Wedge-Shaped Resection of the Posterior Bony Arch During Open Door Laminoplasty to Prevent Postoperative Motion Limitation

Is laminoplasty or laminectomy the best strategy for C3 segment in French-door laminoplasty? A systematic review and meta-analysis

Background

To compare the clinical outcomes of C₃ laminectomy and C₃ laminoplasty at the C₃ segment during French-door laminoplasty.

Methods

The Cochrane Library, PubMed, Embase, and Web of Science databases were searched from inception to November 10, 2020 for studies comparing the clinical outcomes of two types of French-door laminoplasty in the treatment of multilevel cervical spondylotic myelopathy (MCSM). Review Manager 5.3 was used to analyze the following outcomes: operative time, intraoperative blood loss, preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, recovery rate, cervical curvature, cervical range of motion (ROM), incidence of axial symptoms (AS), and C_2-3 bony fusion rate.

Results

A total of eight studies involving 776 patients were included; there were 424 patients in the C₃ laminectomy group and 352 patients in the C₃ laminoplasty group. The results of the meta-analysis showed that the C₃ laminectomy group was superior to the C₃ laminoplasty group in terms of operative time (P < 0.00001), cervical ROM (P = 0.04), and incidence of AS (P < 0.0001). However, no statistically significant differences between the two groups were noted regarding intraoperative bleeding (P = 0.44), preoperative JOA score (P = 0.57), postoperative JOA score (P = 0.09), recovery rate (P = 0.25), cervical curvature (P = 0.22), and C_2-3 bony fusion rate (P = 0.06).

Conclusion

This meta-analysis demonstrated that both C₃ laminoplasty and C₃ laminectomy could effectively improve neurological function in patients with MCSM in French-door laminoplasty. However, C₃ laminectomy can reduce the operative time, preserve cervical ROM, and reduce the incidence of postoperative AS.

Trial registration

PROSPERO registration number is CRD42021230798.

Date of registration: February 11, 2021.

The impact of plating level on the postoperative loss of cervical lordosis in alternative skipped-level plating laminoplasty

PURPOSE

The aim of this study is to evaluate the impact of plating level on the loss of cervical lordosis (LCL) after laminoplasty with skipped-level plating.

METHODS

This retrospective study included patients who underwent alternative skipped-level plating laminoplasty from C3 to C6. Patients were divided into two groups according to the plating level. Group 1 had miniplate fixed at C3 and C5 (C3/C5 group), while patients in group 2 were fixed at C4 and C6 (C4/C6 group). The outcome of interest was the difference of LCL between the two groups; meanwhile, kyphosis development after laminoplasty was also compared.

RESULTS

A total of 70 patients were included in our study with a mean age of 60.44 ± 9.97 years. The median follow-up was 15 (12, 16) months. Median lordosis was 15.43° (9.35°, 22.23°) before surgery and 9.88° (4.15°, 18.94°) after, with a median LCL of 4.48° (-0.66°, 8.11°). There were 17 patients in the C3/C5 group, whereas 53 patients in the C4/C6 group. While preoperative C2-C7 Cobb's angle was comparable between the two groups (15.32° (9.73°, 23.84°) vs. 15.51° (9.03°, 21.70°), p = 0.864), there were statistical differences regarding postoperative C2-C7 Cobb's angle (6.54° (2.49°, 16.42°) vs. 10.62° (5.89°, 18.85°), p = 0.006) and LCL (4.74° (4.17°, 12.03°) vs. 4.07° (-1.89°, 6.69°), p = 0.034) between the C3/C5 group and the C4/C6 group. In all, 94.1% (16 of 17) of patients showed some degree of LCL after laminoplasty in the C3/C5 group, which was significantly higher when compared with 64.2% (34 of 52) of C4/C6 group (p = 0.038). Before surgery, there were no kyphosis patients in either the C3/C5 group or the C4/C6 group. Postoperatively, four patients (23.5%) developed kyphotic alignment in the C3/C5 group, but only one (1.9%) in the C4/C6 group (p = 0.013).

