Extensor muscle-preserving laminectomy in treating multilevel cervical spondylotic myelopathy compared with laminoplasty

Hidden blood loss in unilateral open-door cervical laminoplasty for multilevel cervical spondylotic myelopathy

OBJECTIVES

This study aims to evaluate the hidden blood loss (HBL) and its possible risk factors after unilateral open-door cervical laminoplasty (UOCL) in patients with multilevel cervical spondylotic myelopathy (MCSM).

PATIENTS AND METHODS

Between January 2018 and March 2023, a total of 105 patients (55 males, 50 females; median age: 76 years; range, 52 to 93 years) who underwent C3-7 UOCL for MCSM were retrospectively analyzed. Data of the patients were recorded, including age, sex, height, weight, plasma albumin, blood glucose, hematocrit, American Society of Anesthesiologists (ASA) score, surgical time, and intraoperative blood loss. The HBL was calculated according to the Sehat formula, and risk factors were identified.

RESULTS

The median surgical time was 180.7 min. The median total blood loss (TBL) and median HBL were 507.4 mL and 201.7 mL, respectively. Correlation analyses revealed that body mass index and surgical time were correlated with HBL (p<0.05). However, multiple linear regression analysis showed that HBL was positively correlated with surgical time (β=0.293, p<0.05).

CONCLUSION

Our study results showed that surgical time is an independent risk factor for HBL. Therefore, HBL should not be overlooked in patients with MCSM undergoing UOCL, particularly in the patients with expected long surgical time.

Comparison of Clinical Outcomes of Cervical Laminoplasty for Cervical Spondylotic Myelopathy: Double-Door With Lamina Staple, Single-Door With Miniplate, and Double-Door With Spacer-A 2-Year Follow-Up Study

BACKGROUND

There were few studies to compare the outcomes of different types of cervical laminoplasties.

OBJECTIVE

To compare the clinical outcomes of double-door cervical laminoplasty with lamina staple (double-door staple), single-door cervical laminoplasty with miniplate (single-door miniplate), and double-door cervical laminoplasty with spacer (double-door spacer).

METHODS

The study involved 166 patients with cervical spondylotic myelopathy (CSM). Fifty-two patients underwent double-door staple, 63 patients underwent single-door miniplate, and 51 patients underwent double-door spacer. The clinical outcomes were measured.

RESULTS

There was no significant difference in Japanese Orthopedic Association score among the 3 groups ( P > .05). The operation time was significantly shorter in double-door staple and single-door miniplate groups than in the double-door spacer group ( P < .005). The estimated blood loss was significantly more in the single-door miniplate group than in double-door staple and double-door spacer groups ( P < .005). The expansion ratio of cervical intraspinal cross-sectional area decreased in the order of double-door staple > double-door spacer > single-door miniplate. There were no significant differences in the expansion ratio of dural sac cross-sectional area among the 3 groups.

CONCLUSION

Double-door staple, double-door spacer, and single-door miniplate can achieve favorable clinical outcomes for CSM. The blood loss of double-door staple is less than that of single-door miniplate, and the operation time of double-door staple is shorter than that of double-door spacer. The mean expansion ratio of cervical intraspinal cross-sectional area decreased in the order of double-door staple > double-door spacer > single-door miniplate. Overall, double-door staple is a safe and innovative alternative choice for treatment of CSM.

Uniportal full endoscopic spinous process-preserving laminectomy for bilateral decompression in cervical stenotic myelopathy: patient series

BACKGROUND

Endoscopic decompression for cervical stenotic myelopathy has several advantages over conventional open surgery. However, sometimes performing bilateral decompression, especially contralateral decompression, can be dangerous. The cervical spine has specific characteristics, including a shallower lamina angle and thinner lamina than the lumbar or thoracic lamina. These characteristics may cause cord compression when instruments approach the contralateral side of the lamina. This article introduces a novel surgical technique that can overcome the specificities of the cervical spine and discusses the efficacy and safety of uniportal full endoscopy for cervical decompression.

