration of disease, postoperative deteriorations in cervical kyphosis during neck flexion had a negative impact on outcomes.
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Affiliation(s)
- Masahiro Funaba
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yasuaki Imajo
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hidenori Suzuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Norihiro Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takuya Sakamoto
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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Jimbayashi H, Iida K, Kazu K, Saiwai H, Kawaguchi K, Matsumoto Y, Nakashima Y. Cases requiring reoperation for recurrence of myelopathy by lamina closure after a double-door laminoplasty using a modified Kirita-Miyazaki suture method. J Orthop 2023; 44:12-16. [PMID: 37649794 PMCID: PMC10462786 DOI: 10.1016/j.jor.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/30/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023] Open
Abstract
Background Progression of kyphosis after laminoplasty sometimes results in the recurrence of myelopathy with lamina closure. However, only a few case reports have been published on the reoperation of double-door laminoplasty using the suture method. This study investigated the incidence and clinical features of reoperation cases caused by the recurrence of myelopathy with lamina closure after double-door laminoplasty using a modified Kirita-Miyazaki suture method. Methods A total of 169 patients who underwent double-door laminoplasty were included in this study, with a mean follow-up duration of 6.6 years (range: 2-16). All surgeries were double-door laminoplasties in which the open lamina was sutured to the paravertebral muscle. The reoperation rate for myelopathy recurrence due to lamina closure and the associated risk factors were investigated. The risk factors included age, history, cervical alignment, C2-7 lordosis, the cervical sagittal vertical axis, and C7 slope. Results The reoperation rate for recurrence of myelopathy by lamina closure was 3.0% (5/169). All patients showed kyphosis progression after surgery; the spinal cord was more compressed by closed lamina than before the initial surgery. The reoperation group had more patients with neuromuscular or psychiatric disorders (60% [3/5] vs. 2% [4/164]; p < 0.001), kyphotic alignments (60% [3/5] vs. 10% [16/164]; p < 0.001), and cases with less than -10° of C2-7 lordosis (60% [3/5] vs. 7% [11/164]; p < 0.001). Conclusions Double-door laminoplasty with the suture method may not be suitable for patients with a neuromuscular or psychiatric disease or those with preoperative C2-7 lordosis less than -10°.
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Affiliation(s)
- Hideki Jimbayashi
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Keiichiro Iida
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kobayakawa Kazu
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hirokazu Saiwai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kenichi Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Laminoplasty is relevant for degenerative cervical spondylolisthesis when there is little risk of postoperative excessive kyphosis during neck flexion. J Clin Neurosci 2023; 111:26-31. [PMID: 36924657 DOI: 10.1016/j.jocn.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/25/2023] [Accepted: 03/04/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Elderly patients with degenerative cervical myelopathy frequently have severe symptoms due to spondylolisthesis. The effectiveness of laminoplasty for degenerative cervical spondylolisthesis (DCS) is an important question. OBJECTIVE The aim of this study is to elucidate factors associated with the outcome of laminoplasty for DCS. METHOD Eighty-nine patients with cervical spondylotic myelopathy (CSM) who underwent laminoplasty without instrumented posterior fusion were enrolled. Positive spondylolisthesis was defined as more than 2 mm during neck flexion or extension, from this, 46 DCS cases and 43 non-DCS cases were classified. Radiological parameters, including cervical alignment, balance, range of motion, and slippage along with the Japanese Orthopedic Association (JOA) score, were obtained before and 1 year after surgery. Factors associated with good surgical outcomes for DCS were analyzed using multivariate logistic analysis. RESULTS There were no significant differences in background and preoperative JOA score, but the DCS group recovery rate was significantly less (42% vs 53%). Multivariate logistic analysis revealed only the postoperative C2-7 angle during neck flexion was associated with a favorable outcome for DCS (P = 0.0039, Odds ratio: 1.49, 95% CI: 1.14-1.94). Multivariate regression analysis positively correlated the preoperative C2-7 angle in neutral and during flexion with the postoperative C2-7 angle during flexion. CONCLUSION The major factor related to poor outcome was the magnitude of postoperative kyphotic C2-7 angle during neck flexion. Slippage was not directly related to outcome and postoperative cervical alignment. Caution is recommended for surgeons performing laminoplasty on patients with risk factors for postoperative excessive kyphotic C2-7 angle during flexion.
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Tang Z, Chen T, Tan J, Zhang H. Impact of the K-line in patients with ossification of the posterior longitudinal ligament: Analysis of sagittal cervical curvature changes and surgical outcomes. Front Surg 2023; 10:1095391. [PMID: 36874452 PMCID: PMC9975339 DOI: 10.3389/fsurg.2023.1095391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/18/2023] [Indexed: 02/17/2023] Open
Abstract
Objective This study aimed to investigate the relationship of the K-line with sagittal cervical curvature changes and surgical outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Methods We retrospectively reviewed 84 patients with OPLL who underwent posterior cervical single-door laminoplasty. The patients were divided into a K-line-positive (+) group and a K-line-negative (-) group. Perioperative data, radiographic parameters, and clinical outcomes were compared between the two groups. Results Of 84 total patients, 50 patients were in the K (+) group and 29 patients were in the K (-) group. Neurological function improved in both groups after laminoplasty. The C2-7 Cobb angle, T1 slope, and C2-7 sagittal vertical axis were significantly changed in the K(-) group compared with those in the K (+) group before the operation and at the 3-month and final follow-ups. Conclusion Neurological function was recovered in both groups, and the clinical effect on the K (+) group was better than that on the K (-) group. The cervical curvature in patients with OPLL tends to be anteverted and kyphotic after laminoplasty and is an important factor in reducing the clinical effect.
