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Su N, Fei Q, Wang BQ, Kang N, Zhang QM, Tang HH, Li D, Li JJ, Yang Y. Comparison of clinical outcomes of expansive open-door laminoplasty with unilateral or bilateral fixation and fusion for treating cervical spondylotic myelopathy: a multi-center prospective study. BMC Surg 2019; 19:116. [PMID: 31439029 PMCID: PMC6704717 DOI: 10.1186/s12893-019-0583-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/14/2019] [Indexed: 11/17/2022] Open
Abstract
Background The present study evaluated the clinical outcomes and safety of expansive open-door laminoplasty, when securing with C4 – C6 lateral mass screw and fusion. Methods A total of 110 patients with cervical spondylotic myelopathy (CSM) were enrolled. There were 88 male and 22 female, with mean age at 60.55 ± 10.95 years. All of the patients underwent expansive open-door laminoplasty with unilateral or bilateral C4–6 lateral mass screws fixation and fusion. Clinical data, including age, gender, operation-related information, pre- and post-operation Japanese Orthopedic Association (JOA) scores, and cervical curvatures were collected. Results The mean follow-up time of the cohort was 13.61 ± 9.53 months. Among the 110 patients, 33 of them were allocated to Unilateral group, and 77 of them were in Bilateral group. The mean JOA score of the 110 patients before surgery was 10.07 ± 2.39, and the score was improved significantly to 12.85 ± 2.45 after surgery. There were no reported cases of neurological deterioration or symptom worsening. Patients in both the Unilateral group and Bilateral groups had significant improvement of JOA scores. Among all patients, the most frequently observed complications were axial symptoms (n = 7). The average preoperative cervical curvature among all patients was 15.17 ± 5.26, and the post-surgery curvature was 14.41 ± 4.29. Similar observations were found between Unilateral and Bilateral groups. Conclusion The modified surgical approach provided satisfactory clinical outcome in patients with CSM. The unilateral and bilateral fixation appeared to provide similar outcomes, in terms of cervical curvature maintenance and improvement of clinical symptoms. However, the examination of the exact differences between the two fixation methods await further biomechanical studies.
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Affiliation(s)
- Nan Su
- Department of Orthopaedics, Beijing Friendship Hospital, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Qi Fei
- Department of Orthopaedics, Beijing Friendship Hospital, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Bing-Qiang Wang
- Department of Orthopaedics, Beijing Friendship Hospital, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Nan Kang
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Beijing, China
| | - Qing-Ming Zhang
- Department of Orthopaedics, Beijing Xuan-Wu Hospital, Beijing, China
| | - He-Hu Tang
- Department of Orthopaedics, Beijing Bo-Ai Hospital, Beijing, China
| | - Dong Li
- Department of Orthopaedics, Beijing Friendship Hospital, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Jin-Jun Li
- Department of Orthopaedics, Beijing Friendship Hospital, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Yong Yang
- Department of Orthopaedics, Beijing Friendship Hospital, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China.
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Jhas S, Pirouzmand F. Obtuse-angled Laminotomy as a Modification of Multilevel Laminectomy for Spinal Cord Decompression. Clin Spine Surg 2016; 29:49-51. [PMID: 26889986 DOI: 10.1097/bsd.0000000000000345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this note is to describe an obtuse-angled laminotomy of C7 during cervical decompression that aims to preserve cervicothoracic junction stability and potentially reduce pain. Cervical spondylotic myelopathy can result from degenerative cervical spinal disease including, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multilevel myelopathy aims to decompress the spinal cord and maintain stability of the cervical spine. Multilevel laminectomy is traditionally used when degenerative changes affect 3 or more levels and when there is primarily dorsal compressive disease. Traditional laminectomy can result in instability and kyphosis. The C7 lamina can be particularly vulnerable given the location at cervicothoracic junction. We describe an obtuse-angled laminotomy for the most caudal lamina in a planned decompression. This lamina is left attached to ligamentum nuchea, adjacent fascia, and paravertebral muscles. Only the base of spinous process and ventral portion of lamina's cortical and cancellous bone are removed in an obtuse angle through the opening. This variation is aimed to preserve as much of the cervical stability while still achieving the goal of decompression.