OBSERVATIONS

Fourteen patients underwent uniportal full endoscopic spinous process-preserving laminectomy (ESP-L) for bilateral decompression of multilevel cervical stenotic myelopathy. The mean follow-up period was 13.44 months (range: 4-17 months). The preoperative and postoperative cervical spine angle and cervical range of motion did not differ significantly. The Japanese Orthopaedic Association score significantly improved postoperatively. The numeric rating scale scores significantly improved postoperatively. The mean duration of postoperative hospitalization was 2.3 days.

LESSONS

ESP-L is a new, safe, effective, and noninvasive technique that can achieve complete decompression of multilevel cervical stenotic myelopathy.

Association Between the Cervical Extensor Musculature and the Demographic Features, Symptoms, and Sagittal Balance in Patients with Multilevel Cervical Spondylotic Myelopathy

OBJECTIVE

To obtain the quantitative measurements of the muscle morphology of cervical extensors in patients with multilevel cervical spondylotic myelopathy, and determine whether the morphological parameter of each muscle correlates with the patients' demographic features, symptoms, and cervical sagittal balance.

METHODS

We retrospectively evaluated 100 hospitalized patients scheduled to undergo surgery for multilevel cervical spondylotic myelopathy. Demographic data, including age, sex, and body mass index, were recorded, and symptoms were evaluated using the visual analog scale (VAS), neck disability index (NDI), and modified Japanese Orthopedic Association scale scores. The cross-sectional area (CSA) of the multifidus, semispinalis capitis, semispinalis cervicis, splenius capitis and splenius cervicis were measured on magnetic resonance imaging. The CSA of the total extensor muscles, deep extensor muscles (DEM, consisting of multifidus and semispinalis capitis), and superficial extensor muscles (consisting of semispinalis cervicis, splenius capitis and splenius cervicis) were calculated. The adjusted CSA (aCSA) was calculated as the CSA of the muscle/CSA of the corresponding vertebral body. The fat infiltration ratio (FIR) of the posterior extensor muscles was assessed using a pseudocoloring technique. Sagittal parameters, including cervical lordosis (CL), C2-7 cervical sagittal vertical axis (SVA), T1-slope, mismatch between T1-slope and CL (T1S-CL), and range of motion, were measured. The measured parameters were compared between the males and the females, between the patients with higher muscle aCSA and the patients with lower muscle aCSA, and between the patients with and without sagittal balance. A Pearson correlation analysis was conducted to determine the correlations between the paraspinal muscle measurements, and the clinical and radiographic parameters.

RESULTS

There were 67 males and 33 females in this study, and the mean age was 59.22 ± 9.54 years. Compared with females, male patients showed higher CSA and aCSA of extensor muscles. Patients with lower muscle aCSA were significantly older and had worse NDI scores, with significantly greater C2-7 SVA and T1S-CL. Patients with sagittal imbalance showed significantly lower aCSA of total extensor muscles and DEM, as well as a significantly higher FIR. Age was significantly correlated with the aCSA of each measured muscle and the FIR. The aCSA of the DEM was correlated with the NDI score, the visual analog scale score, the SVA, the T1-slope, and the T1S-CL.

CONCLUSIONS

In patients with multilevel CSM, age and sex were demographic factors that were highly correlated with muscle morphology changes. Extensor muscles, especially DEM, play important roles in maintaining cervical sagittal balance and are associated with the severity of neck symptoms.

Evaluating a paradigm shift from anterior decompression and fusion to muscle-preserving selective laminectomy: a single-center study of degenerative cervical myelopathy

OBJECTIVE

Muscle-preserving selective laminectomy (SL) is an alternative to conventional decompression surgery in patients with degenerative cervical myelopathy (DCM). It is less invasive, preserves the extensor musculature, and maintains the range of motion of the cervical spine. Therefore, the preferred treatment for DCM at the authors' institution has changed from anterior decompression and fusion (ADF), including anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF), toward SL. The aim of this study was to evaluate surgical outcomes before and after this paradigm shift with patient-reported outcome measures (PROMs), complications, reoperations, and cost-effectiveness.