CONCLUSIONS

Cervical alignment was compromised after laminoplasty. When alternative skipped-level plating is adopted in laminoplasty from C3 to C6, plating at C4/C6 may better preserve cervical lordosis than plating at C3/C5 after surgery.

C3 laminectomy combined with modified unilateral laminoplasty and in situ reconstruction of the midline structures maintained cervical sagittal balance: a retrospective matched-pair case-control study

BACKGROUND CONTEXT

Open-door laminoplasty often results in postoperative complications such as loss of cervical lordosis, limitations of cervical motion, and axial symptoms. However, current modified laminoplasty techniques such as muscle-sparing type or spinous process splitting technique are not as effective as expected.

PURPOSE

To evaluate the radiological and clinical outcomes of C3 laminectomy combined with modified unilateral laminoplasty (preservation of posterior muscle-ligament complex and reconstruction of the midline structures) versus traditional open door laminoplasty in treating cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament.

STUDY DESIGN

Retrospective case-control study.

PATIENT SAMPLE

One hundred and eleven patients with multilevel cord compression and myelopathic symptoms.

OUTCOME MEASURES

The outcome parameters were operation time, blood loss volume, complications, osseous fusion status, C0-C2 and C2-C7 Cobb angles, T1 slope, cervical sagittal vertical axis (cSVA), cervical curvature index (CCI), range of motion (ROM), cross-sectional area (CSA) of the semispinalis cervicis, axial symptoms, visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score, and neck disability index (NDI).

METHODS

We matched 37 patients who underwent modified laminoplasty with 74 patients treated by traditional open door laminoplasty (ratio, 1:2) according to age, sex, body mass index, compromised level, and radiographic characteristics. Preoperative and postoperative cervical parameters, namely, the C2-C7 Cobb angle, ROM, and CCI were measured on X-ray films. The CSA of the semispinalis cervicis was assessed on magnetic resonance images, and osseous fusion status of the hinge side and the osteotomy site was evaluated by computed tomography. We used the JOA and VAS scores, and the NDI to evaluate clinical outcomes.

RESULTS

The average follow-up period in the modified group was 24.1 months (range, 18-37 months) compared with 24.7 months (range, 18-38 months) in the control group. At the final follow-up, C0-C2 Cobb angle, T1 slope, and cSVA increased in the control group and were unchanged in the modified group. The C2-C7 Cobb angle decreased significantly in the control group and did not change in the modified group. ROM and CCI loss rate did not change in the modified group but decreased significantly in the control group. The CSA loss in the semispinalis cervicis was 222.90±79.56 mm² in the control group and 49.11±75.93 mm² in the modified group, with a significant difference (p<.001). The final CSA of the semispinalis cervicis at C2 and C4-C7 levels showed no significant difference in the modified group and decreased significantly in the control group compared with preoperation. Changes in the C2-C7 Cobb angle and cSVA were both correlated with the CSA loss of the semispinalis cervicis (r=0.282, p=.003; r=0.267, p=.005, respectively). Moreover, the CSA loss of the semispinalis cervicis also correlated with the CCI loss rate and the changes in ROM (r=0.312, p=.001; r=0.287, p=.002, respectively). Clinical outcomes such as VAS and NDI scores, improved significantly more in the modified group versus the controls (p<.001 and p=.005, respectively), while JOA scores improved similarly in both groups (p=.132). The incidence of axial symptoms was significantly lower in the modified group versus controls (5.4% vs 9.5%, respectively; p=.023).

CONCLUSIONS

C3 laminectomy combined with modified unilateral laminoplasty is effective for treating patients with multilevel cord compression. This modified technique reconstructs the midline structures and may lead to improved alignment and less axial pain.

Correlation Between Parameters of Intervertebral Disc and Cervical Lordosis in Cervical Spondylotic Myelopathy

Background

In cervical disc degeneration, cervical disc height (CDH) and cervical disc angle (CDA)have a certain but unidentified relationship with cervical lordosis (CL). This study aimed to reveal the relationship among CDH, CDA, and CL in patients diagnosed with cervical spondylotic myelopathy (CSM).

