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Wang B, Qu R, Liu Z, Zhao N, Pan S, Chen X, Zhao Y, Dang L, Zhou H, Wei F, Sun Y, Zhou F, Jiang L. Comparison of Postoperative Pain and Surgical Outcomes Between Three Types of Modified Muscle-Sparing Laminoplasty and Conventional Laminoplasty for Multilevel Degenerative Cervical Myelopathy. Global Spine J 2024:21925682241265625. [PMID: 38910265 DOI: 10.1177/21925682241265625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE This study aimed to compare postoperative pain and surgical outcomes of open-door laminoplasty (LP) and three types of muscle-sparing laminoplasties, namely unilateral muscle-preservation laminoplasty (UL), spinous process splitting double-door laminoplasty (DL) and intermuscular "raising roof" laminoplasty (RL) for multilevel degenerative cervical myelopathy (MDCM). METHODS Consecutive MDCM patients underwent LP or modified laminoplasties (UL, DL, RL) in 2022 were enrolled. Patients' preoperative baseline data and surgical characteristics were collected. Postoperative transient pain (TP), the axial pain and Japanese Orthopedic Association (JOA) score and neck disability index (NDI) at 6-month and 12-month follow-up were documented. RESULTS A total of 154 MDCM patients were included and a 12-month follow-up was completed for 148 patients (LP: 36, UL:39, DL: 37, RL:36). No significant difference was observed in the baseline data. Four groups presented favorable and comparable surgical outcome. The RL group reported significantly the least severe TP on the first three days following surgery. However, no significant difference was found in the axial pain and axial symptoms at both follow-ups. After regression analysis, RL group exhibited significantly better efficacy in alleviating Day-1 TP (P = 0.047) and 6-month axial pain (P = 0.040). However, this superiority was not observed at 12-month follow-up. CONCLUSION All the three muscle-sparing laminoplasty procedures showed similar short-term surgical outcomes compared to LP. The RL procedure demonstrated superiority in alleviating TP and 6-month axial pain compared to LP. The RL and DL groups showed less C5 palsy compared to LP.
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Affiliation(s)
- Ben Wang
- Orthopedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Ruomu Qu
- Orthopedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Zexiang Liu
- Orthopedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Nan Zhao
- Orthopedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Shengfa Pan
- Orthopedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Xin Chen
- Orthopedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Yanbin Zhao
- Orthopedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Lei Dang
- Orthopedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Hua Zhou
- Orthopedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Feng Wei
- Orthopedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Yu Sun
- Orthopedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Feifei Zhou
- Orthopedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Liang Jiang
- Orthopedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
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Ruan C, Jiang W, Lu W, Wang Y, Hu X, Ma W. Incidence and Risk Factors for the Development of Axial Symptoms Following Posterior Single-Door Laminoplasty: A Retrospective Analysis. World Neurosurg 2024; 183:e603-e612. [PMID: 38185458 DOI: 10.1016/j.wneu.2023.12.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Posterior single-door laminoplasty is a widely practiced clinical procedure, but the occurrence of postoperative axial syndrome (AS) remains a significant concern. The aim of this study was to identify risk factors associated with AS and develop a risk prediction model. METHODS Clinical data from 226 patients who underwent posterior single-door laminoplasty between June 2017 and June 2022 were collected. Through Logistic model analysis, the risk factors of AS are clarified and the intensity of each risk factor is explained in the form of forest plot. Subsequently, we constructed a predictive model and plotted receiver operating characteristic curves to assess the model's predictive value. RESULTS In the end, 87 cases were diagnosed with AS, resulting in an incidence rate of 38.5%. Logistic regression analysis revealed that preoperative encroachment rate of anterior spinal canal (pre-op ERASC), intraoperative facet joints destruction, intraoperative open-door angle, postoperative loss of cervical curvature, and postoperative loss of cervical range of motion were independent risk factors for AS. Conversely, preoperative cervical curvature (pre-op CC) and postoperation early function training were protective factors against AS. The Youden index indicated that the cutoff values for pre-op ERASC and pre-op CC were 26.6°and 16.5, respectively. The risk prediction model for AS was constructed and a nomogram was plotted. The model has high clinical value. CONCLUSIONS Pre-op ERASC, pre-op CC, intraoperative facet joints destruction, intraoperative open-door angle, postoperative loss of cervical curvature, postoperative loss of cervical range of motion, and postoperation early function training are independent influencing factors for AS occurrence. The risk model has good practicability.
