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El-Ghandour NMF. Commentary: Thoracic Laminoplasty for Post-Traumatic Syrinx Fenestration with Duraplasty, Syringo-Subarachnoid, and Subarachnoid-Subarachnoid Shunts: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:475-476. [PMID: 38032209 DOI: 10.1227/ons.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
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2
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Martins Coelho VDP, O'Toole JE. Thoracic Laminoplasty for Posttraumatic Syrinx Fenestration With Duraplasty, Syringo-Subarachnoid and Subarachnoid-Subarachnoid Shunts: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:474. [PMID: 37976450 DOI: 10.1227/ons.0000000000000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/22/2023] [Indexed: 11/19/2023] Open
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3
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Bouyagoub S. A glimpse into the future: perfusion and diffusion MRI techniques for the assessment of cervical spondylotic myelopathy. Eur Radiol 2024; 34:1346-1348. [PMID: 37973634 DOI: 10.1007/s00330-023-10451-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Samira Bouyagoub
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9RR, UK.
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4
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Lu J, Guan F, Zhang Z, Gao Q, Li Q, Yu Z, Gu J. Comparison between gravity drainage group and suction drainage group after cervical laminoplasty: a retrospective STROBE-compliant cohort study. Br J Neurosurg 2024; 38:68-71. [PMID: 34608847 DOI: 10.1080/02688697.2021.1900538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES A retrospective study was conducted to compare gravity drainage and suction drainage after cervical laminoplasty. PATIENTS AND METHODS A total of 375 patients who underwent laminoplasty between January 2011 and December 2015 were engaged in this analysis. We investigated the patients' basic characteristics, drainage characteristics and postoperative complications. RESULTS During the initial 24 h after laminoplasty, the drainage volume in the suction drainage group was 177.31 ± 92.02 mL, and the drainage volume in the gravity drainage group was 133.33 ± 92.40 mL. The drainage volume showed significant difference (p < 0.01). The total drainage volume was 357.49 ± 195.16 mL and 250.16 ± 27.44 mL in the suction drainage group and gravity drainage group, respectively. The total drainage volume between the two groups was statistically different (p = 0.03). The postoperative Hb was significantly different between the gravity group and suction group on the first day after the operation (108.37 ± 23.92 mL vs. 87.32 ± 21.53 mL, p = 0.02). The number of patients required blood transfusion was significantly different between the two groups as well (p = 0.04). Two cases had symptomatic epidural hematomas (SEH) after laminoplaty. However, the occurrence of SEH among the two groups was not different significantly. Twelve patients had surgical site infection (SSI). Of these 12, nine had applied gravity drainage and three suction drainage. The rate of SSI was similar between the two groups (p = 0.71). CONCLUSION The initial 24 h' drainage volume and the total drainage volume increased significantly in the suction drainage group. The postoperative Hb was lower in the suction group than the gravity drainage group the first postoperative day. More patients needed blood transfusion if suction drainage was performed. The application of suction drainage cannot decrease the incidence of SSI and SEH after laminoplasty. Gravity drainage is recommended for laminoplasty.
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Affiliation(s)
- Juncheng Lu
- Hospital of Harbin Medical University, Harbin, China
| | - Fulin Guan
- Hospital of Harbin Medical University, Harbin, China
| | | | - Qichang Gao
- Hospital of Harbin Medical University, Harbin, China
| | - Qingsong Li
- Hospital of Harbin Medical University, Harbin, China
| | - Zhange Yu
- Hospital of Harbin Medical University, Harbin, China
| | - Jiaao Gu
- Hospital of Harbin Medical University, Harbin, China
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Knafo S, Aghakhani N, Parker F. Laminoplasty with tented duraplasty for Hirayama disease. Acta Neurochir (Wien) 2024; 166:5. [PMID: 38214785 DOI: 10.1007/s00701-024-05893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Hirayama disease (HD) is a characterized by progressive amyotrophy of the upper limbs due to a forward displacement of the cervical dura during neck flexion. METHODS Unlike other treatment options aiming at preventing cervical flexion (e.g., collar or arthrodesis), laminoplasty with tented duraplasty addresses dural dysplasia. Technically, the procedure consists in enlarging the dural sac by performing an expansile duraplasty that is secured to the yellow ligaments, in association with an open-book laminoplasty. CONCLUSION Laminoplasty with tented duraplasty is a surgical option addressing the cause of HD to prevent further neurological deterioration while preserving cervical motion.
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Affiliation(s)
- Steven Knafo
- Department of Neurosurgery, Bicêtre Hospital, AP-HP, Le Kremlin-Bicetre, France.
- Faculty of Medicine, University Paris-Saclay, Le Kremlin-Bicetre, France.
| | - Nozar Aghakhani
- Department of Neurosurgery, Bicêtre Hospital, AP-HP, Le Kremlin-Bicetre, France
- Faculty of Medicine, University Paris-Saclay, Le Kremlin-Bicetre, France
| | - Fabrice Parker
- Department of Neurosurgery, Bicêtre Hospital, AP-HP, Le Kremlin-Bicetre, France
- Faculty of Medicine, University Paris-Saclay, Le Kremlin-Bicetre, France
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6
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Jagtiani P, Karabacak M, Jenkins AL, Margetis K. Cervical laminoplasty versus laminectomy and fusion: An umbrella review of postoperative outcomes. Neurosurg Rev 2023; 47:5. [PMID: 38062318 DOI: 10.1007/s10143-023-02239-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/20/2023] [Accepted: 12/03/2023] [Indexed: 12/18/2023]
Abstract
While multiple studies exist comparing cervical laminoplasty (CLP) and posterior cervical laminectomy with fusion (PCF), no clear consensus exists on which intervention is better. An umbrella review helps provide an overall assessment by analyzing a given condition's multiple interventions and outcomes. It integrates all available information on a topic and allows a consensus to be reached on the intervention of choice. A literature search was conducted using specific search criteria in PubMed, Scopus, and Web of Science databases. Titles and abstracts were screened based on inclusion criteria. A full-text review of articles that passed the initial inclusion criteria was performed. Nine meta-analyses were deemed eligible for the umbrella review. Data was extracted on reported variables from these meta-analyses. Subsequent quality assessment using AMSTAR2 and data analysis using the R package metaumbrella were used to determine the significance of postoperative outcomes. When the meta-analyses were pooled, statistically significant differences between CLP and PCF were found for postoperative overall complications rate and postoperative JOA score. PCF was associated with a lower overall complication rate and a higher postoperative JOA score, both supported by a weak level of evidence (class IV). Data regarding all other outcomes were non-significant. Our umbrella review investigates CLP and PCF by providing a comprehensive overview of existing evidence and evaluating inconsistencies within the literature. This umbrella review revealed that PCF had better outcomes for overall complications rate and postoperative JOA than CLP, but they were classified as being of weak significance.
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Affiliation(s)
- Pemla Jagtiani
- School of Medicine, SUNY Downstate Health Sciences University, New York, NY, 11203, USA
| | - Mert Karabacak
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, 10029, USA
| | - Arthur L Jenkins
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, 10029, USA
- Jenkins NeuroSpine, New York, NY, 10029, USA
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7
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Hayashi H, Hashikata H, Sawada M, Toda H. Low back pain improvement after cervical laminoplasty in patients without tandem lumbar stenosis. Eur Spine J 2023; 32:4437-4443. [PMID: 37736774 DOI: 10.1007/s00586-023-07951-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/09/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE This study aimed to demonstrate the impact of lumbar spinal stenosis (LSS) on LBP after cervical laminoplasty for cervical spinal stenosis by analyzing the clinical characteristics and surgical outcomes. METHODS This retrospective cohort study analyzed 56 consecutive patients with cervical spinal stenosis who underwent cervical laminoplasty. Data on age, sex, Japanese Orthopaedic Association (JOA) scores, JOA Back Pain Evaluation Questionnaire (BPEQ), and visual analog scale (VAS) were collected. The patients with VAS for LBP ≥ 30 or more were included and divided into two groups: without LSS [LSS (-)]or with LSS [LSS (+)]. Preoperative clinical characteristics and postoperative changes were compared between the groups. RESULTS Preoperative VAS for LBP were 50.7 ± 16.2 mm and 59.8 ± 19.5 mm in the LSS (+) and LSS (-), respectively (p = 0.09). Patients in the LSS (-) were younger (57.6 ± 11.2 vs. 70.7 ± 8.6, p < 0.001) and showed significantly milder preoperative lumbar symptoms in terms of JOA and BPEQ. Patients in the LSS (-) group showed more postoperative changes in low back pain (18.3 ± 26.4 vs. - 8.3 ± 37.6, p = 0.005) and lumbar function (10.8 ± 25.7 vs. - 2.0 ± 22.5, p = 0.04) at BPEQ, and higher recovery in terms of VAS of LBP (23.0 ± 23.8 mm vs. 5.3 ± 25.9 mm, p = 0.008) and buttocks and low limbs (12.5 ± 35.0 mm vs. - 4.3 ± 24.4 mm, p = 0.029). Nine patients in the LSS (+) group underwent lumbar surgery at 12.8 ± 8.5 months after cervical laminoplasty. CONCLUSION LBP improved after cervical laminoplasty in patients without lumbar stenosis.