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Affiliation(s)
- Zhongxin Tang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tailong Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Tan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huafeng Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Li C, Zha G, Yang Z, Pang Y, Qiu S, Fan W, Liu Y, Jiang W. K-line in patients with cervical ossification of the posterior longitudinal ligament: relationship with change in sagittal cervical curvature and laminoplasty outcomes. Arch Orthop Trauma Surg 2022; 142:1743-1751. [PMID: 33555403 DOI: 10.1007/s00402-020-03741-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/19/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To analyze how K-line is related to change in sagittal cervical curvature and laminoplasty outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL). MATERIALS AND METHODS The study retrospectively analyzed 81 patients with OPLL who had undergone posterior cervical single-door laminoplasty and arch plate fixation between June 2011 and June 2017. Fifty-five were K-line positive (K[+]) and 26 were K-line negative (K[-]). Clinical and radiological results were compared between the groups. Patients were followed up for at least 2 years. RESULTS Before the operation, Japanese Orthopedic Association (JOA) score, visual analogue scale (VAS) score, neck disability index (NDI), and short-form-36 (SF-36) quality of life score did not differ significantly between the groups. Neurological function was improved in both groups after the procedure. At last follow-up, JOA score, VAS score, NDI, SF-36 score, and JOA score improvement rate differed significantly between the groups. Before the operation, at the 3-month and final follow-ups, C2-7 Cobb angle, T1 slope, and C2-7 SVA differed significantly between the groups. The changes were more marked in the K(-) group than in the K(+) group. The incidence of cervical kyphosis differed significantly between the groups (P < 0.05), as well as between patients with lordosis < 7° and those with lordosis ≥ 7°. CONCLUSIONS K-line negativity and lordosis < 7° may predict kyphosis after laminoplasty in patients with OPLL. The cervical curvature in patients with OPLL tends towards kyphosis and anteversion after laminoplasty, which contributes to the reduced clinical effect of the procedure.
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Affiliation(s)
- Cheng Li
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, Jiangsu Province, China
| | - Guochun Zha
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Zhi Yang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Yong Pang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Shang Qiu
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Wei Fan
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, Jiangsu Province, China
| | - Yijie Liu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, Jiangsu Province, China
| | - Weimin Jiang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, Jiangsu Province, China.
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Wadhwa H, Sharma J, Varshneya K, Fatemi P, Nathan J, Medress ZA, Stienen MN, Ratliff JK, Veeravagu A. Anterior Cervical Discectomy and Fusion Versus Laminoplasty for Multilevel Cervical Spondylotic Myelopathy: A National Administrative Database Analysis. World Neurosurg 2021; 152:e738-e744. [PMID: 34153482 DOI: 10.1016/j.wneu.2021.06.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) is effective for the treatment of single-level cervical spondylotic myelopathy (CSM). However, the data surrounding multilevel CSM have remained controversial. One alternative is laminoplasty, although evidence comparing these strategies has remained sparse. In the present report, we retrospectively reviewed the readmission and reoperation rates for patients who had undergone ACDF or laminoplasty for multilevel CSM from a national longitudinal administrative claims database. METHODS We queried the MarketScan Commercial Claims and Encounters database to identify patients who had undergone ACDF or laminoplasty for multilevel CSM from 2007 to 2016. The patients were stratified by operation type. Patients aged <18 years, patients with a history of tumor or trauma, and patients who had undergone anteroposterior approach were excluded from the present study. RESULTS A total of 5445 patients were included, of whom 1521 had undergone laminoplasty. A matched cohort who had undergone ACDF was identified. The overall 90-day postoperative complication rate was greater in the laminoplasty cohort (odds ratio, 1.48; 95% confidence interval, 1.18-1.86; P < 0.0001). The mean length of stay and 90-day readmission rates were greater in the laminoplasty cohort. The hospital and total payments of the index hospitalization were greater in the ACDF cohort, as were the total payments for ≤2 years after the index hospitalization. CONCLUSIONS In the present administrative claims database study, no difference was found in the reoperation rate between ACDF and laminoplasty. ACDF resulted in fewer complications and readmissions compared with laminoplasty but was associated with greater costs. Additional prospective research is required to investigate the factors driving the higher costs of ACDF in this population and the long-term clinical outcomes.
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Affiliation(s)
- Harsh Wadhwa
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Jigyasa Sharma
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Kunal Varshneya
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Parastou Fatemi
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Jay Nathan
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Zachary A Medress
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Martin N Stienen
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - John K Ratliff
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA.
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Marcó Del Pont F, Giovannini SJM, Ries Centeno T, Caffaratti G, Lorefice E, Cervio A. Cervical laminoplasty with unilateral C4-5 foraminotomy: Technical note and case series. ACTA ACUST UNITED AC 2021; 32:224-230. [PMID: 34148852 DOI: 10.1016/j.neucie.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/25/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The open-door laminoplasty technique is widely used in the treatment of multilevel cervical myelopathy. Despite the satisfactory functional and radiological results of this technique, postoperative C5 palsy is still a severe and disabling complication with a variable incidence in the literature. The objective of this article is to describe and demonstrate the surgical technique step by step with the addition of unilateral C4-5 foraminotomy and to evaluate the results obtained to date, with special emphasis on C5 palsy. MATERIAL AND METHODS Retrospective study of 20 patients operated on for cervical myelopathy using the "extended" laminoplasty technique, which is described step by step. RESULTS Between January 2013 and April 2019, 20 patients were operated on using the extended laminoplasty technique. Only one patient (5%) presented postoperative C5 palsy. The postoperative recovery rate of the modified JOA (Japanese Orthopaedic Association) score was 54.5%, similar to that observed in other series. CONCLUSION The extended cervical laminoplasty technique with unilateral C4-5 foraminotomy was developed and demonstrated for the prevention of C5 palsy. The results were analysed and an incidence of C5 palsy coinciding with the lowest percentage reported in the literature was obtained. A prospective randomised study would be useful to assess the role of preventive unilateral C4-5 foraminotomy.
