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Li H, Song C, Wang Y, Qiu Z, Yan J, Liu X. Effectiveness of additional C2 decompression of the cervical spinal canal after cervical laminoplasty: a retrospective cohort study. Br J Neurosurg 2024; 38:698-705. [PMID: 34319203 DOI: 10.1080/02688697.2021.1958152] [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: 02/05/2021] [Revised: 06/15/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to assess the effects of additional C2 decompression of the cervical spinal canal on the postoperative outcomes after cervical laminoplasty in patients with cervical stenosis caused by ossification of the posterior longitudinal ligament (OPLL). MATERIALS AND METHODS This retrospective cohort study included patients with cervical stenosis due to OPLL and treated between April 2014 and December 2015. The patients who underwent C2-7 (additional C2 decompression) and C3-7 posterior decompression were compared using the Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) scores, axial symptom scores, and intervals between the posterior margin of the vertebral body and the K-line. RESULTS There were 36 and 24 patients in the additional C2 decompression and control groups, respectively. The JOA scores were higher in the additional C2 decompression group than the controls at 1 and 3 years (p < 0.05). Upper extremity motor function after the operation and at 1 and 3 years and lower extremity motor function after operation were improved in the additional C2 decompression group (all p < 0.05 vs. controls). VAS scores were lower in the additional C2 decompression group than controls at 1 year (p < 0.05). Axial symptom scores in the additional C2 decompression group were decreased postoperatively but increased at 1 and 3 years (p < 0.05 vs. controls). Finally, the posterior shift of the K-line in the additional C2 decompression group was significant (from 0.98 to 1.68 cm, p < 0.05). CONCLUSIONS Additional C2 decompression might improve the effectiveness of cervical laminoplasty in patients with cervical stenosis caused by OPLL.
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Affiliation(s)
- Huashuai Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Chengchao Song
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yufu Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Zhaowen Qiu
- Heilongjiang Tuomeng Technology Co. Ltd., Harbin, China
| | - Jinglong Yan
- Department of Orthopedic Surgery, 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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Liu J, Liu S, Jiang E, Tan Y, Bao X, Niu D, Guo C, Qi J, Shi Z, Xu G. Clinical and Radiographic Outcomes of Modified Posterior Atlantoaxial Temporary Fixation with Preservation of Semispinalis Cervicis: A Comparative Study. Global Spine J 2024; 14:272-282. [PMID: 35603736 PMCID: PMC10676176 DOI: 10.1177/21925682221103832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE Current studies suggested that the posterior cervical deep muscles should be preserved during the atlantoaxial posterior approach. This study aimed to modify the conventional temporary posterior fixation by preserving the semispinalis cervicis and to evaluate the radiographic and clinical outcomes compared with the conventional technique. METHODS Applied anatomical and imaging study were assessed prior to the clinical studies. Thirty patients with odontoid fracture were enrolled. 12 patients underwent modified operation with preservation of semispinalis cervicis (Group P-SSC), and 18 patients underwent conventional approach with detachment of the semispinalis cervicis (Group D-SSC) as controls. Clinical and radiological assessments were evaluated postoperatively, including activities of daily living (ADL), axial symptom scoring system (Ass), cervical range of motion (ROM), and the average atrophy rate of muscles. RESULTS All patients experienced fracture healed within 10 months after temporary fixation. At early follow-up, ADL accompanying extension and flexion were significantly different between the two groups. The Ass scores in the Group P-SSC were constantly higher than that in Group D-SSC. Flexion-Extension ROM in Group P-SSC was significantly larger than that of Group D-SSC. The average atrophy rate at the C3 and C5 level in Group P-SSC was 7.62±3.38% and 7.55±3.89%, repectivcly, while 15.67±5.97% and 8.56±4.76% in Group D-SSC, respectively. Significant differences in the atrophy rate were found between groups at C3 level. CONCLUSIONS Compared with the conventional technique, the modified surgical technique with preservation of semispinalis cervicis was effective in improving axial symptoms, decreasing the atrophy rate of muscles, and increasing the cervical ROM.