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Affiliation(s)
- Hideki Hayashi
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan.
| | - Hirokuni Hashikata
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Masahiro Sawada
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Hiroki Toda
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
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8
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Wang Z, Li W, Wang H, Kuang X, Liu X. The "Hand as Foot" teaching method in double-door cervical laminoplasty. Asian J Surg 2023; 46:5968-5969. [PMID: 37704474 DOI: 10.1016/j.asjsur.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Zhe Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - WenKe Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - HaoHui Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - XiYan Kuang
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - XiaoQi Liu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, China.
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9
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Kim TS, Yuh WT, Han J, Kim J, Lee CH, Kim CH, Chung CK. Is laminectomy necessary for C1-C2 epidural schwannomas? Acta Neurochir (Wien) 2023; 165:3065-3076. [PMID: 37400543 DOI: 10.1007/s00701-023-05707-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/24/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE Spinal schwannomas often require laminectomy for gross total resection. However, laminectomy may not be necessary due to the unique anatomy of epidural schwannomas at the C1-2 level, even with the intradural part. This study aimed to determine the need for laminectomy by comparing factors between patients who underwent laminectomy and those who did not and to identify the benefits of not performing laminectomy. METHODS Fifty patients with spinal epidural schwannoma confined to C1-C2 level were retrospectively collected and divided into groups based on whether laminectomy was intended and performed. In all cases where laminectomy was conducted, patients underwent laminoplasty using microplate-and-screws, which deviates from the conventional laminectomy approach. Tumor characteristics were compared, and a cut-off value for laminectomy was determined. Outcomes were compared between groups, and factors influencing laminectomy were identified. Postoperative changes in cervical curves were measured. RESULTS The diameter of the intradural part of the tumor was significantly longer in the laminectomy performed group, with a 14.86 mm cut-off diameter requiring laminectomy. Recurrence rates did not differ significantly between groups. Surgery time was substantially longer for the laminectomy performed group. No significant changes were observed in Cobb's angles of Oc-C2, C1-C2, and Oc-C1 before and after surgery. CONCLUSION The study showed that the diameter of the intradural part of the tumor influenced the decision to perform laminectomy for removing epidural schwannomas at C1-C2. The cut-off value of the diameter of the intradural part of the tumor for the laminectomy was 14.86 mm. Not performing laminectomy can be a viable option with no significant differences in removal and complication rates.
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Affiliation(s)
- Tae-Shin Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-Si, Republic of Korea
| | - Junghoon Han
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Junhoe Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Brain and Cognitive Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Nagata K, Miyahara J, Tozawa K, Ito Y, Schmidt G, Chang C, Sasaki K, Yamato Y, Ohtomo N, Nakajima K, Kato S, Doi T, Taniguchi Y, Matsubayashi Y, Sumitani M, Tanaka S, Oshima Y. Adaptation and Limitations of painDETECT Questionnaire Score Approach Before and After Posterior Cervical Decompression Surgery. World Neurosurg 2023; 176:e391-e399. [PMID: 37236307 DOI: 10.1016/j.wneu.2023.05.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The painDETECT questionnaire (PDQ) is one of the available screening tools for neuropathic pain (NeP), with a cut-off score of 13. This study aimed to investigate changes in PDQ scores in patients undergoing posterior cervical decompression surgery for degenerative cervical myelopathy (DCM). METHODS Patients with DCM undergoing cervical laminoplasty or laminectomy with posterior fusion were recruited. They were asked to complete a booklet questionnaire including PDQ and Numerical Rating Scales (NRS) for pain at baseline and one year after surgery. Patients with a preoperative PDQ score ≥13 were further investigated. RESULTS A total of 131 patients (mean age = 70.1 years; 77 male and 54 female) were analyzed. After posterior cervical decompression surgery for DCM, mean PDQ scores decreased from 8.93 to 7.28 (P = 0.008) in all patients. Of the 35 patients (27%) with preoperative PDQ scores ≥13, mean PDQ changed from 18.83 to 12.09 (P < 0.001). Comparing the NeP improved group (17 patients with postoperative PDQ scores ≤12) with the NeP residual group (18 patients with postoperative PDQ scores ≥13), the NeP improved group showed less preoperative neck pain (2.8 vs. 4.4, P = 0.043) compared to the NeP residual group. There was no difference in the postoperative satisfaction rate between the two groups. CONCLUSIONS Approximately 30% of patients exhibited preoperative PDQ scores ≥13, and about half of these patients demonstrated improvements to below to the cut-off value for NeP after posterior cervical decompression surgery. The PDQ score change was relatively associated with preoperative neck pain.
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Affiliation(s)
- Kosei Nagata
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan
| | - Junya Miyahara
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan
| | - Keiichiro Tozawa
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan
| | - Yusuke Ito
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan
| | - Grant Schmidt
- Norton Leatherman Spine Center, Louisville, Kentucky, USA
| | - Chang Chang
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan
| | - Katsuyuki Sasaki
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan
| | - Yukimasa Yamato
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan
| | - Koji Nakajima
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan.
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Fujishiro T, Obo T, Mizutani M, Nakaya Y, Hayama S, Usami Y, Neo M. Letter to the Editor Regarding "Indication of C2-C7 Cervical Laminoplasty with Muscle and Ligament Preservation in Patients with Kyphosis". World Neurosurg 2023; 176:258-259. [PMID: 37550933 DOI: 10.1016/j.wneu.2023.03.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Takashi Fujishiro
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan; Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan.
| | - Takuya Obo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masahiro Mizutani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yoshiharu Nakaya
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Sachio Hayama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yoshitada Usami
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Iseda K, Takahashi K, Nakajima M. In Reply to the Letter to the Editor Regarding "Indication of C2-C7 Cervical Laminoplasty with Muscle and Ligament Preservation in Patients with Kyphosis". World Neurosurg 2023; 176:260. [PMID: 37550934 DOI: 10.1016/j.wneu.2023.05.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Keiichi Iseda
- Department of Neurosurgery, Okayama Saiseikai General Hospital, Okayama, Japan.
| | - Kenji Takahashi
- Department of Neurosurgery, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Masaaki Nakajima
- Department of Neurosurgery, Okayama Saiseikai General Hospital, Okayama, Japan
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13
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Zhong H, Guan HS, Liu HF. [Progress on the impact of adjacent vertebral arch after single open door laminoplasty]. Zhongguo Gu Shang 2023; 36:691-6. [PMID: 37475637 DOI: 10.12200/j.issn.1003-0034.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Single-door laminoplasty has been widely used in the treatment of multisegment cervical myelopathy, with the clinical advantages of decompression of the spinal cord, relieving preoperative neurological symptoms or signs, and maintaining cervical mobility. However, in clinical work, patients with limited cervical spine activity after single open door laminoplasty are often encountered, and the direct contact with the adjacent vertebral arch can be observed in the postoperative X-ray of the anterior and lateral cervical spine, which is called the adjacent vertebral arch bone impact, which is one of the important causes of the limited cervical spine movement. In recent years, there have been many reports on the prevention of bone impact, although the short-term clinical effect is significant, but long-term clinical efficacy to be further study, and the cause and the pathogenesis of bone impact is no consensus, this paper on the surgery of adjacent vertebral arch impact epidemiology, biomechanics, clinical performance, surgical effect and improvement.