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Affiliation(s)
| | | | | | | | | | - Andres Cervio
- Departamento de Neurocirugía, FLENI, Buenos Aires, Argentina
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Lee SH, Son DW, Shin JJ, Ha Y, Song GS, Lee JS, Lee SW. Preoperative Radiological Parameters to Predict Clinical and Radiological Outcomes after Laminoplasty. J Korean Neurosurg Soc 2021; 64:677-692. [PMID: 34044492 PMCID: PMC8435653 DOI: 10.3340/jkns.2020.0294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/19/2020] [Indexed: 12/23/2022] Open
Abstract
Many studies have focused on pre-operative sagittal alignment parameters which could predict poor clinical or radiological outcomes after laminoplasty. However, the influx of too many new factors causes confusion. This study reviewed sagittal alignment parameters, predictive of clinical or radiological outcomes, in the literature. Preoperative kyphotic alignment was initially proposed as a predictor of clinical outcomes. The clinical significance of the K-line and K-line variants also has been studied. Sagittal vertical axis, T1 slope (T1s), T1s-cervical lordosis (CL), anterolisthesis, local kyphosis, the longitudinal distance index, and range of motion were proposed to have relationships with clinical outcomes. The relationship between loss of cervical lordosis (LCL) and T1s has been widely studied, but controversy remains. Extension function, the ratio of CL to T1s (CL/T1s), and Sharma classification were recently proposed as LCL predictors. In predicting postoperative kyphosis, T1s cannot predict postoperative kyphosis, but a low CL/T1s ratio was associated with postoperative kyphosis.
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Affiliation(s)
- Su Hun Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
| | - Jun Jae Shin
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
| | - Jun Seok Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
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Analysis of Cervical Spine Alignment Change after Modified Kurokawa Cervical Laminoplasty in the Patients with Cervical Myelopathy and Straight Cervical Spine. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6658766. [PMID: 33542923 PMCID: PMC7843173 DOI: 10.1155/2021/6658766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/20/2020] [Accepted: 01/08/2021] [Indexed: 11/17/2022]
Abstract
Laminoplasty is widely used to decompress the spinal cord in patients with multilevel cervical lesions. Straight cervical alignment may not be a good candidate for laminoplasty because of postoperation progression of kyphosis and loss of cervical spine range of motion (ROM). However, clinical outcomes of laminoplasty did not show a strong and consistent effect based on cervical sagittal alignment. Moreover, the kyphosis progression and ROM change after operation for the patients with preoperative strange cervical alignment are still unclear. This study is to evaluate the change of cervical alignment and ROM in patients with straight cervical alignment after modified Kurokawa cervical laminoplasty. Thirty patients with multiple-level cervical spondylosis (CSM) and straight cervical alignment were included. All patients underwent laminoplasty with the reconstruction of the spinous process-ligament-muscular complex (SPLMC). The modified JOA score was analyzed for clinical assessment. The change of cervical alignment, ROM, T1 slope, and intervertebral disc space Cobb angle were analyzed for radiological assessment. The average JOA score at preoperative and 2 years follow-up were 7.8 ± 1.4 and 13.6 ± 2.1, respectively. The recovery ratio was 63%. At the 2 years follow-up, there were 18 patients who acquired lordotic cervical alignment. 10 patients remained as straight cervical curve, and 2 patients' cervical alignment developed mild kyphosis. 28 out of 30 patients showed improvement of cervical alignment. The cervical alignment was improved from 1.29 ± 10.04° preoperative to 9.58 ± 8.65° postoperative. However, the ROM decreased from 36.8 ± 18.92 preoperative to 25.08 ± 12.10° postoperative. A positive correlation was found between the C2/4 angle change and cervical alignment change, T1 slope and cervical alignment, cervical alignment, and neutral position flexion reserved ROM. A negative correlation was found between the C1/2 angle change and cervical alignment change. Laminoplasty with a reconstruction of SPLMC followed by appropriate postoperative muscle exercises may be an encouraging way to maintain or improve physiological alignment and prevent postoperation kyphosis deformity at 2 years follow-up.
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Marcó Del Pont F, Giovannini SJM, Ries Centeno T, Caffaratti G, Lorefice E, Cervio A. Cervical laminoplasty with unilateral C4-5 foraminotomy: Technical note and case series. Neurocirugia (Astur) 2020; 32:S1130-1473(20)30130-5. [PMID: 33342747 DOI: 10.1016/j.neucir.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/10/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The open-door laminoplasty technique is widely used in the treatment of multilevel cervical myelopathy. Despite the satisfactory functional and radiological results of this technique, postoperative C5 palsy is still a severe and disabling complication with a variable incidence in the literature. The objective of this article is to describe and demonstrate the surgical technique step by step with the addition of unilateral C4-5 foraminotomy and to evaluate the results obtained to date, with special emphasis on C5 palsy. MATERIAL AND METHODS Retrospective study of 20 patients operated on for cervical myelopathy using the "extended" laminoplasty technique, which is described step by step. RESULTS Between January 2013 and April 2019, 20 patients were operated on using the extended laminoplasty technique. Only one patient (5%) presented postoperative C5 palsy. The postoperative recovery rate of the modified JOA (Japanese Orthopaedic Association) score was 54.5%, similar to that observed in other series. CONCLUSION The extended cervical laminoplasty technique with unilateral C4-5 foraminotomy was developed and demonstrated for the prevention of C5 palsy. The results were analysed and an incidence of C5 palsy coinciding with the lowest percentage reported in the literature was obtained. A prospective randomised study would be useful to assess the role of preventive unilateral C4-5 foraminotomy.