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Affiliation(s)
- Jia Liu
- Department of Orthopedic Surgery, Spine Center, Second Affiliated Hospital of Naval Medical University, Shanghai, P. R. China
| | - Shu Liu
- Department of Spine Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, P. R. China
| | - Enze Jiang
- Department of Orthopedic Surgery, Spine Center, Second Affiliated Hospital of Naval Medical University, Shanghai, P. R. China
| | - Yixuan Tan
- Department of Orthopedic Surgery, Spine Center, Second Affiliated Hospital of Naval Medical University, Shanghai, P. R. China
| | - Xiaogang Bao
- Department of Orthopedic Surgery, Spine Center, Second Affiliated Hospital of Naval Medical University, Shanghai, P. R. China
| | - Dongyang Niu
- Department of Orthopedic Surgery, Spine Center, Second Affiliated Hospital of Naval Medical University, Shanghai, P. R. China
| | - Chao Guo
- Department of Orthopedic Surgery, Spine Center, Second Affiliated Hospital of Naval Medical University, Shanghai, P. R. China
| | - Junqiang Qi
- Department of Orthopedic Surgery, Spine Center, Second Affiliated Hospital of Naval Medical University, Shanghai, P. R. China
| | - Zhicai Shi
- Department of Spine Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, P. R. China
| | - Guohua Xu
- Department of Orthopedic Surgery, Spine Center, Second Affiliated Hospital of Naval Medical University, Shanghai, P. R. China
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Oe S, Kurosu K, Hasegawa T, Shimizu S, Yoshida G, Fujita T, Kobayashi S, Yamada T, Ide K, Nakai K, Yotsuya K, Yamato Y, Yasuda T, Banno T, Arima H, Mihara Y, Ushirozako H, Watanabe Y, Matsuyama Y. Risk Factors for Cervical Deformity After Posterior Cervical Decompression Surgery: A Multicenter Study. Global Spine J 2023; 13:1457-1466. [PMID: 34344229 PMCID: PMC10448089 DOI: 10.1177/21925682211036660] [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: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVE Posterior decompression surgery for cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) is a common surgery; however, it can cause postoperative cervical deformity (CD). The purpose of this study was to investigate the risk factors for CD. METHODS The participants were 193 patients underwent laminoplasty or laminectomy for CSM or OPLL. CD was defined as a C2-7 sagittal vertical axis (SVA) ≥ 40 mm or a cervical lordosis angle (CL) ≤ -10°. The participants were divided into 2 groups: NCD (without CD before surgery), CD (with CD before surgery). NCD group was divided based on the presence of CD 1 year after surgery as follows: postoperative CD (PCD) and no PCD (NPCD). RESULTS There were 153 patients (NCD), 40 (CD), 126 (NPCD), and 27 (PCD). There was significant difference in the number of decompressed lamina (NPCD: PCD = 4.1:4.5), the presence of C2 decompression (2: 11%), and C5 palsy (0: 11%). The risk factors for onset of CD, PCD, and CL ≤ -10° as assessed by multiple logistic regression analysis were preoperative C2-7 SVA ≥ 30 mm (odds ratio [OR]: 19.0), decompression of C2 or C7 lamina (OR 3.1), and preoperative CL ≤ 2° (OR 42.0), respectively. CONCLUSIONS To prevent postoperative CD, it is important to avoid decompression of the C2 or C7 lamina. Moreover, in case with C2-7 SVA ≥ 30 mm or CL ≤ 2° before surgery, it is important to explain the risks and consider adding fusion surgery.
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Affiliation(s)
- Shin Oe
- Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Orthopedic Surgery, Haibara General Hospital, Makinohara, Japan
| | - Kenta Kurosu
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Orthopedic Surgery, Shizuoka City Hospital, Shizuoka, Japan
| | - Tomohiko Hasegawa
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Orthopedic Surgery, Japanese Red Cross Hamamatsu Hospital, Hamamatsu, Japan
| | - Satoshi Shimizu
- Department of Orthopedic Surgery, Narita Memorial Hospital, Toyohashi, Japan
| | - Go Yoshida
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Orthopedic Surgery, Aoyama Hospital, Toyokawa, Japan
| | - Tomotada Fujita
- Department of Orthopedic Surgery, Enshu Hospital, Hamamatsu, Japan
| | - Sho Kobayashi
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Tomohiro Yamada
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Orthopedic Surgery, Kikugawa General Hospital, Kikugawa, Japan
| | - Koichiro Ide
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Orthopedic Surgery, Narita Memorial Hospital, Toyohashi, Japan
| | - Keiichi Nakai
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Orthopedic Surgery, Iwata City Hospital, Iwata, Japan