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Affiliation(s)
- Hua Zhong
- Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China
| | - Hai-Shan Guan
- Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China
| | - Hai-Feng Liu
- Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China
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14
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Liu J, Wang J, Ding Z, Hai Y, Zhang Y, Kang N, Wang Q. Effect of K‑line on posterior cervical surgery versus anterior cervical surgery in patients with multi-level ossification of posterior longitudinal ligament. Eur Spine J 2023; 32:2396-2401. [PMID: 37150768 DOI: 10.1007/s00586-023-07736-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/03/2022] [Accepted: 04/20/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To evaluate the influence of K-line on the outcome of open-door laminoplasty versus anterior cervical corpectomy decompression and fusion (ACCF) for patients with more than two levels of ossification of the posterior longitudinal ligament (OPLL). METHODS 60 patients undergoing open-door laminoplasty and 62 patients undergoing ACCF from January 2013 to January 2020 with more than 2 years of follow-up were included. Eighty-four cases with the ossification mass not beyond the K-line were grouped as K-line (+), while thirty-eight cases were grouped as K-line (-). The operation time, intraoperative blood loss, hospital stay, preoperative, postoperative, and last follow-up JOA scores, and postoperative complications were investigated. RESULTS The improvement rate of JOA scores after posterior approaches in cases of group K-line (+) and K-line (-) was 72.4% and 53.1%, respectively, which showed a significant difference (P < 0.01). In group K-line (+), the improvement of JOA scores for open-door laminoplasty was 73.4% and 71.8% for ACCF, which showed no significant difference (P > 0.05). In group K-line (-), the improvement of JOA scores for ACCF was 52.1% and 42.9% for open-door laminoplasty, which showed a significant difference (P < 0.05). The incidence of C5 palsy was significantly lower in cases with ACCF than in cases with open-door laminoplasty (P < 0.05). CONCLUSION For patients with more than two levels of OPLL, preoperative K-line (+) predicates a better outcome than K-line (-). For cases with K-line (-), ACCF provides better neurologic function recovery. For patients with K-line (+), open-door laminoplasty provides the same neurologic function recovery of ACCF.
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Affiliation(s)
- Jingwei Liu
- Department of Orthopedic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Dongdan DaHuaLu 1#, Dong-Cheng District, Beijing, 100730, China
| | - Jianqiang Wang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Zihao Ding
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China.
| | - Yiqi Zhang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Nan Kang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China.
| | - Qiang Wang
- Department of Orthopedic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Dongdan DaHuaLu 1#, Dong-Cheng District, Beijing, 100730, China.
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Murata S, Takami M, Endo T, Hashizume H, Iwasaki H, Tsutsui S, Nagata K, Murakami K, Taiji R, Kozaki T, Heller JG, Yamada H. Using Electrical Stimulation of the Ulnar Nerve Trunk to Predict Postoperative Improvement in Hand Clumsiness in Patients With Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976) 2023; 48:702-709. [PMID: 36730659 DOI: 10.1097/brs.0000000000004539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/21/2022] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE To investigate whether the immediate and short-term effects of preoperative electrical peripheral nerve stimulation (ePNS) on performance of the 10-second test could predict the early postoperative outcomes of patients with cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA Previous studies have shown that early clinical improvement in CSM patients may be because of reversal of spinal cord ischemia after spinal cord compression. MATERIALS AND METHODS We conducted a 10-second test before surgery, after ePNS, and at discharge (one week after surgery) in 44 patients with CSM who underwent C3-C7 laminoplasty and evaluated their correlations. The effects of the procedures (ePNS or operation) and sides (stimulated or nonstimulated side) for the 10-second test were analyzed using repeated measures analysis of variance. The Pearson correlation coefficient was used to measure the relationship between the 10-second test values according to the method (after ePNS vs. surgery). In addition, the Bland-Altman method was used to evaluate the degree of agreement between the 10-second test obtained after ePNS versus shortly after surgery. RESULTS The preoperative 10-second test showed the most improvement immediately after the administration of ePNS, with a gradual decrease for the first 30 minutes after completion. After the initial 30 minutes, performance decreased rapidly, and by 60 minutes performance essentially returned to baseline. The 10-second post-ePNS had a strong positive correlation with the 10-second test in the early postoperative period (at discharge=one week after surgery). These phenomena were observed with the left hand, the side stimulated with ePNS, as well as the right hand, the side not stimulated. CONCLUSIONS Early postoperative outcomes after CSM surgery may be predicted by the results of preoperative ePNS. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Shizumasa Murata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Toru Endo
- Department of Orthopaedic Surgery, Endo Clinic, Otsu, Shiga, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Kimihide Murakami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takuhei Kozaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - John G Heller
- Department of Orthopaedic Surgery, The Emory Spine Center, Emory Muskuloskeletal Institute, Atlanta, GA
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
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Cappelletto B, Rispoli R, Robiony M, Tel A. Computerized Three-Dimensional Analysis: A Novel Method to Assess the Effect of Open-Door Laminoplasty. Acta Neurochir Suppl 2023; 135:301-306. [PMID: 38153485 DOI: 10.1007/978-3-031-36084-8_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
INTRODUCTION The three-dimensional elaboration of morphological data derived from computed tomography (CT) and magnetic resonance imaging (MRI) scans generates virtual anatomical reconstructions. Here, we propose a novel protocol to analyze the postoperative results of open-door laminoplasty to evaluate differences in the volume of the spinal canal. The protocol uses geometric models in patients with cervical degenerative myelopathy before versus after cervical laminoplasty. MATERIALS AND METHODS Mimics and 3-Matic software (Materialise, Leuven, BE) programs were used to segment anatomical structures and create polygon meshes of spines. Patients with cervical spondylotic myelopathy were enrolled. The models obtained before and after laminoplasty were superimposed by using a global registration function. The magnitude of divergence was quantified by using the root-mean-square error (RMSE). RESULTS Using this novel protocol, we were able to map the differences in the volume of the spinal canal before laminoplasty and after laminoplasty and to quantify its magnitude and calculate the volumes. DISCUSSION AND CONCLUSIONS The development of a procedure to measure the space within the cervical bone walls using geometric parameters represents a new, powerful method to verify the results obtained by cervical laminoplasty. Further research horizons may include the routine use of virtual models in surgical planning for this procedure.
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Affiliation(s)
- Barbara Cappelletto
- Spine and Spinal Cord Surgery Unit, Neurosciences Department, ASU FC, Academic Hospital of Udine, Udine, Italy.
| | - Rossella Rispoli
- Spine and Spinal Cord Surgery Unit, Neurosciences Department, ASU FC, Academic Hospital of Udine, Udine, Italy
| | - Massimo Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
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Miyazaki M, Ishihara T, Kanezaki S, Hirakawa M, Iwasaki T, Abe T, Tsumura H. Relationship between K-line distance and surgical outcome in cases of laminoplasty for cervical ossification of the posterior longitudinal ligament. Medicine (Baltimore) 2022; 101:e31605. [PMID: 36451404 PMCID: PMC9704886 DOI: 10.1097/md.0000000000031605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Although previous studies indicate that changes in cervical alignment after laminoplasty and dynamic factors influence surgical outcomes of cervical ossification of the posterior longitudinal ligament (OPLL), the relationship between the surgical outcomes, the distance between the kyphosis-line (K-line) and OPLL, and dynamic factors have not yet been quantitatively evaluated. The purpose of the present study was to analyze the relationship between ΔK-line distance and surgical outcomes in cases of laminoplasty for OPLL of the cervical spine. We retrospectively reviewed 46 consecutive patients (33 men and 13 women) with cervical OPLL who underwent laminoplasty. "K-line distance" was measured as the minimum interval between the K-line and OPLL on lateral radiographs. The following factors were analyzed: K-line distance in neutral, flexion, and extension neck positions, ΔK-line distance, preoperative C2-7 range of motion (ROM), preoperative segmental ROM, preoperative C2-7 lordotic angle, occupying ratio of the OPLL, disease duration, preoperative and postoperative Japanese Orthopaedic Association (JOA) score, and recovery rate. Patients were divided into flexion K-line (+) and flexion K-line (-) groups. We then analyzed the influence of the K-line distance on surgical outcomes and conducted multivariate analysis to analyze the factors affecting surgical outcomes. The JOA score recovery rate in the flexion K-line (-) group was significantly lower than that in the flexion K-line (+) group (P = .024). The ΔK-line distance was significantly negatively correlated with the JOA score recovery rate (r = -0.531, P < .001). Additionally, multivariate analysis showed that ΔK-line distance (OR = -2.143, P = .015) was negatively correlated with the JOA score recovery rate. The ΔK-line distance is considered useful for the quantitative evaluation of dynamic factors and static compression factors due to OPLL through the measurement of dynamic radiographic images.