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Affiliation(s)
| | | | | | | | | | - Andres Cervio
- Departamento de Neurocirugía, FLENI, Buenos Aires, Argentina
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13
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Xu Z, Sun B, Chen Y, Zhang Y, Wang JX, Shi CG, Zhang K, Wu HQ, Xie W, Wu XD. Thoracic de-kyphosis for revision surgery of a failure case of endoscopic discectomy: a case report and literature review. Br J Neurosurg 2020; 35:43-48. [PMID: 32279570 DOI: 10.1080/02688697.2020.1751069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Indications and clinical outcomes of percutaneous endoscopic thoracic discectomy(PETD) in treating thoracic disc herniation is rarely reported and still controversial. We reported an unsatisfied recovery of thoracic disc herniation with PETD, treated by a second posterior thoracic laminectomy and Ponte osteotomy. CASE DESCRIPTION A male presented with lower extremity weakness and stagger caused by T3/4 intervertebral disc herniation. The upper thoracic curve was in excessive kyphosis with T2-5 Cobb angle of 34.3 degrees. The preoperative ODI score was 34 and Roelzs's JOA score was 14. Percutaneous transforaminal endoscopic thoracic discectomy (PETD) from a posterior lateral approach was performed. At five-month follow-up, his thoracic back pain and staggering gait did not improve. The postoperative T2-5 Cobb angle was 32.1 degrees, the ODI score was 24 and Roelzs's JOA score was 14. A second posterior thoracic decompression this time with fixation was performed, but no disc herniation was detected. A Ponte osteotomy was performed to correct the kyphosis. One month after the second surgery, muscle strength of the lower limbs was improving with the T2-5 Cobb angle decreased to 19.4 degrees, the ODI score decreased to 10 and Roelzs's JOA score increase to 16. Six month later, the ODI score decreased to 0 and Roelzs's JOA score improved to 18. In review of the literature, PETD doesn't guarantee the patient a satisfactory neurological recovery for kyphotic thoracic disc herniation. Posterior decompression with Ponte osteotomy may be beneficial to release the tension and decompression of the spinal cord tension. CONCLUSIONS Thoracic disc herniation with kyphosis angle >20 degrees (T2-5), percutaneous endoscopic thoracic discectomy is not likely to get good neurologic results. Posterior laminectomy with ponte osteotomy might be beneficial for these patients to induce dorsal drifting of the spinal cord from anterior herniation.
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Affiliation(s)
- Zeng Xu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Bin Sun
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yu Chen
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ying Zhang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jian-Xi Wang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chang-Gui Shi
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ke Zhang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hui-Qiao Wu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wei Xie
- Department of Orthopaedics, Songjiang Fangta Hospital of Traditional Chinese Medicine, Songjiang District, Shanghai, China
| | - Xiao-Dong Wu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Analysis of Cervical Spine Alignment and its Relationship with Other Spinopelvic Parameters After Laminoplasty in Patients with Degenerative Cervical Myelopathy. J Clin Med 2020; 9:jcm9030713. [PMID: 32151098 PMCID: PMC7141301 DOI: 10.3390/jcm9030713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 11/17/2022] Open
Abstract
For patients with kyphosis of the cervical spine, laminoplasty is usually incapable of improving neurological symptoms as it worsens kyphotic alignment. Thus, laminoplasty is not recommended in the presence of kyphotic alignment. Nevertheless, laminoplasty may be selected for myelopathy due to multiple-segment intervertebral disc herniation or ossification of posterior longitudinal ligament despite kyphotic alignment. This study examined whether cervical alignment influences surgical outcomes. Cervical alignment before the surgery was classified into lordosis and non-lordosis, and the non-lordosis group was subclassified into reducible and non-reducible groups to determine the change in cervical alignment before and after the surgery and to analyze its relationship with spinopelvic parameters. The lordosis group showed an increase in upper cervical motion (C0-2 Range of Motion (ROM), C0-2ROM/C0-7ROM) after surgery, while the non-lordosis group exhibited a decrease in C2-7ROM and C0-7ROM. The C0-2ROM was maintained without any reduction in the reducible group, while there was no significant change in cervical alignment and ROM of the non-reducible group. None of these changes showed significant association with the spinopelvic parameters of other sites. However, having a non-reducible type non-lordosis is not a proper indication for laminoplasty, as it does not change the alignment after surgery. Therefore, cervical alignment and reducibility should be identified before surgery.
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Chen HY, Yang MH, Lin YP, Lin FH, Chen PQ, Hu MH, Yang SH. Impact of cervical sagittal parameters and spinal cord morphology in cervical spondylotic myelopathy status post spinous process-splitting laminoplasty. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:1052-1060. [DOI: 10.1007/s00586-019-06247-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
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Lu CB, Yang XJ, Wu JC, Lin YZ, Sang HX. Clinical Investigation of the Association of Opening Size with Sagittal Canal Diameter Based on Single-Door Cervical Laminoplasty. Med Sci Monit 2019; 25:7370-7375. [PMID: 31571675 PMCID: PMC6788323 DOI: 10.12659/msm.919485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Many clinical studies have assessed the association of laminoplasty opening size (LOS) with sagittal canal diameter (SCD) based on single-door cervical laminoplasty (SDCL). Nevertheless, the “worn-off” lamina extracted in SDCL was neglected in these reports. We aimed to develop a simple mathematical model to analyze the relationship between the effective LOS and SCD, taking into consideration the worn-off lamina. Material/Methods A total of 106 patients treated by SDCL at our hospital were included in this study. Pre-operative and post-operative SCDs were assessed using a picture archiving and communication system (PACS) based on computed tomography scans. Mini-plate sizes as well as drill bit diameters were recorded in detail in order to determine the effective LOS for each vertebral lamina involved. Results SCD in all patients was increased significantly after SDCL (P<0.01). A linear correlation was found between effective LOS and the post-operative SCD increment from C3 to C7 (R2>0.933, P<0.001). The 12 mm mini-plate was most often used in SDCL, accounting for 64.45% of all cases, whereas 10 mm and 16 mm mini-plates were the least used, accounting for 3.85% and 3.00%, respectively. Conclusions There is a strong linear correlation between effective LOS and the post-operative SCD increment. The SCD was increased by about 0.5 mm per mm increase in effective LOS. Thus, post-operative SCD could be precisely calculated and predicted, enabling the selection of optimal mini-plate prior to SDCL.