METHODS

This study was a retrospective register-based cohort study. All patients with DCM who underwent ADF or SL at the authors' institution from 2008 to 2019 were reviewed. Using ANCOVA, changes in PROMs from baseline to the 2-year follow-up were compared between the two groups, adjusting for clinicodemographic parameters, baseline PROMs, number of decompressed levels, and MRI measurements (C2-7 Cobb angle, C2-7 sagittal vertical axis [SVA], and modified K-line interval [mK-line INT]). The PROMs, including the European Myelopathy Score (EMS), the Neck Disability Index (NDI), and the EQ-5D, were collected from the national Swedish Spine Register. Complications, reoperations, and in-hospital treatment costs were also compared between the two groups.

RESULTS

Ninety patients (mean age 60.7 years, 51 men [57%]) were included in the ADF group and 63 patients (mean age 68.8 years, 41 men [65%]) in the SL group. The ADF and SL groups had similar PROMs at baseline. The preoperative MR images showed similar C2-7 Cobb angles (10.7° [ADF] vs 14.1° [SL], p = 0.12) and mK-line INTs (4.08 vs 4.88 mm, p = 0.07), but different C2-7 SVA values (16.2 vs 19.3 mm, p = 0.04). The comparison of ANCOVA-adjusted mean changes in PROMs from baseline to the 2-year follow-up presented no significant differences between the groups (EMS, p = 0.901; NDI, p = 0.639; EQ-5D, p = 0.378; and EQ-5D health, p = 0.418). The overall complication rate was twice as high in the ADF group (22.2% vs 9.5%, p = 0.049), while the reoperation rate was comparable (16.7% vs 7.9%, p = 0.146). The average in-hospital treatment cost per patient was $6617 (USD) for SL, $7046 for ACDF, and $12,000 for ACCF.

CONCLUSIONS

SL provides similar PROMs after 2 years, a significantly lower complication rate, and better cost-effectiveness compared with ADF.

Comparative Effectiveness and Safety of Open-Door Laminoplasty, French-Door Laminoplasty, Laminectomy and Fusion, and Laminectomy Alone for Multilevel Degenerative Cervical Myelopathy: A Bayesian Network Analysis

OBJECTIVES

To evaluate the comparative effectiveness and safety of open-door laminoplasty (OLP), French-door laminoplasty (FLP), laminectomy and fusion (LF), and laminectomy alone (LA) in treating multilevel degenerative cervical myelopathy (MDCM).

METHODS

Embase, PubMed, and Cochrane library were searched from their inception date to 7 January 2021. Randomized controlled trials and cohort studies comparing OLP, FLP, LF, and LA were identified to perform a network meta-analysis (NMA).

RESULTS

A total of 30 studies with 2671 patients were included. Our NMA results showed no significant difference between LF and OLP, but both are superior to LA and FLP in the comparison of JOA (Japanese Orthopaedic Association) score improvement. LF showed a most unsatisfactory outcome in postoperative range of motion (ROM) compared with LA or OLP or with FLP. For the complication outcome, no significant differences were found. The surface under the cumulative ranking curves (SUCRA) for JOA improvement was as follows: LF, OPL, LA, and FLP. For ROM reduction it was LA, OPL, FPL, and LF. For complications it was LF, LA, OLP, and FLP.

CONCLUSIONS

Considering all the evaluated criteria, none of the procedures showed the best outcome with least complications and optimal efficacy. However, OLP can be most recommended because of its second-ranking spectra in both of JOA improvement and ROM reduction, also with an acceptable incidence of complications, with the third least.