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Affiliation(s)
- Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
- * Correspondence: Masashi Miyazaki, Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (e-mail: )
| | - Toshinobu Ishihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Masashi Hirakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Tatsuya Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Janich KW, Wang MC. Editorial. Cervical laminoplasty for degenerative cervical myelopathy: still much more to learn. J Neurosurg Spine 2022; 38:1-3. [PMID: 36057127 DOI: 10.3171/2022.5.spine22374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Wang H, He B, Wang Y, Chen H, Huang S, Xu J. Lymphoplasmacyte-rich meningioma in the central nervous system: An unusual case report. Medicine (Baltimore) 2021; 100:e27991. [PMID: 34967348 PMCID: PMC8718218 DOI: 10.1097/md.0000000000027991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Lymphoplasmacyte-rich meningioma (LPRM) is a rare meningioma characterized by significant infiltration of plasma cells and lymphocytes, and changes in the ratio of meningeal epithelial components. According to the World Health Organization, tumors of the central nervous system are classified as grade I tumors. PATIENT CONCERNS A 44-year-old man presented to our department with complaints of limb weakness accompanied by hand numbness. Half a month before admission, the patient's limb weakness worsened and he could not walk and raise his hands, with limb sensory disturbance and incontinence. DIAGNOSIS Magnetic resonance imaging of the head and cervical spinal cord showed a diffuse extramedullary mass creeping on the tentorium and skull base meninges along the clivus down to the sixth cervical spinal meninges. The cervical spinal cord was enveloped and pressed (Fig. 1A-C). Postoperative histopathological examination showed meningothelial areas admixed with lymphocytes and plasma cells (Fig. 2D-H), indicating that the mass was a LPRM. INTERVENTION Suboccipital craniotomy, C1 laminectomy, and C2-C6 laminoplasty were performed for this patient, and postsurgical pathology showed that the tumor was a LPRM with large amounts of lymphocytes and plasma cells. OUTCOME After 2 weeks of active treatment, the patient died of worsening pneumonia. LESSONS LPRM is a rare variant of meningioma, and it is more unusual that the lesions involve the intracranial dura mater and the entire cervical spinal meninges. So far, surgical resection has been the main treatment for LPRM, but according to its own characteristics of lymphoplasmacyte-rich, immunotherapy may become a new treatment option.
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Affiliation(s)
- Han Wang
- Department of Neurosurgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, PR China
- Department of Neurosurgery, the second People's Hospital of Yibin, Yibin, Sichuan Province, China
| | - Bin He
- Department of Obstetrics, West China Second Hospital, Sichuan University, Chengdu, PR China
| | - Yuelong Wang
- Department of Neurosurgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, PR China
| | - Haifeng Chen
- Department of Neurosurgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, PR China
| | - Siqing Huang
- Department of Neurosurgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, PR China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, PR China
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20
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Minamide A, Yoshida M, Nakagawa Y, Okada M, Takami M, Iwasaki H, Tsutsui S, Kozaki T, Murata S, Taiji R, Murakami K, Hashizume H, Yukawa Y, Taneichi H, Yamada H, Schoenfeld AJ, Simpson AK. Long-term Clinical Outcomes of Microendoscopic Laminotomy for Cervical Spondylotic Myelopathy: A 5-Year Follow-up Study Compared With Conventional Laminoplasty. Clin Spine Surg 2021; 34:383-390. [PMID: 34121073 DOI: 10.1097/bsd.0000000000001200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to characterize the long-term clinical and radiographic results of articular segmental decompression surgery using endoscopy [cervical microendoscopic laminotomy (CMEL)] for cervical spondylotic myelopathy (CSM) and to compare outcomes to conventional expansive laminoplasty (ELAP). SUMMARY OF BACKGROUND DATA The spinal cord compression in CSM consists of a pincer mechanism due to bulging disk and a hypertrophied ligamentum flavum. The long-term clinical benefits of segmental decompression surgery, which removes the dorsal compressive elements of articular segment in CSM patients, have not yet been elucidated. MATERIALS AND METHODS Consecutive patients with CSM who required surgical treatment were enrolled. All enrolled patients (n=81) underwent CMEL or ELAP. All patients were followed postoperatively for >5 years. The preoperative and 5-year follow-up evaluation included neurological assessment [Japanese Orthopaedic Association (JOA) score], JOA recovery rates, axial neck pain (visual analog scale), and cervical sagittal alignment (C2-C7 subaxial cervical angle). RESULTS Sixty-four patients (CMEL group: 33, ELAP group: 31) were included for analysis. The preoperative JOA score was 10.1 points in the CMEL group and 11.1 points in the ELAP group (P=0.15). The JOA recovery rates were similar, 58.6% in the CMEL group and 55.2% in the ELAP group (P=0.55). The axial neck pain in the CMEL group was significantly lower than that in the ELAP group (P<0.01). At 5-year follow-up, cervical alignment was more favorable in the CMEL group, with an average 2.9 degrees gain in lordosis [vs. 2.3 degrees loss of lordosis in the ELAP group (P<0.05)] and lower incidence of postoperative kyphosis. CONCLUSIONS CMEL is a novel, less invasive, technique that allows for multilevel posterior cervical decompression for treatment of CSM. Our 5-year follow-up data demonstrates that patients after CMEL have similar neurological outcomes to conventional laminoplasty, with significantly less postoperative axial pain and improved subaxial cervical lordosis when compared with their traditional laminoplasty counterparts.
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Affiliation(s)
- Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
- Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Yukihiro Nakagawa
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Motohiro Okada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Takuhei Kozaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Shizumasa Murata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Kimihide Murakami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Yasutsugu Yukawa
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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21
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Ohtonari T. [What are the Criteria for Deciding Posterior Cervical Decompression with/without Fusion?]. No Shinkei Geka 2021; 49:1224-1232. [PMID: 34879342 DOI: 10.11477/mf.1436204509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We herein report on the knowledge regarding posterior cervical decompression with or without posterior fusion mainly performed in patients with cervical spondylotic myelopathy in the past decade(2011-2020). In cases of preoperative cervical kyphosis >15° in the C2-7 Cobb angle, with a horizontal displacement >3 mm, and severe local kyphosis at an intervertebral space in dynamic lateral radiography, posterior fusion should be considered over laminoplasty. However, a short fusion may be sufficient in cases with apparent single local instability. Moreover, in cases with normal or mild kyphotic alignment compared to severe global cervical kyphosis, further development of laminoplasty or laminectomy aimed at the preservation and reconstruction of the posterior cervical structure is expected to maintain the alignment and avoid the unnecessary use of a spacer or mini-plate for the re-closure of the opened lamina in laminoplasty. A properly planned surgical strategy is mandatory in posterior cervical decompression. The choice of surgical procedure should not be based on a compelling motivation regarding familiarity with a surgical method or usage of implants but rather on the pathophysiology of myelopathy, age and sex of the patient, and the presence of osteoporosis, instability, or alignment.
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Affiliation(s)
- Tatsuya Ohtonari
- Department of Spinal Surgery, Brain Attack Center, Ota Memorial Hospital
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22
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Park BJ, Seaman SC, Woodroffe RW, Noeller J, Hitchon PW. Surgical Options in Treating Ossification of the Posterior Longitudinal Ligament: Single-Center Experience. World Neurosurg 2021; 148:e617-e626. [PMID: 33482410 DOI: 10.1016/j.wneu.2021.01.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Ossified posterior longitudinal ligament (OPLL) of the cervical spine can lead to spinal stenosis and become clinically symptomatic. The optimal approach in addressing OPLL is a debated topic and dependent on factors such as preoperative lordosis and levels affected. METHODS In this study, we retrospectively identified patients undergoing operative management for OPLL. Demographics, operative details, radiographic parameters, outcome measurements, and complications were compared between the different approaches for OPLL treatment. RESULTS We identified a total of 44 patients with 16 undergoing laminoplasty (Plasty), 18 anterior corpectomy and diskectomy (Ant), and 10 laminectomy and instrumentation (Linst). Ant had least OPLL levels with median (range) 3 (2-5), compared with Plasty 4 (2-7) and Linst 4 (3-6). Plasty was associated with the shortest operative time and hospital stay. Ant showed significant correction in kyphosis from 0.5° (-13 to 16°) to 9.5° (-7 to 20°). There was loss in lordosis in Plasty and Linst. Sagittal balance significantly increased irrespective of surgical approach with the least increase in the Ant group. Complications were least in the Plasty group with similar overall improvement in outcome measurements. CONCLUSIONS All 3 approaches in the management of OPLL were associated with clinical improvement without 1 approach surpassing the others. Laminoplasty had the advantage of addressing more levels of stenosis than the anterior approach and was associated with a shorter operating time. Laminoplasty patients had a shorter hospital stay than those undergoing laminectomy and instrumentation and appeared to have fewer complications than the other approaches. Laminoplasty is the preferred approach in patients with preserved motion and lordosis, with the anterior approach effective in the correction of kyphosis.