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Affiliation(s)
- Chang-Bo Lu
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi'an, Shaanxi, China (mainland)
| | - Xiao-Jiang Yang
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi'an, Shaanxi, China (mainland)
| | - Jia-Chang Wu
- Department of Orthopedics, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China (mainland)
| | - Yun-Zhi Lin
- Department of Orthopedics, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China (mainland)
| | - Hong-Xun Sang
- Department of Orthopedics, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China (mainland)
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Siasios I, Winograd E, Khan A, Vakharia K, Dimopoulos VG, Pollina J. Cervical sagittal balance parameters after single-level anterior cervical discectomy and fusion: Correlations with clinical and functional outcomes. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2018; 9:56-62. [PMID: 29755238 PMCID: PMC5934966 DOI: 10.4103/jcvjs.jcvjs_9_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Normal sagittal cervical alignment has been associated with improved outcome after anterior cervical discectomy and fusion (ACDF). Objective: The aim of this study is to identify alterations of cervical sagittal balance parameters after single-level ACDF and assess correlations with postoperative functionality. Methods: A retrospective chart review was performed between January 2010 and January 2014 to identify adult patients with no previous cervical spine surgery who underwent ACDF at any one level between C2 and C7 for the single-level degenerative disease. Tumor, infection, and trauma cases were excluded from the study. For the included cases, the following data were recorded preoperatively and 6 months–1 year after surgery: sagittal balance-marker measurements of the C1–C2 angle, C2–C7 angle, C7 slope, segmental angle at the operated level, and sagittal vertical axis (SVA) distance between C2 and C7, as well as the neck disability index and visual analog scale of pain. Results: The present study included 47 patients (average age: 51.2 years; range: 28–86 years). A moderate negative correlation between a smaller C2–C7 angle and the presence of right arm pain before treatment was found (P = 0.0281). Postoperatively, functionality scores significantly improved in all patients. C1–C2 angle increased with statistical significance (P = 0.0255). C2–C7 angle, segmental angle, C7 slope, and SVA C2–C7 distance did not change with statistical significance after surgery. C7 slope significantly correlated with overall cervical sagittal balance (P < 0.05). Conclusions: Single-level ACDF significantly increases upper cervical lordosis (C1–C2) without significantly changing lower cervical lordosis (C2–C7). The C7 slope is a significant marker of overall cervical sagittal alignment (P < 0.05).
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Affiliation(s)
- Ioannis Siasios
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA.,Department of Neurosurgery, Kaleida Health, Buffalo, New York, USA
| | - Evan Winograd
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA.,Department of Neurosurgery, Kaleida Health, Buffalo, New York, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA.,Department of Neurosurgery, Kaleida Health, Buffalo, New York, USA
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA.,Department of Neurosurgery, Kaleida Health, Buffalo, New York, USA
| | - Vassilios G Dimopoulos
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA.,Department of Neurosurgery, Kaleida Health, Buffalo, New York, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA.,Department of Neurosurgery, Kaleida Health, Buffalo, New York, USA
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Laminoplasty is the Preferred Procedure for a Posteriorly Based Multilevel Surgery in a Patient With a Neutral Spine and Cervical Spondylotic Myelopathy: True or False? Clin Spine Surg 2018; 31:1-5. [PMID: 29252599 DOI: 10.1097/bsd.0000000000000600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Miyazaki M, Ishihara T, Notani N, Kanezaki S, Tsumura H. Relationship of T1 slope with loss of lordosis and surgical outcomes after laminoplasty for cervical ossification of the posterior longitudinal ligament. Clin Neurol Neurosurg 2018; 164:19-24. [DOI: 10.1016/j.clineuro.2017.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/30/2017] [Accepted: 11/11/2017] [Indexed: 11/15/2022]
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20
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Ajiboye RM, Zoller SD, Ashana AA, Sharma A, Sheppard W, Holly LT. Regression of Disc-Osteophyte Complexes Following Laminoplasty Versus Laminectomy with Fusion for Cervical Spondylotic Myelopathy. Int J Spine Surg 2017; 11:17. [PMID: 28765801 DOI: 10.14444/4017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Laminectomy with fusion (LF) and laminoplasty are two posterior-based surgical approaches for the surgical treatment of cervical spondylotic myelopathy (CSM). The decompressive effect of these approaches is thought to be primarily related to the dorsal drift of the spinal cord away from ventral compressive structures. A lesser known mechanism of spinal cord decompression following cervical LF is regression of the ventral disc osteophyte complexes which is postulated to result from the alteration of motion across the fused motion segment. The goal of this study was to determine whether regression of the ventral disc-osteophyte complexes occur following laminoplasty and compare the magnitude of this occurrence to cervical laminectomy and fusion. METHODS Seventy patients with CSM who underwent pre- and postoperative magnetic resonance imaging (MRI) and were treated with either laminoplasty or LF. The size of the disc-osteophyte complex at all operative levels were measured on pre- and postoperative MRI using digital calipers. RESULTS The laminoplasty group consisted of 25 patients with an average age of 54.9 and a mean of 3.24 surgical levels while the LF group consisted of 45 patients with an average age of 65.4 and a mean of 3.44 surgical levels (age, p < 0.0001; levels, p= 0.46). The average time interval between pre- and post-operative MRI was 16.2 and 15.6 months in the laminoplasty and LF groups, respectively (p = 0.91). The average time interval between surgery and post-operative MRI was 10.1 and 10.7 months in the laminoplasty and LF groups, respectively (p = 0.86). When comparing pre- and post-operative MRI, there was a 9.59% decrease in disc-osteophyte complex size from 3.84mm ± 0.74 to 3.47mm ± 0.86 in the laminoplasty group compared to a 35.4% decrease in disc-osteophyte complex size from 4.60mm ± 1.06 to 2.98mm ± 1.33 in LF group (laminoplasty, p < 0.0001; LF, p = 0.0067). Using logistic regression analysis, LF, increased time interval between surgery and post-operative MRI, high cobb angle, and straight sagittal alignment were all independently associated with increased disc-osteophyte complex regression (p < 0.05). No differences in functional outcomes (as defined by mJOA scores) was found between the two surgical techniques. CONCLUSIONS In patients with CSM that had a posterior surgical approach, LF is associated with a larger interval regression in disc-osteophyte complex size compared to laminoplasty. This is likely related to the loss of motion of the cervical spine after surgery as governed by Wolff's law and the Heuter-Volkmann's principle. Although the decompressive effect of LF and laminoplasty is primarily related to the dorsal drift of the spinal cord away from ventral compressive structures, disc-osteophyte complex regression likely provides another mechanism of spinal cord decompression.