| | - Kumiko Yotsuya
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Orthopedic Surgery, Enshu Hospital, Hamamatsu, Japan
| | - Yu Yamato
- Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tatsuya Yasuda
- Department of Orthopedic Surgery, Iwata City Hospital, Iwata, Japan
| | - Tomohiro Banno
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideyuki Arima
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuki Mihara
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroki Ushirozako
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuh Watanabe
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Liang Z, Xu G, Liu T, Zhong Y, Mo F, Li Z. Quantitatively biomechanical response analysis of posterior musculature reconstruction in cervical single-door laminoplasty. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 233:107479. [PMID: 36933316 DOI: 10.1016/j.cmpb.2023.107479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND AND OBJECTIVE The current trend of laminoplasty is developing toward the goal of muscle preservation and minimum tissue damage. Given this, muscle-preserving techniques in cervical single-door laminoplasty have been modified with protecting the spinous processes at the sites of C2 and/or C7 muscle attachment and reconstruct the posterior musculature in recent years. To date, no study has reported the effect of preserving the posterior musculature during the reconstruction. The purpose of this study is to quantitatively evaluate the biomechanical effect of multiple modified single-door laminoplasty procedures for restoring stability and reducing response level on the cervical spine. METHODS Different cervical laminoplasty models were established for evaluating kinematics and response simulations based on a detailed finite element (FE) head-neck active model (HNAM), including ① C3 - C7 laminoplasty (LP_C37), ② C3 - C6 laminoplasty with C7 spinous process preservation (LP_C36), ③ C3 laminectomy hybrid decompression with C4 - C6 laminoplasty (LT_C3 + LP_C46) and ④ C3 - C7 laminoplasty with unilateral musculature preservation (LP_C37 + UMP). The laminoplasty model was validated by the global range of motion (ROM) and percentage changes relative to the intact state. The C2 - T1 ROM, axial muscle tensile force, and stress/strain levels of functional spinal units were compared among the different laminoplasty groups. The obtained effects were further analysed by comparison with a review of clinical data on cervical laminoplasty scenarios. RESULTS Analysis of the locations of concentration of muscle load showed that the C2 muscle attachment sustained more tensile loading than the C7 muscle attachment, primarily in flexion-extension (FE) and in lateral bending (LB) and axial rotation (AR), respectively. Simulated results further quantified that LP_C36 primarily produced 10% decreases in LB and AR modes relative to LP_C37. Compared with LP_C36, LT_C3 + LP_C46 resulted in approximately 30% decreases in FE motion; LP C37 + UMP also showed a similar trend. Additionally, when compared to LP_C37, LT_C3 + LP_C46 and LP C37 + UMP reduced the peak stress level at the intervertebral disc by at most 2-fold as well as the peak strain level of the facet joint capsule by 2-3-fold. All these findings were well correlated with the result of clinical studies comparing modified laminoplasty and classic laminoplasty. CONCLUSIONS Modified muscle-preserving laminoplasty is superior to classic laminoplasty due to the biomechanical effect of the posterior musculature reconstruction, with a retained postoperative ROM and loading response levels of the functional spinal units. More motion-sparing is beneficial for increasing cervical stability, which probably accelerates the recovery of postoperative neck movement and reduces the risk of the complication for eventual kyphosis and axial pain. Surgeons are encouraged to make every effort to preserve the attachment of the C2 whenever feasible in laminoplasty.
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Affiliation(s)
- Z Liang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China; College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan 410082, China
| | - G Xu
- Department of Orthopedics, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Guangzhou University of Chinese Medicine, Shenzhen 518000, China
| | - T Liu
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Y Zhong
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi 530023, China
| | - F Mo
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan 410082, China.
| | - Z Li
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi 530023, China.