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Affiliation(s)
- Brian J Park
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Scott C Seaman
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Royce W Woodroffe
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jennifer Noeller
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Patrick W Hitchon
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
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Zhai JL, Guo SG, Nie L, Hu JH. Comparison of the anterior and posterior approach in treating four-level cervical spondylotic myelopathy. Chin Med J (Engl) 2020; 133:2816-2821. [PMID: 33273330 PMCID: PMC10631575 DOI: 10.1097/cm9.0000000000001146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy. METHODS A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study. Perioperative information, intraoperative blood loss, clinical and radiological outcomes, and complications were recorded. Japanese Orthopedic Association (JOA) score, 36-item short form survey (SF-36) score and cervical alignment were assessed. RESULTS There were no significant differences in JOA scores between the anterior and posterior group preoperatively (11.6 ± 1.6 vs. 12.1 ± 1.5), immediately postoperatively (14.4 ± 1.1 vs. 13.8 ± 1.3), or at the last follow-up (14.6 ± 1.0 vs. 14.2 ± 1.1) (P > 0.05). The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values. The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up. The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value (69.4 vs. 61.7). Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively (-2.0° ± 7.3° vs. -1.4° ± 7.5°). The Cobb angle significantly improved immediately postoperatively (12.3° ± 4.2° vs. 9.2° ± 3.6°) and at the last follow-up (12.4° ± 3.5° vs. 9.0° ± 2.6°) in both groups compared with their preoperative values (P = 0.00). Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group. CONCLUSIONS Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features. However, the JOA score recovery rate and SF-36 score in the anterior group were significantly higher. Persistent axial pain could be a major concern when undertaking the posterior approach.
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Affiliation(s)
- Ji-Liang Zhai
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Shi-Gong Guo
- Department of Rehabilitation Medicine, University Hospital of Wales Cardiff, UK
| | - Li Nie
- Department of Research and Education, Beijing Centers of Disease Prevention and Control, Beijing 102206, China
| | - Jian-Hua Hu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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Yoshii T, Egawa S, Chikuda H, Wakao N, Furuya T, Kanchiku T, Nagoshi N, Fujiwara Y, Yoshida M, Taguchi T, Watanabe M. Comparison of anterior decompression with fusion and posterior decompression with fusion for cervical spondylotic myelopathy-A systematic review and meta-analysis. J Orthop Sci 2020; 25:938-945. [PMID: 32008876 DOI: 10.1016/j.jos.2019.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/21/2019] [Accepted: 12/03/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The optimal surgical procedure for the treatment of cervical spondylotic myelopathy (CSM) remains controversial. Recently, laminectomy/laminoplasty with instrumented fusion (LAMF) has been increasingly applied to treat CSM. However, few comprehensive studies have compared anterior decompression with fusion (ADF) and LAMF. Therefore, we conducted a meta-analysis to evaluate the evidence in the literature and to compare the surgical outcomes between the 2 procedures. Since the surgical outcomes and risks differ between patients with CSM and ossification of the posterior longitudinal ligament (OPLL) and between only posterior decompression and decompression with fusion treatments, we excluded patients with OPLL and patients with only posterior decompression in this review. METHODS An extensive literature search was performed using PubMed, Embase, and the Cochrane Library to identify comparative studies of ADF and LAMF for the treatment of CSM. The language was restricted to English, and the publication period was from January 2001 to July 2019. We only included studies about CSM and excluded studies that involved patients with ossification of the posterior longitudinal ligament and with the treatment of posterior decompression without fusion. We extracted outcomes from the studies, such as preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, neck disability index (NDI) scores, cervical alignment data, and surgical complications. Then, a meta-analysis was performed on these surgical outcomes. RESULTS Eleven studies were obtained, and the quality of the studies was acceptable. In the meta-analysis, the pre- and postoperative JOA scores were similar between the ADF and LAMF groups. The ADF group exhibited more favorable results than the LAMF group in terms of postoperative cervical alignment and the NDI. Overall complications were similar between the ADF and LAMF groups; however, C5 palsy was more frequently observed in the LAMF group than in the ADF group. CONCLUSIONS While the ADF and LAMF groups demonstrated similar results in terms of neurological recovery, postoperative cervical lordosis and NDI scores were more favorable with ADF than with LAMF. The overall complication rate was similar between the ADF and LAMF groups. Surgeons should understand the merits and shortcomings of both procedures when deciding on a surgical procedure.
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Affiliation(s)
- Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, 113-8511, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan.
| | - Satroru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, 113-8511, Japan
| | - Hirotaka Chikuda
- Department of Orthopedic Surgery, Gunma University School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8513, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Norimitsu Wakao
- Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Moriokacho 7-430, Obu, Aichi, 474-8511, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Tsukasa Kanchiku
- Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, 1315-4, Oaza-Onoda, Onoda, Yamaguchi, 756-0095, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Yasushi Fujiwara
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, Hiroshima, 731-0293, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Masahiro Yoshida
- Department of Surgery, International University of Health and Welfare Ichikawa Hospital, Konodai 6-1-14, Ichikawashi, Chiba, 272-0827, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Toshihiko Taguchi
- Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, 1315-4, Oaza-Onoda, Onoda, Yamaguchi, 756-0095, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
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Eichberg DG, Komotar RJ, Urakov TM. Commentary: Posterior C2-6 Laminoplasty for Resection of Arteriovenous Malformation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 18:E140-E141. [PMID: 32047933 DOI: 10.1093/ons/opaa006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/15/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Daniel G Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Timur M Urakov
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Qin R, Sun W, Qian B, Hao J, Zhou P, Xu C, Chen C, Yang K, Zhang F, Chen X. Anterior Cervical Corpectomy and Fusion Versus Posterior Laminoplasty for Cervical Oppressive Myelopathy Secondary to Ossification of the Posterior Longitudinal Ligament: A Meta-analysis. Orthopedics 2019; 42:e309-e316. [PMID: 30964542 DOI: 10.3928/01477447-20190403-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 07/05/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to compare the clinical effect of anterior cervical corpectomy with fusion vs laminoplasty for cervical ossification of the posterior longitudinal ligament. The outcome measures included the Japanese Orthopaedic Association score, neurological recovery rate, and complication rate. Subgroup A represented studies with the mean preoperative canal occupying ratio being less than 50%, whereas subgroup B represented studies with the mean canal occupying ratio being 50% or greater. In subgroup A, no difference was found between the 2 groups in the postoperative Japanese Orthopaedic Association score and neurological recovery rate. In subgroup B, the anterior cervical corpectomy with fusion group had a higher postoperative Japanese Orthopaedic Association score and neurological recovery rate. The authors recommend anterior cervical corpectomy with fusion for cervical ossification of the posterior longitudinal ligament when the canal occupying ratio is 50% or greater, and they prefer laminoplasty when the canal occupying ratio is less than 50%. [Orthopedics. 2019; 42(3):e309-e316.].
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Li Y, Jiang L, Liu ZJ, Liu XG, Wei F, Yu M, Tao LY. [Efficacy and safety of applying ultrasonic osteotome in cervical expansive open-door laminoplasty]. Beijing Da Xue Xue Bao Yi Xue Ban 2018; 50:1092-1097. [PMID: 30562788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the safety and efficacy of applying ultrasonic osteotome in patients undergoning cervical expansive open-door laminoplasty (CEOL). METHODS In the study, 94 consecutive patients who were administrated in the spine group of Orthopedic Department of Peking University Third Hospital from March 2015 to March 2016 were reviewed retrospectively. All the patients were diagnosed as multilevel cervical spondylosis myelopathy and underwent CEOL. These patients were divided into two groups: ultrasonic osteotome group and traditional group, by whether the ultrasonic osteotome device was used in operation. The parameters we studied were as follows: the duration of operation, blood loss in operation, volume of drainage on the first postoperative day, days of remaining the drainage tube, preoperative and postoperative Japanese Orthopedic Association (JOA) scores, complications of cerebrospinal fluid leak and hinge bone nonunion. RESULTS Compared with the traditional group, the duration of operation of the ultrasonic osteotome group was increased, but the blood loss in operation, volume of drainage on the 1st postoperative day and days of remaining the drainage tube of the ultrasonic osteotome group were all reduced. There was no obvious difference between the two groups when considering the cerebrospinal fluid leak. At the end of the 3-month follow-up, the JOA score and improvement rate of the JOA score were of no obvious difference between the two groups. But the hinge bone union of the traditional group was better than the ultrasonic osteotome group. At the end of the 12-month follow-up, all the JOA score, the improvement rate of the JOA score and the hinge bone union were not obviously different between the two groups. CONCLUSION Applying ultrasonic osteotome in patients undergoing cervical expansive open-door laminoplasty is both safe and effective. Compared with the rongeur, ultrasonic osteotome can cause the delayed union of the hinge bone, but it reduces the blood loss in operation, volume of postoperative drainage and days of remaining the drainage tube.