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Affiliation(s)
- Sumit Jhas
- Sunnybrook Health Sciences Center, Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
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Abstract
PURPOSE Cervical spondylotic myelopathy (CSM) is a condition resulting from cervical stenosis. Manifestations of CSM include paresthesia in the extremities, loss of fine motor skills, balance problems, and bowel and bladder dysfunction in advanced disease. Laminoplasty is one surgical treatment option. The goal of laminoplasty is to reposition the laminae to expand the spinal canal, allowing the spinal cord to migrate posteriorly. There are various laminoplasty techniques; the main ones being open-door laminoplasty and double-door laminoplasty. This manuscript demonstrates a double-door laminoplasty otherwise known as a "French-door" laminoplasty discusses the indications and outcomes of this procedure. METHODS The double-door laminoplasty creates an opening in the midline of the spinous processes and a symmetrical expansion with hinges on both laminae. Bilateral troughs are drilled on each laminae using a bur, and opened liked a French-door, allowing the spinal cord to move posteriorly in the enlarged spinal canal. The space between the gapped laminae are then stabilized by allograft. RESULTS This manuscript presents the case of a 56-year-old man with CSM caused by multilevel cervical stenosis. The patient had classic signs and symptoms of CSM including problems with fine motor skills and walking difficulty. The video demonstrates the spinal cord decompression achieved with the French-door technique from C4 to C6 with a dome laminectomy at C3. CONCLUSIONS There are many surgical treatments for cervical stenosis including anterior cervical discectomy and fusions and posterior procedures such as laminoplasty or laminectomy and fusion. The indications and technical pearls for French-door laminoplasty are presented as an effective option for the treatment of multilevel cervical stenosis.
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Arantes Júnior AA, Silva Junior GAD, Malheiros JA, Gonçalves FF, Magaldi M, Santiago E, Nicolato AA, Gusmão SNS. A new expansive two-open-doors laminoplasty for multilevel cervical spondylotic myelopathy: technical report and follow-up results. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:49-54. [PMID: 24637983 DOI: 10.1590/0004-282x20130240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 11/04/2013] [Indexed: 11/22/2022]
Abstract
UNLABELLED The laminoplasty technique was devised by Hirabayashi in 1978 for patients diagnosed with multilevel cervical spondylotic myelopathy. OBJECTIVE To describe an easy modification of Hirabayashi's method and present the clinical and radiological results from a five-year follow-up study. METHOD AND RESULTS Eighty patients had 5 levels of decompression (C3-C7), 3 patients had 6 levels of decompression (C2-T1) and 3 patients had 4 levels of decompression (C3-C6). Foraminotomies were performed in 23 cases (27%). Following Nurick`s scale, 76 patients (88%) improved, 9 (11%) had the same Nurick grade, and one patient worsened and was advised to undergo another surgical procedure. No deaths were observed. The mean surgery time was 122 min. Radiographic evaluation showed an increase in the mean sagittal diameter from 11.2 mm at pretreatment to 17.3 mm post surgery. There was no significant difference between pretreatment and post-surgery C2-C7 angles. CONCLUSIONS This two-open-doors laminoplasty technique is safe, easy and effective and can be used as an alternative treatment for cases of multilevel cervical spondylotic myelopathy without instability.