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Affiliation(s)
- Remi M Ajiboye
- Department of Orthopaedics, David Geffen UCLA School of Medicine, Los Angeles, USA
| | - Stephen D Zoller
- Department of Orthopaedics, David Geffen UCLA School of Medicine, Los Angeles, USA
| | - Adedayo A Ashana
- Department of Orthopaedics, David Geffen UCLA School of Medicine, Los Angeles, USA
| | - Akshay Sharma
- Case Western Reserve School of Medicine, Cleveland, USA
| | - William Sheppard
- Department of Orthopaedics, David Geffen UCLA School of Medicine, Los Angeles, USA
| | - Langston T Holly
- Department of Orthopaedics, David Geffen UCLA School of Medicine, Los Angeles, USA.,Department of Orthopaedics, David Geffen UCLA School of Medicine, Los Angeles, USA
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Li J, Zhang Y, Zhang N, Xv ZK, Li H, Chen G, Li FC, Chen QX. Clinical outcome of laminoplasty for cervical ossification of the posterior longitudinal ligament with K-line (-) in the neck neutral position but K-line (+) in the neck extension position: A retrospective observational study. Medicine (Baltimore) 2017; 96:e6964. [PMID: 28562546 PMCID: PMC5459711 DOI: 10.1097/md.0000000000006964] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Patients with cervical ossification of the posterior longitudinal ligament (OPLL) who are K-line (-) are thought to have poor clinical outcomes after laminoplasty. The aim of this study is to compare the clinical results of patients with OPLL who were K-line (-) in the neck neutral position but K-line (+) in the neck extension position (NEP group) with patients with OPLL who were K-line (+) in the neck neutral position (NNP group).Retrospectively, 42 patients who underwent cervical laminoplasty for OPLL by our surgical group during 2012 and 2013 were reviewed and were followed for at least 2 years. The patients were divided into 2 groups according to K-line status. Standing plain radiographs of the cervical spine were obtained pre- and postoperatively. Cervical spine alignment parameters included the C2-7 Cobb angle and range of motion (ROM) measured on lateral radiographs. Clinical evaluation included pre- and postoperative JOA, NDI, and VAS scores.Ten patients were classified in the NEP group, and 32 patients were classified in the NNP group. Preoperatively, the OPLL involved segments were 4.10 ± 1.66 in the NEP group and 2.53 ± 1.16 in the NNP group (P = .005). The canal-occupying ratios were 58.40 ± 11.11% in the NEP group and 29.08 ± 11.38% in the NNP group (P < .001). The mean Cobb angle of both the groups had not changed significantly at the last follow-up. The mean cervical ROM of both the groups had decreased at the last follow-up. The mean JOA score of the NEP group improved significantly from 9.70 ± 2.16 to 12.50 ± 2.27 (P = .014). The mean JOA score of the NNP group improved significantly from 11.91 ± 1.69 to 14.93 ± 1.58 (P < .001). The mean JOA recovery rate was 32.71 ± 40.45% in the NEP group and 59.00 ± 33.80% in the NNP group (P = .036). The NDI scores of both groups were significantly decreased, and the VAS scores of both groups had not changed significantly at the last follow-up.Laminoplasty is a relatively effective and safe procedure for patients with K-line (-) in the neck neutral position but K-line (+) in the neck extension position. Instead of anterior surgery, we recommend laminoplasty for those patients with OPLL extending to 3 or more segments.
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Affiliation(s)
- Jun Li
- Department of Orthopedics, the Second Affiliated Hospital
| | - Yan Zhang
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ning Zhang
- Department of Orthopedics, the Second Affiliated Hospital
| | - Zheng-Kuan Xv
- Department of Orthopedics, the Second Affiliated Hospital
| | - Hao Li
- Department of Orthopedics, the Second Affiliated Hospital
| | - Gang Chen
- Department of Orthopedics, the Second Affiliated Hospital
| | - Fang-Cai Li
- Department of Orthopedics, the Second Affiliated Hospital
| | - Qi-Xin Chen
- Department of Orthopedics, the Second Affiliated Hospital
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Wedge-Shaped Resection of the Posterior Bony Arch During Open Door Laminoplasty to Prevent Postoperative Motion Limitation. Spine (Phila Pa 1976) 2017; 42:143-150. [PMID: 27172286 DOI: 10.1097/brs.0000000000001689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective randomized double-arm noninferiority study. OBJECTIVE To evaluate an additional surgical procedure (wedge-shaped resection of the cranial portion of the posterior bony arch) during open-door laminoplasty (ODLP), and to compare the outcomes with those of conventional ODLP surgery. SUMMARY OF BACKGROUND DATA In clinical practice, spine surgeons sometimes encounter patients who show bony impingement on lateral radiographs after ODLP; bony impingement may lead to reduced motion of the cervical spine and posterior neck pain. However, this problem has not been well studied, and no methods have been developed to prevent it. METHODS Of total 79 patients, 75 were enrolled and randomly assigned to either group A (additional procedure in ODLP, n = 38) or group B (ODLP alone, n = 37). The primary outcome measure was range of motion (ROM) of the cervical spine. Secondary endpoints included clinical outcomes based on pain intensity, 12-item short form health survey (SF-12), and modified Japanese Orthopedic Association scale; presence of bony impingement on dynamic lateral radiographs; surgical outcomes; and surgery-related complications. RESULTS ROM of the cervical spine was significantly greater at 6 months (P = 0.04) and 1 year (P = 0.02) postoperative in group A than in group B. Pain intensity at the posterior neck was significantly lower 1 year after surgery in group A than in group B (P = 0.03). In lateral radiographs 1 year after surgery, the presence of posterior bony impingement was 0% in group A and 32.4% in group B (P <0.01). Clinical outcomes and surgery-related complications were similar between groups. CONCLUSION Performing wedge-shaped resection of the cranial portion of the posterior bony arch in ODLP surgery can lead to better outcomes than ODLP alone in terms of preservation of cervical ROM, prevention of posterior bony impingement, and amelioration of posterior neck pain. LEVEL OF EVIDENCE 2.