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Kitamura K, de Dios E, Bodon G, Barany L, MacDowall A. Evaluating a paradigm shift from anterior decompression and fusion to muscle-preserving selective laminectomy: a single-center study of degenerative cervical myelopathy. J Neurosurg Spine 2022; 37:740-748. [PMID: 35901775 DOI: 10.3171/2022.4.spine211562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Muscle-preserving selective laminectomy (SL) is an alternative to conventional decompression surgery in patients with degenerative cervical myelopathy (DCM). It is less invasive, preserves the extensor musculature, and maintains the range of motion of the cervical spine. Therefore, the preferred treatment for DCM at the authors' institution has changed from anterior decompression and fusion (ADF), including anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF), toward SL. The aim of this study was to evaluate surgical outcomes before and after this paradigm shift with patient-reported outcome measures (PROMs), complications, reoperations, and cost-effectiveness. METHODS This study was a retrospective register-based cohort study. All patients with DCM who underwent ADF or SL at the authors' institution from 2008 to 2019 were reviewed. Using ANCOVA, changes in PROMs from baseline to the 2-year follow-up were compared between the two groups, adjusting for clinicodemographic parameters, baseline PROMs, number of decompressed levels, and MRI measurements (C2-7 Cobb angle, C2-7 sagittal vertical axis [SVA], and modified K-line interval [mK-line INT]). The PROMs, including the European Myelopathy Score (EMS), the Neck Disability Index (NDI), and the EQ-5D, were collected from the national Swedish Spine Register. Complications, reoperations, and in-hospital treatment costs were also compared between the two groups. RESULTS Ninety patients (mean age 60.7 years, 51 men [57%]) were included in the ADF group and 63 patients (mean age 68.8 years, 41 men [65%]) in the SL group. The ADF and SL groups had similar PROMs at baseline. The preoperative MR images showed similar C2-7 Cobb angles (10.7° [ADF] vs 14.1° [SL], p = 0.12) and mK-line INTs (4.08 vs 4.88 mm, p = 0.07), but different C2-7 SVA values (16.2 vs 19.3 mm, p = 0.04). The comparison of ANCOVA-adjusted mean changes in PROMs from baseline to the 2-year follow-up presented no significant differences between the groups (EMS, p = 0.901; NDI, p = 0.639; EQ-5D, p = 0.378; and EQ-5D health, p = 0.418). The overall complication rate was twice as high in the ADF group (22.2% vs 9.5%, p = 0.049), while the reoperation rate was comparable (16.7% vs 7.9%, p = 0.146). The average in-hospital treatment cost per patient was $6617 (USD) for SL, $7046 for ACDF, and $12,000 for ACCF. CONCLUSIONS SL provides similar PROMs after 2 years, a significantly lower complication rate, and better cost-effectiveness compared with ADF.
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Affiliation(s)
- Kazuya Kitamura
- 1Department of Orthopaedic Surgery, National Defense Medical College, Saitama, Japan
- 2Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- 3Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Eddie de Dios
- 3Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Gergely Bodon
- 4Department of Orthopaedic and Trauma Surgery, Klinikum Esslingen, Esslingen am Neckar, Germany; and
| | - Laszlo Barany
- 5Department of Neurosurgery, University of Erlangen, Erlangen, Germany
| | - Anna MacDowall
- 3Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Zuo KK, Qin W, Miao Y, Zhu L. Analysis of risk factors of axial neck pain in posterior cervical single-door laminoplasty from the perspective of cervical sagittal plane. Front Surg 2022; 9:973924. [PMID: 36189387 PMCID: PMC9515390 DOI: 10.3389/fsurg.2022.973924] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
Objective We carried out this study to explore the possible relationship between the cervical sagittal parameters in radiological images and axial neck pain (ANP) for patients who had underwent posterior cervical single-door laminoplasty. Method 141 patients were enrolled in the study from January 2018 to January 2021, among which 38 were enrolled into the ANP group and 103 were enrolled into the non-ANP group. C2–7 Cobb angle, C2–7 sagittal vertex axis (SVA), thoracic inlet angle, neck tilt, and T1 slope were measured using computed tomography. Spearman correlation tests were used to analyze the possible correlation between radiological parameters and ANP. Logistic regression was carried out to analyze the potential risk factor for the occurrence of ANP. Receiver operating characteristic (ROC) curve and area under the ROC curve were used to evaluate the significant result and the optimal diagnostic value. Results As for radiographic parameters in the sagittal plane, the results suggested that only T1 slope and C2–7 SVA were statistically different between the ANP and non-ANP group (p = 0.001 and p = 0.047). Patients whose surgery involved the C2 spinous process demonstrated severe ANP symptoms than patients in the non-ANP group (p = 0.003). The Spearman correlation test showed that no statistical differences were found between visual analog scale (VAS) and radiological morphology parameters and only C2 involvement was found to correlate with postoperative VAS with respect to surgery. Logistic multivariate regression analysis demonstrated that only C2 involvement and T1 slope were significantly different when C2–7 SVA, T1 slope, C2 involvement together were included into consideration, with p values of 0.01 and 0.001. Conclusion According to our research, C2 involvement and greater T1 slope were independent risk factors of ANP for the patients who underwent laminoplasty of cervical spine.