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Affiliation(s)
| | | | - José Augusto Malheiros
- Department of Neurosurgery, Clinical Hospital, Federal University of Minas Gerais, Belo HorizonteMG, Brazil
| | | | - Marcelo Magaldi
- Department of Neurosurgery, Clinical Hospital, Federal University of Minas Gerais, Belo HorizonteMG, Brazil
| | - Erica Santiago
- Federal University of Minas Gerais, School of Medicine, Belo HorizonteMG, Brazil
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Seng C, Tow BPB, Siddiqui MA, Srivastava A, Wang L, Yew AKS, Yeo W, Khoo SHR, Balakrishnan NMS, Bin Abd Razak HR, Chen JLT, Guo CM, Tan SB, Yue WM. Surgically treated cervical myelopathy: a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty. Spine J 2013; 13:723-31. [PMID: 23541452 DOI: 10.1016/j.spinee.2013.02.038] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Revised: 11/25/2012] [Accepted: 02/18/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Multilevel cervical myelopathy can be treated with anterior cervical discectomy and fusion (ACDF) or corpectomy via the anterior approach and laminoplasty via the posterior approach. Till date, there is no proven superior approach. PURPOSE To elucidate any potential advantage of one approach over the other with regard to clinical midterm outcomes in this study. STUDY DESIGN A prospective, 2-year follow-up of patients with cervical myelopathy treated with multilevel anterior cervical decompression fusion and plating and posterior laminoplasty. PATIENT SAMPLE In total, 116 patients were studied. Sixty-four patients underwent ACDF two levels and above or anterior cervical corpectomy and fusion one level and above. Fifty-two patients underwent posterior cervical surgery (laminoplasty C3-C6 and C3-C7). OUTCOME MEASURES Self-report measures: Japan Orthopedic Association (JOA) score, JOA recovery rate, visual analog scale for neck pain (VASNP), neck disability index (NDI), and American Academy of Orthopaedic Surgeons (AAOS) neurogenic symptom score (AAOS-NSS). Physiologic measures: range of motion (ROM) flexion and extension of neck. Functional measures: short-form 36 (SF-36) score comprising physical functioning, physical role function, bodily pain, general health, vitality, social role function, emotional role function, and mental health scales. METHODS Comparison of the JOA scores, JOA recovery rates, NDI scores, SF-36 scores, VASNP, and ROM preoperatively to 2 years. Chi-square and two-sided Student t tests were used to analyze the variables. RESULTS Posterior surgery took an hour shorter (p<.05) and had better improvement in JOA scores at early follow-up of 6 months (p=.025). Anterior surgery group had better improvement of NDI scores at early follow-up of 6 months (p=.024) and was associated with less blood loss intraoperatively compared with posterior surgery. There was no statistical difference between the two groups for JOA scores, JOA recovery rates, SF-36 quality-of-life scores, NDI, AAOS-NSS, VAS neck pain, and ROM at 2 years. Complications were higher for anterior surgery group: two hematoma postoperation, one vocal cord paresis, and one new onset C6/C7 dermatome numbness versus one dura leak in posterior surgery group. CONCLUSIONS Our study showed that patients with multilevel disease treated with laminoplasty do well and compare favorably with patients treated with an anterior approach. Notably, posterior surgery was associated with shorter operating time, better improvement in JOA scores at 6 months, and a tendency toward lesser complications. Posterior surgery was not associated with increased neck disability and neck pain at 2 years. Anterior surgery had better NDI improvement at early follow-up. There is a need for a larger study that is prospectively randomized with long-term follow-up before we can confidently advocate one approach over the other in the management of cervical myelopathy.
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Affiliation(s)
- Chusheng Seng
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Rd, Singapore 169608, Singapore
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Nurboja B, Kachramanoglou C, Choi D. Cervical laminectomy vs laminoplasty: is there a difference in outcome and postoperative pain? Neurosurgery 2012; 70:965-70; discussion 970. [PMID: 22015812 DOI: 10.1227/neu.0b013e31823cf16b] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cervical laminoplasty is often used for the decompression of multilevel cervical spondylotic myelopathy without creating spinal instability and kyphosis. OBJECTIVE To assess the axial pain, quality of life, sagittal alignment, and extent of decompression after standard cervical laminectomy or laminoplasty. We further evaluate whether the sagittal alignment changes over time after both procedures and whether axial pain depends on sagittal alignment. METHODS We reviewed 268 patients with cervical radiculopathy or myelopathy who had undergone standard cervical laminectomy or laminoplasty between January 1999 and January 2009. The clinical outcome was analyzed by visual analog scale for neck pain. The quality of life was analyzed by EQ-5D questionnaire. The degree of deformity and extent of decompression were assessed using the Ishihara index and Pavlov's ratio, respectively. RESULTS Laminoplasty was associated with more neck pain and worse quality of life when 4 or more levels were decompressed compared with the laminectomy group. For operations of 3 or fewer levels, there was no difference. Interestingly, the radiological effectiveness of decompression was greater in the laminoplasty group. CONCLUSION Laminoplasty for 4 or more cervical levels was associated with more axial pain and consequently poorer quality of life than laminectomy. There was a similar loss of sagittal alignment in both the laminectomy and laminoplasty groups over time. Our results suggest there is no clear benefit of laminoplasty over laminectomy in patients who do not have spinal instability.