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Liu X, Chen Y, Yang H, Li T, Xu B, Chen D. Expansive open-door laminoplasty versus laminectomy and instrumented fusion for cases with cervical ossification of the posterior longitudinal ligament and straight lordosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1173-1180. [PMID: 28028648 DOI: 10.1007/s00586-016-4912-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 11/06/2016] [Accepted: 12/04/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE To identify whether expansive open-door laminoplasty (Lam) is more appropriate than laminectomy and instrumented fusion (LIF) for cases with ossification of the posterior longitudinal ligament (OPLL) and straight cervical lordosis. METHODS A total of 67 cases were included and divided into Group Lam (n = 32) and Group LIF (n = 35), and the mean follow-up periods were 38 and 42 months, respectively. The cervical lordosis was elevated by C2-7 Cobb angle and cervical sagittal balance by C2-C7 sagittal vertical axis (SVA). Japanese Orthopedic Association (JOA), neurological recovery rate (RR) being calculated by the JOA, visual analog scale (VAS) and neck disability index (NDI) were used to assess clinical outcomes. RESULTS Differences in general data between two groups were not significant. Total blood loss and operation duration in Group Lam were both significantly less than that in the Group LIF. By the final follow-up, the cervical lordosis significantly decreased in Group Lam and increased in Group LIF, the SVA significantly increased in Group Lam and kept unchanged in Group LIF, and the JOA, VAS, NDI significantly improved in both groups. Although there was no significant difference in RR between the two groups, cases in Group Lam had significantly larger incidence of postoperative kyphosis and kyphotic change rate, and less VAS, NDI and incidence of axial pain than cases in Group LIF. CONCLUSIONS When compared with the LIF, the Lam is recommended for cases with OPLL and straight cervical lordosis when taking comparable neurological recovery, less axial pain and better neck function improvement into consideration.
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Affiliation(s)
- Xiaowei Liu
- Department of Orthopedics, Jinling Hospital, Medicine College, Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Yu Chen
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Haisong Yang
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Tiefeng Li
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Bin Xu
- Department of Orthopedics, Jinling Hospital, Medicine College, Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Deyu Chen
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China.
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Yamane K, Sugimoto Y, Tanaka M, Arataki S, Takigawa T, Ozaki T. Laminar closure rates in patients with cervical myelopathies treated with either open-door laminoplasty with reattachment of spinous processes and extensor musculature or Hirabayashi open-door laminoplasty: a case–control study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:1869-74. [DOI: 10.1007/s00586-016-4398-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 11/30/2022]
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Chen H, Liu H, Deng Y, Gong Q, Li T, Song Y. Multivariate Analysis of Factors Associated With Axial Symptoms in Unilateral Expansive Open-Door Cervical Laminoplasty With Miniplate Fixation. Medicine (Baltimore) 2016; 95:e2292. [PMID: 26765404 PMCID: PMC4718230 DOI: 10.1097/md.0000000000002292] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Retrospective case-control study.Unilateral expansive open-door cervical laminoplasty with miniplate fixation is an efficient and increasing popular surgery for multilevel cervical spondylotic myelopathy. Axial symptoms are the most frequent complaints after cervical laminoplasty. But the mechanisms have not been fully clarified yet.The objective of this study is to compare the clinical and radiologic data between patients with or without axial symptoms and to investigate the factors associated with axial symptoms by multivariate analysis in cervical laminoplasty with miniplate fixation.A total of 129 patients who underwent cervical laminoplasty with miniplate fixation were comprised from August 2009 to March 2014. Patients were grouped according to whether they suffered from postoperative axial symptoms (PA) or not (NA). The clinical data including gender, age, duration of symptoms, diagnosis type, medical comorbidity, operative level, blood loss, operative time, pre- and post-Japanese Orthopedic Association (JOA) score, JOA recovery rates, and other complications were recorded. The radiologic data including cervical canal diameter, C2-7 Cobb angle, cervical range of motion (ROM), cross-sectional area, open angle, hinge union, and facet joint destroyed would be measured according to X-ray plain and CT scan images. The univariate analysis and multivariate logistic regression analysis were performed.There were 39 patients in PA group and 90 patients in NA group. Both groups gained significant JOA improvement postoperatively (P < 0.05). The preoperative neck pain (P = 0.048), negative change of cervical ROM (P = 0.018), and facet joints destroyed (P = 0.022) were significant different between the 2 groups. There were no significant differences for other clinical and radiography parameters between the groups (P > 0.05). The multivariate analysis showed that the negative change of cervical ROM (OR = 1.062, P = 0.047) and facet joints destroyed (OR = 0.661, P = 0.024) were related to axial symptoms.The change of cervical ROM and facet joints destroyed by miniscrews might be associated with axial symptoms after cervical laminoplasty with miniplate fixation. Cervical spine surgeons should carefully operate to decrease the injury of posterior musculature structure and protect the facet joints.