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Affiliation(s)
- Chaoyue Ruan
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Weiyu Jiang
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Wenjie Lu
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Yang Wang
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Xudong Hu
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Weihu Ma
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China.
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Suzuki H, Funaba M, Fujimoto K, Ichihara Y, Nishida N, Sakai T. Current Concepts of Cervical Spine Alignment, Sagittal Deformity, and Cervical Spine Surgery. J Clin Med 2024; 13:1196. [PMID: 38592040 PMCID: PMC10932435 DOI: 10.3390/jcm13051196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 04/10/2024] Open
Abstract
There are not many reports on cervical spine alignment, and only a few analyze ideal surgical approaches and optimal amounts of correction needed for the various types of deformity. We comprehensively reviewed the present literature on cervical spinal deformities (with or without myelopathy) and their surgical management to provide a framework for surgical planning. A general assessment of the parameters actually in use and correlations between cervical and thoracolumbar spine alignment are provided. We also analyzed posterior, anterior, and combined cervical surgical approaches and indications for the associated techniques of laminoplasty, laminectomy and fusion, and anterior cervical discectomy and fusion. Finally, on the basis of the NDI, SF-36, VAS, and mJOA questionnaires, we fully evaluated the outcomes and measures of postoperative health-related quality of life. We found the need for additional prospective studies to further enhance our understanding of the importance of cervical alignment when assessing and treating cervical deformities with or without myelopathy. Future studies need to focus on correlations between cervical alignment parameters, disability scores, and myelopathy outcomes. Through this comprehensive literature review, we offer guidance on practical and important points of surgical technique, cervical alignment, and goals surgeons can meet to improve symptoms in all patients.
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Affiliation(s)
- Hidenori Suzuki
- Department of Orthopedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan; (M.F.); (K.F.); (Y.I.); (N.N.); (T.S.)
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Ruan C, Jiang W, Lu W, Wang Y, Hu X, Ma W. Analysis of risk factors for axial symptoms after posterior cervical open-door laminoplasty. J Orthop Surg Res 2023; 18:954. [PMID: 38082364 PMCID: PMC10714461 DOI: 10.1186/s13018-023-04426-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Laminoplasty (LP), a procedure commonly used to treat cervical spondylotic myelopathy (CSM), often results in the development of axial symptoms (AS) postoperatively. This study aims to analyze the risk factors associated with the occurrence of AS after LP. METHODS We collected and evaluated clinical data from 264 patients with CSM who underwent LP treatment at our institution from January 2018 to January 2022 through a single-center retrospective study. Of the patients, 153 were male and 111 were female, with an average age of 58.1 ± 6.7 years. All patients underwent C3-7 posterior laminoplasty. Based on the occurrence of postoperative axial symptoms, the patients were divided into an AS group and a non-AS group. General information, including age, gender, disease duration, Japanese Orthopaedic Association (JOA) score, postoperation early function training, and collar-wearing time, was recorded and compared between the two groups. Surgical-related data, such as operative segments, surgical time, intraoperative blood loss, intraoperative facet joint destruction, and destruction of the C7 spinous process muscle insertion, were also compared. Imaging data, including preoperative cervical curvature, cervical range of motion, preoperative encroachment rate of the anterior spinal canal, and angle of laminar opening, were collected. Univariate and multivariate logistic regression analyses were used to identify risk factors for the development of AS after LP, and receiver operator characteristic (ROC) curves were utilized to explore the optimal preoperative parameters. RESULTS All 264 patients successfully underwent surgery and were followed up for an average of 19.5 ± 6.8 months. At the 6-month follow-up, 117 patients were diagnosed with AS, resulting in an incidence rate of 40.2%. The multivariate