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Affiliation(s)
- Besnik Nurboja
- Department of Neurosurgery, Kings College Hospital, London, United Kingdom.
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Laminoplasty techniques for the treatment of multilevel cervical stenosis. Adv Orthop 2012; 2012:307916. [PMID: 22496982 PMCID: PMC3310284 DOI: 10.1155/2012/307916] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 11/14/2011] [Indexed: 11/17/2022] Open
Abstract
Laminoplasty is one surgical option for cervical spondylotic myelopathy. It was developed to avoid the significant risk of complications associated with alternative surgical options such as anterior decompression and fusion and laminectomy with or without posterior fusion. Various laminoplasty techniques have been described. All of these variations are designed to reposition the laminae and expand the spinal canal while retaining the dorsal elements to protect the dura from scar formation and to preserve postoperative cervical stability and alignment. With the right surgical indications, reliable results can be expected with laminoplasty in treating patients with multilevel cervical myelopathy.
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Ruggeri A, Pichierri A, Marotta N, Tarantino R, Delfini R. Laminotomy in adults: technique and results. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21:364-72. [PMID: 21547383 DOI: 10.1007/s00586-011-1826-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 04/08/2011] [Accepted: 04/16/2011] [Indexed: 11/30/2022]
Abstract
The objective of this study was to describe step by step our surgical technique of laminotomy and analyze our series with regard to spinal deformities (risk and predisposing factors), postoperative pain and rate of postoperative contusions. Data regarding patients who underwent our technique of laminotomy (N = 40, mean follow-up: 52 ms) (N = 40) between 2002 and 2006 were retrospectively evaluated. The technique used is illustrated in depth. Chronic pain was present in 30% with a mean score of 3/10 cm (Graphic Rating Scale). Postoperative kyphoses occurred in three patients, all below 35 years of age and with laminotomies which involved C2 and/or C7. None of these deformities required further surgical treatment because they were self-limiting or asymptomatic at a mean follow-up of 52 months. Based on the results, our technique proved to be safe and effective in terms of late deformities, blood loss, early and chronic postoperative pain and protection from postoperative accidents over the surgical site.
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Affiliation(s)
- Andrea Ruggeri
- Department of Neurological Sciences, Neurosurgery, "Sapienza" University of Rome, v. le del Policlinico, 155, 00161 Rome, Italy
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Acharya S, Srivastava A, Virmani S, Tandon R. Resolution of physical signs and recovery in severe cervical spondylotic myelopathy after cervical laminoplasty. Spine (Phila Pa 1976) 2010; 35:E1083-7. [PMID: 20838272 DOI: 10.1097/brs.0b013e3181df1a8e] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case series review. OBJECTIVE To determine the recovery and prevalence of myelopathic signs and their resolution in cervical spondylotic myelopathy after treatment by laminoplasty. SUMMARY OF BACKGROUND DATA Myelopathic signs are an integral component of diagnosis of cervical myelopathy. Effect of surgical intervention (laminoplasty) on recovery of these reflexes has not been studied and remains undetermined. Their recovery and its rate remain unclear. This may be important because resolution may affect recovery, and reappearance may mark relapse. METHODS Patients diagnosed as having cervical spondylotic myelopathy based on symptoms, corroborative imaging, and improvement of at least 1 grade in Nurick score were part of study. The patients were evaluated for a period of 1 year from surgery. Hyperreflexia and provocative signs (Hoffman, inverted brachioradialis reflex, clonus, and Babinski) and recovery (Nurick and mJOA) were noted at subsequent follow-up, and improvement was analyzed. RESULTS Twenty-one patients had severe spondylotic myelopathy with Nurick score ≥ 3. Myelopathic signs were highly sensitive in diagnosing the presence of severe SCM, because 100% of the SCM patients revealed at least 1 sign on examination. The recovery of these signs was maximum within the first 6 months, with lesser than half of total occurring in immediate and major half in the subsequent 6 months. Beyond this, plateau was seen in recovery, with marginal improvement of these signs. Patients with adverse cord signal changes (t2 hyper/T1 low) had higher prevalence and persistence of individual myelopathic signs compared with patients with only T1 hyperintensity/normal cord in preoperative period and follow-up at the end of 1 year. CONCLUSION At least 1 myelopathic sign is universal in severe SCM patients. However, individual myelopathic signs cannot alone diagnose disease in all patients. The benefit of laminoplasty is apparent in immediate postoperative period (<7 days), but it is maximum in first 6 months after which the recovery stabilized or these are a marginal improvement. Similarly, the resolution of signs is maximum in period of first 6 months, which parallels recovery. Babinski and inverted brachioradialis reflex revert to normal in most patients and can serve as markers of relapse in long follow-up. Hoffman is not a sensitive test and is likely to persist in patient with severe cord changes.