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Affiliation(s)
- Hua Chen
- From the Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, P.R. China
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Abstract
Cervical laminoplasty was developed as an alternative to cervical laminectomy for treatment of cervical myelopathy, in which hinges are created to lift the lamina. Various techniques of laminoplasty have since been developed after two prototype techniques: Hirabayashi’s open-door laminoplasty and Kurokawa’s spinous process splitting (double-door) laminoplasty. Several in vitro studies report superior biomechanical stability of the cervical spine after laminoplasty compared with laminectomy. In clinical situation, randomized control studies are scarce and superiority of one procedure over another is not uniformly shown. Lack of hard evidence supporting the purported advantages of laminoplasty over laminectomy, that is, reduced rate of postoperative instability and kyphosis development, while preserving range of motion (ROM), has been a weak selling point. Currently, laminoplasty is performed by majority of spine surgeons in Japan, but is rarely performed in the United States and Europe. Recent development in laminoplasty is preservation of muscle attachment, which enabled dynamic stabilization of the cervical spine by neck extensor muscles. After treatment with new laminoplasty techniques with active postoperative neck ROM exercises, postoperative instability, kyphosis, axial neck pain, and loss of ROM seems minimal. Well-designed clinical trials to show the effectiveness and long-term outcome of this surgical procedure are warranted.
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Affiliation(s)
- Ryu Kurokawa
- Department of Neurologic Surgery, Dokkyo Medical University Hospital
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Duetzmann S, Cole T, Ratliff JK. Cervical laminoplasty developments and trends, 2003-2013: a systematic review. J Neurosurg Spine 2015; 23:24-34. [PMID: 25909270 DOI: 10.3171/2014.11.spine14427] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Despite extensive clinical experience with laminoplasty, the efficacy of the procedure and its advantages over laminectomy remain unclear. Specific clinical elements, such as incidence or progression of kyphosis, incidence of axial neck pain, postoperative cervical range of motion, and incidence of postoperative C-5 palsies, are of concern. The authors sought to comprehensively review the laminoplasty literature over the past 10 years while focusing on these clinical elements. METHODS The authors conducted a literature search of articles in the Medline database published between 2003 and 2013, in which the terms "laminoplasty," "laminectomy," and "posterior cervical spine procedures" were used as key words. Included was every single case series in which patient outcomes after a laminoplasty procedure were reported. Excluded were studies that did not report on at least one of the above-mentioned items. RESULTS A total of 103 studies, the results of which contained at least 1 of the prespecified outcome variables, were identified. These studies reported 130 patient groups comprising 8949 patients. There were 3 prospective randomized studies, 1 prospective nonrandomized alternating study, 15 prospective nonrandomized data collections, and 84 retrospective reviews. The review revealed a trend for the use of miniplates or hydroxyapatite spacers on the open side in Hirabayashi-type laminoplasty or on the open side in a Kurokawa-type laminoplasty. Japanese Orthopaedic Association (JOA) scoring was reported most commonly; in the 4949 patients for whom a JOA score was reported, there was improvement from a mean (± SD) score of 9.91 (± 1.65) to a score of 13.68 (± 1.05) after a mean follow-up of 44.18 months (± 35.1 months). The mean preoperative and postoperative C2-7 angles (available for 2470 patients) remained stable from 14.17° (± 0.19°) to 13.98° (± 0.19°) of lordosis (average follow-up 39 months). The authors found significantly decreased kyphosis when muscle/posterior element-sparing techniques were used (p = 0.02). The use of hardware in the form of hydroxyapatite spacers or miniplates did not influence the progression of deformity (p = 0.889). An overall mean (calculated from 2390 patients) of 47.3% loss of range of motion was reported. For the studies that used a visual analog scale score (totaling 986 patients), the mean (cohort size-adjusted) postoperative pain level at a mean follow-up of 29 months was 2.78. For the studies that used percentages of patients who complained of postoperative axial neck pain (totaling 1249 patients), the mean patient number-adjusted percentage was 30% at a mean follow-up of 51 months. The authors found that 16% of the studies that were published in the last 10 years reported a C-5 palsy rate of more than 10% (534 patients), 41% of the studies reported a rate of 5%-10% (n = 1006), 23% of the studies reported a rate of 1%-5% (n = 857), and 12.5% reported a rate of 0% (n = 168). CONCLUSIONS Laminoplasty remains a valid option for decompression of the spinal cord. An understanding of the importance of the muscle-ligament complex, plus the introduction of hardware, has led to progress in this type of surgery. Reporting of outcome metrics remains variable, which makes comparisons among the techniques difficult.
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Affiliation(s)
- Stephan Duetzmann
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Tyler Cole
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - John K Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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König SA, Spetzger U. Modified open-door laminoplasty for the surgical treatment of cervical spondylotic myelopathy in elderly patients. Acta Neurochir (Wien) 2014; 156:1225-30. [PMID: 24736988 DOI: 10.1007/s00701-014-2078-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/19/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The authors describe their experience with a modified version of the standard technique of open-door laminoplasty for the surgical treatment of spondylotic myelopathy in elderly patients with temporary removal of the laminae, extensive decompression, and pre-plating of the laminae beyond the surgical field. METHODS Description of surgical anatomy, surgical technique, indications, limitations, complications, and specific perioperative considerations, as well as specific information to give to the patient about surgery and potential risks. A summary of ten key points is given. CONCLUSIONS Transection of the laminae on both sides (temporary laminectomy) and pre-plating of the laminae outside of the surgical field has several advantages: better decompression of the spinal canal and the neuroforamina on both sides, easier undercutting of adjacent vertebral arches for cranio-caudal decompression, and no risk of spinal cord injury by the screwdriver when attaching plates to the laminae.
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