logistic regression analysis identified that preoperative encroachment rate of anterior spinal canal (Pre-op ERASC), intraoperative facet joints destruction (Intra-op FJD), intraoperative open-door angle (Intra-op OA), destroy the C7 spinous process muscle insertion (Destroy C7 SPMI), postoperative loss of cervical curvature (Post-op LCC), and postoperative loss of cervical range of motion (Post-op LCROM) were independent risk factors for AS. Conversely, preoperative cervical curvature (Pre-op CC) and postoperation early function training (Post-op EFT) were protective factors against AS. According to the ROC curve, the cutoff values for preoperative anterior spinal canal occupation rate and preoperative cervical curvature were 28.5% and 16.5°, respectively. When the preoperative anterior spinal canal occupation rate was greater than 28.5% or the preoperative cervical curvature was less than 16.5°, AS was more likely to occur after surgery. CONCLUSION High preoperative anterior spinal canal occupation rate, facet joint damage during surgery, C7 spinous process muscle stop point damage, larger angle of laminar opening, and greater postoperative cervical curvature loss and cervical range of motion loss are associated with an increased risk of developing AS after cervical laminoplasty. Conversely, a larger preoperative cervical curvature and early postoperative functional exercises can help reduce the occurrence of AS.
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Affiliation(s)
- Chaoyue Ruan
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China
| | - Weiyu Jiang
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China
| | - Wenjie Lu
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China
| | - Yang Wang
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China
| | - Xudong Hu
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China
| | - Weihu Ma
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China.
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Qu L, Li Z, Wang X, Yuan L, Li C. Axial Symptoms After Conventional and Modified Laminoplasty: A Meta-analysis. World Neurosurg 2023; 180:112-122. [PMID: 37757947 DOI: 10.1016/j.wneu.2023.09.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE The study aims to evaluate the impact of procedural variations in single-door laminoplasty on axial symptoms (AS) and neurologic outcomes. METHODS A comprehensive literature search was conducted across PubMed, EMBASE, and the Cochrane Library, adhering to specific inclusion criteria. We extracted data on the prevalence of AS in both the modified and conventional laminoplasty groups from the selected studies. Neurologic outcomes were assessed using the Japanese Orthopedic Association (JOA) recovery rate, which was subsequently converted to Hedge's g for analysis. Forest plots were generated to visualize the effect sizes, and publication bias was assessed using both funnel plots and Egger's test. RESULTS Fourteen studies comprising 1201 patients were included in this meta-analysis focused on AS. The aggregated SMD was -0.891 with a 95% CI of -1.146 to -0.631 (P < 0.01), denoting a statistically significant reduction in AS in the modified laminoplasty group compared with the conventional approach. Of the 14 studies, 10, encompassing 898 patients, contributed data for JOA recovery rate analysis. The overall effect size was 0.089, with a 95% CI ranging from -0.090 to 0.267, and a P value of 0.2901, indicating no significant difference in neurologic outcomes between the 2 techniques. No evidence of publication bias was detected. CONCLUSIONS This meta-analysis demonstrates that modified laminoplasty is associated with a significant reduction in the incidence and severity of axial symptoms, without compromising neurologic functionality.
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Affiliation(s)
- Luqiang Qu
- Department of Spine Surgery, Taicang Affiliated Hospital of Soochow University, The First People's Hospital of Taicang, Taicang, Jiangsu, China
| | - Zhonghua Li
- Department of Spine Surgery, Taicang Affiliated Hospital of Soochow University, The First People's Hospital of Taicang, Taicang, Jiangsu, China
| | - Xinwei Wang
- Department of Spine Surgery, Shanghai Changzheng Hospital, Shanghai, China
| | - Lijie Yuan
- Department of Spine Surgery, Taicang Affiliated Hospital of Soochow University, The First People's Hospital of Taicang, Taicang, Jiangsu, China
| | - Chan Li
- Department of Spine Surgery, Taicang Affiliated Hospital of Soochow University, The First People's Hospital of Taicang, Taicang, Jiangsu, China.