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Hale JJ, Gruson KI, Spivak JM. Laminoplasty: a review of its role in compressive cervical myelopathy. Spine J 2006; 6:289S-298S. [PMID: 17097549 DOI: 10.1016/j.spinee.2005.12.032] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2005] [Accepted: 12/12/2005] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The currently accepted surgical treatments for compressive cervical myelopathy include both anterior and posterior decompression. Anterior approaches including multilevel discectomy with fusion or vertebral corpectomy with strut grafting, both with and without instrumentation, have enjoyed successful outcomes, but have been associated with select postoperative complications. Laminoplasty has been developed to decompress the spine posteriorly while avoiding the spinal destabilization seen after laminectomy. PURPOSE The purpose of this article is to provide a review of the various techniques, biomechanical basis, predictive value of imaging modalities, clinical outcomes, and postoperative complications associated with cervical laminoplasty. STUDY DESIGN A review of the literature. METHODS A comprehensive literature review using Medline was performed identifying relevant articles that addressed the techniques, clinical outcomes, and complications after cervical laminoplasty, as well as preoperative radiographic predictors of outcome. RESULTS The various modifications of cervical laminoplasty have generally been associated with excellent clinical outcomes when used for myelopathy secondary to cervical spondylosis or ossification of the posterior longitudinal ligament (OPLL). Recent long-term studies have identified issues with this technique including axial neck pain, canal restenosis, nerve root palsy, diminished cervical motion, and loss of cervical lordotic alignment. CONCLUSIONS Cervical laminoplasty remains a reliable procedure for posterior decompression of the spine, but the optimal approach to cervical myelopathy must take into account both patient and disease characteristics, as well as the capabilities and experience of the surgeon.
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Affiliation(s)
- James J Hale
- New York University-Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA
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Fushimi K, Miyamoto K, Nishimoto H, Hosoe H, Kodama H, Shimizu K. Clinical outcomes of multilevel anterior corpectomy and fusion as a revision surgery of the cervical spine: report of seven cases. Spinal Cord 2005; 44:449-56. [PMID: 16317426 DOI: 10.1038/sj.sc.3101868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Report of seven cases. OBJECTIVE There is no general consensus on the best surgical procedures for late-onset complications of cervical operations. We reported seven patients who had been treated effectively by multilevel anterior corpectomy and fusion (ACF) as revision surgery of the cervical spine. SETTING Gifu University Hospital, Gifu, Japan. METHOD Multilevel ACF using autogenous fibular strut graft as revision surgery was performed on seven patients: four patients having disorders of adjacent discs after anterior discectomy and fusion and three patients having postlaminoplasty disorders. Japanese Orthopedic Association scores (JOA scores) of the cervical myelopathy and severity of radicular and axial pains were used to evaluate outcomes. RESULTS Rigid osseous fusion was achieved in all patients. JOA scores of the cervical myelopathy and the radicular pain, which had worsened just before the revision surgery, were improved significantly. CONCLUSION In the present seven patients who had variety of pathological conditions with various previous surgeries, multilevel ACF using strut graft was effective as a revision procedure in ameliorating their symptoms.
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Affiliation(s)
- K Fushimi
- Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu, Japan
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