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Affiliation(s)
- Y Li
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - L Jiang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Z J Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - X G Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - F Wei
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - M Yu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - L Y Tao
- Research Center of Clinical Epidemicology, Peking University Third Hospital, Beijing 100191, China
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Hoti YUD, Aziz A, Ishaque K, Abbas S, Ud Din TS. Clinical Outcome of Laminoplasty in Cervical Myelopathy. J Coll Physicians Surg Pak 2018; 28:466-469. [PMID: 29848425 DOI: 10.29271/jcpsp.2018.06.466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/26/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of the study was to assess the effectiveness of laminoplasty in terms of improvement in the Japanese Orthopedics Association (JOA) score in cervical spondylotic myelopathy (CSM). STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY Department of Neurosurgery, Lahore General Hospital, Lahore, from June 2014 to October 2016. METHODOLOGY All patients having CSM were assessed preoperatively and postoperatively by JOA score and radiological findings. Preoperative X-rays of cervical spine were done to rule out kyphotic deformity. CT scan and MRI of cervical spine were obtained preoperatively to assess the pathology. Single-door laminoplasty with modified trauma plates were applied in each case by making the hinge over the right side. Digital cervical spine X-rays and CT scans with axial reconstruction were obtained postoperatively in all patients, ensuring spinal canal widening and stability. RESULTS Among the 36 patients, 24 were males and 12 females, age ranging from 35 to 80 years. All the patients did extremely well with marked improvement in the symptomatology. The JOA scored improved in 32 patients, remained static in three patients and one patient had slight deterioration, which later on improved. Three patients developed postoperative kyphotic deformity, which settled in three months. Postoperative radiology showed significant increase in the axial diameter of spine. CONCLUSION Cervical laminoplasty remains an effective method for posterior decompression of spine. The most promising approach to cervical myelopathy ought to take into account both the features of patients and disease, as well as the competency and skills of the surgeon.
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Affiliation(s)
| | - Amir Aziz
- Department of Neurosurgery Unit II, Lahore General Hospital, Lahore
| | - Khurram Ishaque
- Department of Neurosurgery Unit II, Lahore General Hospital, Lahore
| | - Sadia Abbas
- Department of Neurosurgery Unit II, Lahore General Hospital, Lahore
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Abstract
Surgical management of patients with mild degenerative cervical myelopathy (DCM) is controversial. This article reviews 84 subjects with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) who underwent surgical treatment. Nine had mild myelopathy: 6 CSM and 3 OPLL. Seven presented with pain or numbness of upper extremities. MRI revealed intramedullary hyperintensity in 55.6%. Five underwent anterior decompression and fusion, whereas 4 were operated posteriorly. Pain and intramedullary signal change on MRI are important. Management of patients with mild DCM should be determined individually, considering benefits and risks in long-term conservative treatment and surgery.
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Affiliation(s)
- Izumi Koyanagi
- Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, 1-20, Hachiken 9-jo, Higashi 5-chome, Nishi-ku, Sapporo 063-0869, Japan.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Tong MJ, Hu YB, Wang XY, Zhu SP, Tian NF, Fang MQ, Xu HZ, Xiang GH. The Spinal Cord Line Can Predict Postoperative Recovery for Multilevel Cervical Spondylotic Myelopathy. World Neurosurg 2017; 104:361-366. [PMID: 28478247 DOI: 10.1016/j.wneu.2017.03.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/26/2017] [Accepted: 03/27/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report a new index, the spinal cord (SC) line, and a new classification to predict postoperative recovery effect in patients with multilevel cervical spondylotic myelopathy (CSM). METHODS On T2-weighted magnetic resonance imaging (MRI) of the cervical spine, point A is the posteroinferior point of the spinal cord at C2, and point B is the posterosuperior point of the spinal cord at C7. The SC line is defined as a line connecting A and B. The posterior surface of the compressor at the compression level does not exceed the line in SC line type I, touches the line in type II, and exceeds the line in type III. Between January 2010 and January 2015, 121 patients with multilevel CSM who underwent surgery through an anterior approach (anterior cervical corpectomy with fusion or anterior cervical discectomy and fusion) or a posterior approach (laminoplasty or laminectomy) in our hospital were studied retrospectively. The patients were classified into 3 groups according to SC line type (I, II, or III). RESULTS In the anterior surgical approach group, the Japanese Orthopaedic Association (JOA) recovery rate at the last follow-up was 84.88 ± 3.06% for SC line type I, 78.05 ± 2.89% for type II, and 68.69 ± 3.21% for type III. In the posterior surgical approach group, the JOA recovery rate at last follow-up was 69.35 ± 8.73% for type I, 58.05 ± 5.88% for type II, and 47.98 ± 4.31% for type III. The anterior surgery approach was associated with a higher postoperative recovery rate than the posterior surgery approach in type II and type III groups (type II anterior vs. type II posterior: 78.05 ± 2.89% vs. 58.05 ± 5.88%, P = 0.003; type III anterior vs. type III posterior: 68.69 ± 3.21% vs. 47.98 ± 4.31%, P = 0.001). In contrast, the anterior and posterior surgery were associated with similar postoperative recovery rates in the type I group (84.88 ± 3.06% vs. 69.35 ± 8.73%; P = 0.820). CONCLUSIONS The SC line and its classifications can predict postoperative recovery in patients with multilevel CSM.
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Affiliation(s)
- Min-Ji Tong
- Zhejiang Spine Research Center, Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuan-Bo Hu
- Zhejiang Spine Research Center, Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiang-Yang Wang
- Zhejiang Spine Research Center, Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Si-Pin Zhu
- Zhejiang Spine Research Center, Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nai-Feng Tian
- Zhejiang Spine Research Center, Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ming-Qiao Fang
- Zhejiang Spine Research Center, Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hua-Zi Xu
- Zhejiang Spine Research Center, Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Guang-Heng Xiang
- Zhejiang Spine Research Center, Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
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Muheremu A, Sun Y. Atypical symptoms in patients with cervical spondylosis might be the result of stimulation on the dura mater and spinal cord. Med Hypotheses 2016; 91:44-46. [PMID: 27142142 DOI: 10.1016/j.mehy.2016.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/03/2016] [Accepted: 04/06/2016] [Indexed: 11/19/2022]
Abstract
Patients with cervical spondylosis often present with some atypical symptoms such as vertigo, headache, palpitation, nausea, abdominal discomfort, tinnitus and blurred vision and hypomnesia. Although there are a few hypotheses about the etiology of those symptoms, none of them have provided evidence convincing enough to explain the clinical, pathological and anatomic manifestation of those symptoms. One of the more acceptable explanations is that those symptoms are the results of stimulation of the sympathetic nerves in the posterior longitudinal ligament. The clinical fact that dissection of the posterior longitudinal ligament significantly alleviates the severity of those symptoms seems like an evidence for the validity of this hypothesis. However, recent clinical studies showed that laminoplasty, which has no effect on the posterior longitudinal ligament, can achieve the similar effect. In this paper, we hypothesize that stimulation of the dura mater and spinal cord might be the cause of atypical symptoms in patients with cervical spondylosis.
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Affiliation(s)
| | - Yuqing Sun
- Department of Spine Surgery, Beijing Ji Shui Tan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China.
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Zhou H, Sun Y, Wang SB, Zhang FS, Zhang L, Pan SF, Zhou FF. [Reoperation for cervical myelopathy duo to progressing ossification of the posterior longitudinal ligaments in patients with expansive laminoplasty]. Beijing Da Xue Xue Bao Yi Xue Ban 2016; 48:210-214. [PMID: 27080268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To retrospectively analyze the clinical data of the patients with reoperation for cervical myelopathy due to progressing ossification of the posterior longitudinal ligaments, with previous open-door expansive laminoplasty, and to evaluate the outcomes. METHODS From May 2006 to July 2012, a retrospective study was performed on a consecutive series of 17 patients with previous open-door expansive laminoplasty, who had received the reoperation for cervical myelopathy due to progressing ossification of the posterior longitudinal ligaments. The reoperation was performed based on the clinical manifestations and segments of responsibility. The anterior approaches were performed in 12 cases, and the posterior approaches in 5 cases. The correlation between the clinical factors and Japanese Orthopedic Association (JOA) scores or the JOA recovery rate was evaluated by Pearson or Spearman correlation test. The pre- and post-operative JOA scores were analyzed by repeated measures ANOVA and the JOA recovery rates were compared with paired t test. RESULTS The mean follow-up was 137.5 months (range 60-348 months). There were no serious complications after surgical procedures. There was one case that had C5 palsy in the first operation and had recovery after one week. Another case had C5 palsy in the reoperation with posterior approach, which had recovery at the end of 6 months postoperation. Three cases had the cerebrospinal fluid leakage of the reoperation, with two cases in the anterior approaches and one case in the posterior approach. There was no significant correlation between the clinical variables and JOA scores or JOA recovery rates. The JOA scores of the patients in the first operation were improved from 9.4±4.1 to 12.8±2.8 (P<0.01), and the JOA recovery rate was 45.6%. The JOA scores of the reoperation were improved from 10.2±2.8 to 12.7±2.4 (P<0.05) at the end of 6 months and 14.3±1.9 (P<0.01) by the last follow-up. There were significant differences between the JOA recovery rates by the last follow-up (63.2%) and at the end of 6 months (39.3%) of the reoperation or 45.6% of the first operation (P<0.01). CONCLUSION The reoperation for cervical myelopathy duo to progressing ossification of the posterior longitudinal ligaments can significantly promote the recovery of the spinal cord, based on the clinical manifestations combined with segments of responsibility of the imaging.