Material/Methods

A retrospective analysis was conducted using the data of 212 CSM patients (136 males and 76 females). According to CL angle, patients were classified into 2 groups: patients with CL ≤10° constituted Group 1 (n=102); patients with CL >10° constituted Group 2 (n=110). The CDH, CDA, and CL were measured using X-ray imaging. Pearson correlation analysis measured the correlation between CDH, CDA, and CL. Multiple linear regression was utilized to analyze the effects of CDH and CDA on CL.

Results

The CDAs in every level were higher in Group 2 than those in Group 1 (P<0.05).CDH and CDA gradually increased with the increase in vertebral level and dropped at C5–C6 level in both groups. We found statistically significant correlations between C3/4H, C4/5H, C3/4A,C4/5A, C5/6A, and C6/7Aand CL in Group 1 (P<0.05), and between C4/5H, C3/4A, and C4/5Aand CL in Group 2 (P<0.05). C3/4A and C4/5A predicted CL in Group 1 (adjusted R²=0.176, P<0.001), while C4/5A predicted CL with high sensitivity in Group 2 (adjusted R²=0.198, P<0.001).

Conclusions

CDA contributes more than CDH to CL in CSM. Further studies are necessary to reveal the relationship between CL and cervical disc degeneration.

Impact of wedge-shaped resection of the posterior bony arch on postoperative outcomes after open door laminoplasty in the cervical spine: a 2-year follow-up study

BACKGROUND CONTEXT

Open door laminoplasty (ODLP) can also lead to significant postoperative motion restriction that further increases over time, for which one of the possible factors is the bony impingement between neighboring posterior bony arches. Previously, we reported this phenomenon and modified technique of ODLP, wedge-shaped resection of the posterior bony arch that produced greater range of motion (ROM) of the cervical spine and less posterior neck pain compared with conventional ODLP (cODLP) in 1-year follow-up time, but no longer follow-up outcomes of the surgical technique has been reported.

PURPOSE

The study aimed to thoroughly evaluate the impact of posterior bony impingement following ODLP on postoperative cervical motion and related outcomes, and to compare postoperative outcomes of conventional ODLP (cODLP with those of modified ODLP (mODLP) in 2-year follow-up times.

STUDY DESIGN

This is a retrospective comparative study.

PATIENT SAMPLE

A total of 145 patients who underwent cODLP or mODLP and were followed up for at least 2 years were classified into two groups: Group A (cODLP, 79 patients) and Group B (mODLP, 66 patients).

OUTCOME MEASURES

The primary outcome measure was ROM of the cervical spine. Secondary outcome measures included (1) patient satisfaction, (2) radiological outcomes, including the rate of bony impingement and spontaneous fusion, and bone regrowth of the resection site, (3) clinical outcomes based on pain intensity and scores on the 12-item short-form health survey (SF-12) and neck disability index (NDI), (4) surgical outcomes, and (5) surgery-related complications.

METHODS

We compared baseline data in both groups. To evaluate the impact of our surgical modification on postoperative outcome after ODLP, we compared the outcome measures in 2-year follow-up times. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

RESULTS

The ROM of the cervical spine was significantly greater in Group B 2 years after surgery than in Group A (p=.001). Patient satisfaction (p=.02) at 2 years after surgery and pain intensity of the posterior neck at 1 (p=.01) and 2 years (p<.01) after surgery were better in Group B than in Group A. Radiological evidence of posterior bony impingement and spontaneous fusion between ODLPsegments were definitely fewer less in Group B than in Group A (p<.001 and<0.001, respectively). The mean value of bone regrowth was 1.2 mm (range, 0-3 mm). The NDI and SF-12 scores did not differ significantly between groups. Surgical outcomes and postoperative complications were similar between groups.

CONCLUSIONS

These results indicate that posterior bony impingement can be a factor in ROM restriction after cODLP surgery and that wedge-shaped resection during ODLP can be a reliable option for preserving cervical ROM and improving postoperative clinical and radiological outcomes.