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Suo M, Zhang J, Sun T, Wang J, Liu X, Huang H, Li Z. The association between morphological characteristics of paraspinal muscle and spinal disorders. Ann Med 2023; 55:2258922. [PMID: 37722876 PMCID: PMC10512810 DOI: 10.1080/07853890.2023.2258922] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Spinal disorders affect millions of people worldwide, and can cause significant disability and pain. The paraspinal muscles, located on either side of the spinal column, play a crucial role in the movement, support, and stabilization of the spine. Many spinal disorders can affect paraspinal muscles, as evidenced by changes in their morphology, including hypertrophy, atrophy, and degeneration. OBJECTIVES The objectives of this review were to examine the current literature on the relationship between the paraspinal muscles and spinal disorders, summarize the methods used in previous studies, and identify areas for future research. METHODS We reviewed studies on the morphological characteristics of the paravertebral muscle and discussed their relationship with spinal disorders, as well as the current limitations and future research directions. RESULTS The paraspinal muscles play a critical role in spinal disorders and are important targets for the treatment and prevention of spinal disorders. Clinicians should consider the role of the paraspinal muscles in the development and progression of spinal disorders and incorporate assessments of the paraspinal muscle function in clinical practice. CONCLUSION The findings of this review highlight the need for further research to better understand the relationship between the paraspinal muscles and spinal disorders, and to develop effective interventions to improve spinal health and reduce the burden of spinal disorders.
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Affiliation(s)
- Moran Suo
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Jing Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Tianze Sun
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Jinzuo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Xin Liu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Huagui Huang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
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Wu W, Zhang S, Yan T. Initial clinical experiences of the muscle-preserving double door cervical laminoplasty with adjustable mini plates. Front Surg 2023; 9:1049937. [PMID: 36726947 PMCID: PMC9885206 DOI: 10.3389/fsurg.2022.1049937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/27/2022] [Indexed: 01/17/2023] Open
Abstract
Shirashi's double door laminoplasty method was a popular decompression procedure for cervical myelopathy. In this paper, we introduced a modified double door laminoplasty based on Shirashi's method with preliminary results. This study retrospectively analyzed 22 patients who underwent modified double door laminoplasty. During procedure, a single segment of the unilateral lamina was separated from the cervical semispinalis muscle and the multifidus muscle space for the preparation of lamina groove. A self-developed mini titanium plate was used to fix the inner side of the spinous process to complete the fixation after open-door process. The VAS, JOA scores and QoL scale were recorded for pain assessment, neurological and functional recovery. The overall curvature and range of motion of C2-C7 were measured with x-ray images. Changes in sagittal diameter of spinal canal were measured by CT scans. MRI was used to measure the cross-sectional area of cervical paravertebral muscles. All 22 patients successfully recovered with this procedure. The mean operation time, blood loss and follow-up durations were 117 ± 25 min, 149 ± 32 ml and 16.1 ± 3.6 months respectively. The preoperative, 3-month postoperative and 12-month postoperative JOA scores were 9.35 ± 3.25, 13.74 ± 4.86 and 15.73 ± 5.19 respectively. with improvement rates of 57.4% and 83.4%. Mean VAS scores before, 3 months after and 12 months after surgery were 1.81 ± 0.79, 2.82 ± 1.56 and 2.18 ± 1.34 respectively. The C2-7 lordotic angle and overall range of motion shows no statistical difference preoperatively and 12 post-surgery. The average sagittal diameter of the cervical spinal canal was enlarged from 9.15 ± 1.55 mm to 14.25 ± 1.46 mm. The average area of cervical paravertebral volume measured preoperatively and 3 months post operation was 84% of pre-operative value respectively. This value was improved to 93% of the preoperative value at 12 months post-surgery. This paper introduced initial experience on a modified posterior cervical double-door laminoplasty that was based on Shirashi's method, featuring creating bilateral laminar grooves on both sides and fixing central gap with self-developed mini plates. This procedure prevented obvious axial symptoms and improved patients' quality of life, which provided a baseline for further research with larger cohorts.
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