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Affiliation(s)
- H Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, China
| | - Y Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, China
| | - S B Wang
- Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, China
| | - F S Zhang
- Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, China
| | - L Zhang
- Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, China
| | - S F Pan
- Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, China
| | - F F Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, China
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Fei Q, Yang Y. [Modified Operation: Single Open-door Laminoplasty]. Zhonghua Yi Xue Za Zhi 2015; 95:1793-1795. [PMID: 26712392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Dreval' MD, Gushcha AO, Arestov SO, Korepina OS. Surgical treatment of severe spondylogenic cervical myelopathy by laminoplasty. Zh Vopr Neirokhir Im N N Burdenko 2015; 79:77-84. [PMID: 26977797 DOI: 10.17116/neiro201579677-84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM The objective of this study is to analyze the results of surgical treatment of patients with cervical myelopathy by laminoplasty. MATERIAL AND METHODS The experience of surgical treatment of 30 patients (mean age 59.4) with cervical stenosis complicated with myelopathy was analyzed. Hirabayashi laminoplasty was performed in 26 patients and Kurokawa laminoplasty was performed in 4 patients. All patients were diagnosed with extended cervical spinal stenosis. Diagnosis was based on the survey RESULTS including the dynamic clinical and neurological examination, x-ray study, CT, MRI, SSEP, and TMS. Nurick scale, the scale of the Japanese Orthopaedic Association (JOA), and the recovery rate scale were used to assess the severity of myelopathy. RESULTS The long-term outcome of the clinical status, radiographic and neuroimaging parameters in patients with cervical myelopathy who underwent laminoplasty was evaluated. CONCLUSION Laminoplasty is the method of choice in the treatment of extended spondylogenic cervical stenosis. Proper selection of patients based on clinical symptoms, assessment of the extent of stenosis, neurological examination and neuroimaging data leads to excellent results.
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Affiliation(s)
- M D Dreval'
- Scientific Center of Neurology, Moscow, Russia
| | - A O Gushcha
- Scientific Center of Neurology, Moscow, Russia
| | - S O Arestov
- Scientific Center of Neurology, Moscow, Russia
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Lian H, Huang J, Liu J. [Early outcome of different operation methods in treatment of multi-segmental cervical spondylotic myelopathy]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2014; 28:1231-1235. [PMID: 25591298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore the early outcome of 3 different operation methods in the treatment of multi- segmental cervical spondylotic myelopathy (CSM). METHODS A retrospective analysis was made on the clinical data of 74 patients with multi-segmental CSM treated between January 2011 and March 2013. The patients were divided into 3 groups according to operation methods: open-door expansive laminoplasty by plate was used in 21 patients (group A), open-door expansive laminoplasty by anchor fixation in 28 patients (group B), and conventional unilaterally open-door expansive laminoplasty in 25 patients (group C). There was no significant difference in gender, age, disease druation, affected segments, preoperative Japanese Orthopaedic Association (JOA) score, and cervical curvature of C2-7 among 3 groups (P > 0.05). The peration time, intraoperative blood loss, and JOA score, cervical curvature, incidence of axial symptoms were recorded. RESULTS There was no significant difference of operation time and intraoperative blood loss between group A and group B (P > 0.05). All incisions healed by first intention. Cerebrospinal leak occurred in 2 cases (1 case of group B and 1 case of group C) and C5 nerve root palsy in 4 cases (2 cases of group A, 1 case of group B, and 1 case of group C); all the symptoms disappeared after symptomatic treatment. The patients were followed up 12-39 months (mean, 18.3 months). The position of internal fixation was good without loosening and pulling out in groups A and B. Reclosed open-door was observed in 2 cases of group C, which disappeared after the second surgery. The JOA scores were significantly increased at 6 months after operation when compared with preoperative scores in groups A, B, and C (P < 0.05). The cervical curvature of C2-7 at postoperation was significantly improved when compared with preoperative one in groups B and C (P < 0.05) except group A (P > 0.05) . There weresignificant differences in JOA score and the cervical curvature among 3 groups at 6 months after operation (P < 0.05). The incidence of axial symptoms were 4.76% (1/21), 35.71% (10/28), and 72.00% (18/25) in groups A, B, and C respectively, showing significant differences (P < 0.017). CONCLUSION Open-door expansive laminoplasty by plate has better early outcome than open-door expansive laminoplasty by anchor fixation and conventional unilaterally open-door expansive laminoplasty in the treatment of multi-segmental CSM.
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Affiliation(s)
- Hongkai Lian
- Department of Orthopedics, Zhengzhou First People's Hospital, Zhengzhou Henan, P.R. China
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Diao Y, Sun Y, Wang S, Zhang F, Pan S, Liu X, Liu Z. [Measurement and comparison of postoperative anterior cord space between C2-7 and C3-7 laminoplasty on MRI]. Zhonghua Wai Ke Za Zhi 2014; 52:745-749. [PMID: 25573213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To investigate the effect of C(2-7) laminoplasty on postoperative anterior cord space (ACS) compared with C(3-7) laminoplasty, and to provide evidence for reasonable enlargement of decompression range cephalad. METHODS Fifty-seven Patients underwent cervical laminoplasty from February 2008 to October 2011 were studied retrospectively, which were divided into two groups by decompression range: Group C(3-7) and Group C(2-7). The pre-and post operative JOA scores,VAS scores of neek and shoulder pain, and cervical alignment were compared in each group. The postoperative ACS at each level from C(2-3) to C(7)-T(1) measured on MRI were compared between the two groups. RESULTS The postoperative JOA scores increased significantly in both groups. VAS scores and cervical alignment showed no significant difference. ACS at C(2-3) and C(3-4) was 6.13 mm (95%CI: 5.71-6.55) and 6.60 mm (95%CI: 6.10-7.11) respectively in Group C(3-7), which increased 2.5 mm and 2.1 mm respectively in Group C2-7 at the same segment, there was significant difference (P < 0.01). However, there was no significant difference of ACS at C(4-5) and any other caudal levels between the two groups. CONCLUSIONS Compared with conventional C(3-7) laminoplasty, the extensive decompression cephalad to C(2) leads to larger ACS at C(2-3) and C(3-4). When the mid-sagittal diameter of anterior compression is more than 6.10 mm at C(3-4), C(3-7) laminoplasty may cause insufficient decompression, and enlargement of decompression range cephalad should be considered.
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Affiliation(s)
- Yinze Diao
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Yu Sun
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China.
| | - Shaobo Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Fengshan Zhang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Shengfa Pan
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
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Lin S, Zhou F, Sun Y, Chen Z, Zhang F, Pan S. [Changes of sagittal balance of cervical spine after open-door expansive laminoplasty]. Zhonghua Yi Xue Za Zhi 2014; 94:2726-2730. [PMID: 25533976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore the changes of sagittal balance of cervical spine after open-door expansive laminoplasty. METHODS The clinical and radiological data were analyzed retrospectively for 90 patients undergoing open-door expansive laminoplasty due to cervical spondylotic myelopathy. The Japanese Orthopedic Association (JOA) score and 3 cervical sagittal parameters including C2-C7 SVA, C0-2 Cobb angle and T1-Slope on lateral view radiographs were recorded before operation and at the final follow-up. RESULTS The average follow-up period was 16.7 (3-40) months. The post-operative JOA score rose to 14.6 ± 0.2 from pre-operative 12.2 ± 0.3 with 43.5% ± 4.2% recovery rate. The post-operative values of C2-C7 SVA, C0-2 Cobb angle and T1-Slope were significantly different from pre-operative ones (P = 0.022, P < 0.001, P = 0.002) . C2-C7 SVA increased to (23.0 ± 1.2) mm from pre-operative (20.7 ± 1.1) mm. C0-2 Cobb angle increased (23.1 ± 0.8) ° from pre-operative (19.9 ± 0.8)°; T1-Slope increased to (26.2 ± 0.7)° from pre-operative (25.1 ± 0.7)°. The changes of C0-2 Cobb angle and T1-Slope were correlated with that of C2-C7 SVA respectively (Pearson = 0.469, P < 0.001) (Pearson = 0.303, P = 0.004) . Patients with higher preoperative T1-Slope had less JOA improvement (31.5% vs 53.7%, P = 0.019) than those with lower preoperative T1-Slope after laminoplasty. CONCLUSION The sagittal balance of cervical spine significantly changes after open-door expansive laminoplasty with forward tilting of cervical vertebra. And compensation occurs by excessive high-strength contraction of posterior muscles to maintain lordosis in upper cervical spine. A higher pre-OP T1-Slope affects the outcomes of open-door expansive laminoplasty.
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Affiliation(s)
- Shengrong Lin
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Feifei Zhou
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Yu Sun
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China.
| | - Zhongqiang Chen
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Fengshan Zhang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Shengfa Pan
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
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Xie S, Sun T, Tian R, Xu T, Jia Y, Shen Q. [Analysis of risk factors of axial symptoms after single door laminoplasty for cervical myelopathy]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2014; 28:620-624. [PMID: 25073285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the risk factors of axial symptoms after single door laminoplasty for cervical myelopathy. METHODS A retrospective analysis was made on the clinical data of 102 patients with cervical myelopathy who underwent single door laminoplasty and were accorded with selective standard between February 2009 and October 2011. There were 59 males and 43 females, aged 35 to 72 years (mean, 58 years). The disease duration was 1-70 months (mean, 18 months). The operated segments included C3-7 in 58 cases, C3-6 in 23 cases, C4-7 in 15 cases, and C3-5 in 6 cases. The visual analogue scale (VAS) was used to determine whether the patient had axial symptoms (group A) or not (group B). The logistic regression analysis was used to analyze the risk factors of postoperative axial symptoms by assessing the following indexes: preoperative VAS score, preoperative Japanese Orthopaedic Association (JOA) score, gender, age, disease duration, operated segment, operation time, intraoperative blood loss, wearing collar time, preoperative encroachment rate of anterior spinal canal, preoperative cervical curvature, and preoperative cervical range of motion. RESULTS A total of 102 cases were followed up 18-26 months (mean, 24 months). And no postoperative spinal cord injury, cerebrospinal fluid leakage, or infection occurred. Of 102 cases, 50 had axial symptoms (group A) and 52 had no axial symptoms (group B). There were significant differences in age, wearing collar time, preoperative cervical range of motion, preoperative cervical curvature, and preoperative encroachment rate of anterior spinal canal between 2 groups (P < 0.05), but no significant difference was found in preoperative JOA score and VAS score, blood loss, gender, disease duration, operated segment, and operation time (P > 0.05). The logistic regression analysis showed that the increased preoperative encroachment rate of anterior spinal canal, reduced preoperative cervical curvature, and preoperative cervical range of motion loss were the risk factors for cervical axial symptoms. CONCLUSION Age, wearing collar time, preoperative cervical range of motion, preoperative encroachment rate of anterior spinal canal, and preoperative cervical
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Della Pepa GM, Roselli R, La Rocca G, Spallone A, Barbagallo G, Visocchi M. Laminoplasty is better of laminectomy in cervical stenotic myelopathy: myth or truth? Eur Rev Med Pharmacol Sci 2014; 18:50-54. [PMID: 24825042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Laminoplasty has been proposed as a treatment for cervical stenotic myelopathy (CSM) as an alternative to standard laminectomy as this has been considered directly associated with an increased risk of postoperative deformity. METHODS We retrospective reviewed postoperative results of open door laminoplasty (unilateral approach technique) compared with laminectomy in terms of clinical/electophysiological results (somatosensory evoked potentials - SSEP, and motor evoked potentials - MEP); in addition the rate of subsequent spinal deformities was analyzed in both techniques. RESULTS Postoperative results in terms of late follow up neurological assessment and neurophysiological improvement was substantially comparable in both groups. Postoperative dynamic cervical X-rays showed a kyphotic deformity in (12.5%) in patients undergoing laminectomy; none was unstable. No case of kypothic deformity occurred in patients undergoing open door laminoplasty. Complication rate was similar in both groups. DISCUSSION AND CONCLUSIONS Standard laminectomy seems to be associated to late cervical spine deformities in a more relevant percentage of patients, possibly leading to severe forms of kyphosis and segmental instability over time compared with open-door expansive laminoplasty. The unilateral approach represents an evolution to standard open door technique that further spares posterior elements, may decrease the incidence of progressive spinal deformity and prevent the need for subsequent spinal stabilization.
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Affiliation(s)
- G M Della Pepa
- Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
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Kode S, Kallemeyn NA, Smucker JD, Fredericks DC, Grosland NM. The effect of multi-level laminoplasty and laminectomy on the biomechanics of the cervical spine: a finite element study. Iowa Orthop J 2014; 34:150-7. [PMID: 25328475 PMCID: PMC4127738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Laminectomy has been regarded as a standard treatment for multi-level cervical stenosis. Concern for complications such as kyphosis has limited the indication of multi-level laminectomy; hence it is often augmented with an instrumented fusion. Laminoplasty has emerged as a motion preserving alternative. The purpose of this study was to compare the multidirectional flexibility of the cervical spine in response to a plate-only open door laminoplasty, double door laminoplasty, and laminectomy using a computational model. A validated three-dimensional finite element model of a specimen-specific intact cervical spine (C2-T1) was modified to simulate each surgical procedure at levels C3-C6. An additional goal of this work was to compare the instrumented computational model to our multi-specimen experimental findings to ensure similar trends in response to the surgical procedures. Model predictions indicate that mobility was retained following open and double door laminoplasty with a 5.4% and 20% increase in flexion, respectively, compared to the intact state. Laminectomy resulted in 57% increase in flexion as compared to the intact state, creating a concern for eventual kyphosis--a known risk/complication of multi-level laminectomy in the absence of fusion. Increased disc stresses were observed at the altered and adjacent segments post-laminectomy in flexion.
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Affiliation(s)
- Swathi Kode
- Department of Biomedical Engineering The University of Iowa, Iowa City, IA United States ; Center for Computer Aided Design The University of Iowa, Iowa City, IA United States
| | - Nicole A Kallemeyn
- Department of Biomedical Engineering The University of Iowa, Iowa City, IA United States ; Center for Computer Aided Design The University of Iowa, Iowa City, IA United States
| | - Joseph D Smucker
- Department of Orthopaedics and Rehabilitation University of Iowa Hospitals and Clinics, The University of Iowa, Iowa City, IA United States
| | - Douglas C Fredericks
- Department of Orthopaedics and Rehabilitation University of Iowa Hospitals and Clinics, The University of Iowa, Iowa City, IA United States
| | - Nicole M Grosland
- Department of Biomedical Engineering The University of Iowa, Iowa City, IA United States ; Department of Orthopaedics and Rehabilitation University of Iowa Hospitals and Clinics, The University of Iowa, Iowa City, IA United States ; Center for Computer Aided Design The University of Iowa, Iowa City, IA United States
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Yoshida G, Kanemura T, Ishikawa Y, Matsumoto A, Ito Z, Tauchi R, Muramoto A, Matsuyama Y, Ishiguro N. The effects of surgery on locomotion in elderly patients with cervical spondylotic myelopathy. Eur Spine J 2013; 22:2545-51. [PMID: 23955371 DOI: 10.1007/s00586-013-2961-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 07/03/2013] [Accepted: 08/06/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to evaluate the effects of surgery on locomotor ability in patients with cervical spondylotic myelopathy (CSM) and compare the results between elderly and younger patients. METHODS A total of 369 consecutive patients who underwent expansive laminoplasty for CSM were prospectively analysed. Patients were divided into two age groups of ≥ 75 years (elderly group, 76 patients) and <75 years (younger group, 293 patients). Locomotor ability was estimated using part of the functional independence measure (FIM). The sum of gait and stairs items [functional independence measure (locomotion), FIM-L; possible scores, 2-14] and neurological status were estimated using the Japanese Orthopaedic Association (JOA) score (possible score, 0-17). Pre-operative neurological anamnesis was reviewed, and the surgical results of elderly patients with or without co-existing neurological history were evaluated to determine the origin of locomotor disability. RESULTS Peri-operative FIM-L and JOA scores were significantly lower in the elderly group than in the younger group, and the opposite was true for improved FIM score. Cerebral infarction and previous lumbar surgery were identified as neurological co-morbidities in the elderly group. However, there was no significant difference in surgical results between elderly patients with and without co-existing neurological disorders. CONCLUSIONS Decompression surgery can improve locomotor ability and decrease nursing care requirements among elderly patients with CSM. However, other neurological diseases can co-exist in elderly patients, making it difficult to diagnose the origin of locomotor disability. Therefore, detailed peri-operative work-up and timely decompression should be given priority to avoid progression towards fixed locomotor disability.
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Affiliation(s)
- Go Yoshida
- Department of Orthopedic Surgery, Hamamatsu Medical Center, 328 Tomizuka-cho Naka-ku, Hamamatsu, Shizuoka, 432-8580, Japan,
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