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Affiliation(s)
- Kang Kang Zuo
- Department of Orthopaedics, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Wei Qin
- Department of Orthopedics of Xiang Yang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiang Yang, China
| | - Yu Miao
- Department of Orthopedics, Renmin Hospital of Yunyang District, Shiyan, China
| | - Lei Zhu
- Department of Orthopaedics, Renmin Hospital, Hubei University of Medicine, Shiyan, China
- Correspondence: Lei Zhu
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Kurihara K, Iba K, Teramoto A, Emori M, Hirota R, Oshigiri T, Ogon I, Iesato N, Terashima Y, Takashima H, Yoshimoto M, Takebayashi T, Yamashita T. Effect of Minimally Invasive Selective Laminectomy for Cervical Spondylotic Myelopathy on Degenerative Spondylolisthesis. Clin Spine Surg 2022; 35:E242-E247. [PMID: 33769983 DOI: 10.1097/bsd.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected observational data. OBJECTIVE This study aimed to evaluate the slippage, sagittal alignment, and range of motion (ROM) after selective laminectomy (SL) in patients who had cervical spondylotic myelopathy (CSM) with degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA Clinical outcomes have been reported for both decompression and fusion surgeries for DS of the lumbar spine. However, only a few reports have examined cervical spine spondylolisthesis. MATERIALS AND METHODS This study included 178 patients who underwent SL for CSM. Those with ossification of the posterior longitudinal ligament were excluded. Slippage >2 mm was defined as spondylolisthesis, and spondylolisthesis progression was defined as an additional displacement >2 mm on a neutral radiograph. The slippage, translational motion, C2-C7 angle, local kyphosis, and ROM were examined before and ≥2 years after surgery. Radiologic parameters were evaluated according to the slip direction and the number of laminae removed. RESULTS DS was observed in 29 patients (16.3%); 24 patients, comprising 9 and 15 in the anterolisthesis and retrolisthesis groups, respectively, were successfully followed up for more than 2 years. Preoperative and postoperative radiologic changes in slippage, translational motion, C2-C7 angle, local kyphosis, and ROM were not remarkable in either group regardless of the number of laminae removed. Revision surgery for the progression of DS and alignment deterioration was not required in any patient of either group. CONCLUSIONS SL does not affect DS, sagittal alignment, or ROM irrespective of the slip direction and the number of laminae removed, even after >2 years after surgery. Given the preservation of the posterior elements, SL may be an effective treatment for CSM with DS. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Kota Kurihara
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Makoto Emori
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Ryosuke Hirota
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Tsutomu Oshigiri
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Izaya Ogon
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Noriyuki Iesato
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Yoshinori Terashima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Hiroyuki Takashima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Mitsunori Yoshimoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Tsuneo Takebayashi
- Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
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Zhao H, Ren R, Ma W, Xu S, Peng L, Zhong Z, Zheng Y. Comparison of Laminoplasty vs. Laminectomy for Cervical Spondylotic Myelopathy: A Systematic Review and Meta-Analysis. Front Surg 2022; 8:790593. [PMID: 35111804 PMCID: PMC8801503 DOI: 10.3389/fsurg.2021.790593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Laminoplasty (LP) and laminectomy (LC) with or without fusion are recommended as treatment procedures for cervical spondylotic myelopathy (CSM). The purpose of this study is to conduct a meta-analysis to analyze the results of CSM patients undergoing LP or LC surgery. METHODS We systematically and comprehensively searched Web of Science, Cochrane Library, PubMed, EMBASE, OVID, VIP database, Google Scholar, Chinese Bio-medicine Literature database, and China Scientific Journal Full-text database to July 2021 for randomized controlled trials (RCTs) and observational case series that compared LP and LC in patients with CSM. The main endpoints were the surgical process, radiographic outcomes, clinical outcomes, and surgical complications. RESULTS A total of 19 were included the inclusion criteria in this meta-analysis (n = 4,348 patients). There was no significant difference in range of motion (ROM), sagittal vertical axis (SVA), Japanese Orthopedic Association (JOA), Cobb angle, visual analog scale (VAS), cervical curvature index (CCI), Nurick score, Neck Dysfunction Index (NDI), and complications. LP was found to be superior than LC in terms of complications of C5 radiculopathy and surperficial infection. CONCLUSION Our results indicate that LP can achieve better results in C5 radiculopathy and superficial infection in surgical treatment of CSM compared with LC. Further high-quality research is warranted to further verify our findings. SYSTEMATIC REVIEW REGISTRATION PRISMA: CRD42018107070.
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Affiliation(s)
- Huaguo Zhao
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
| | - Rong Ren
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
| | - Weihu Ma
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
| | - Song Xu
- Department of Hepatobiliary Surgery, Shangyu People's Hospital of Shaoxing, Shaoxing, China
| | - Linrui Peng
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
| | - Zhaoping Zhong
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
| | - Yan Zheng
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
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Comparative Effectiveness and Safety of Open-Door Laminoplasty, French-Door Laminoplasty, Laminectomy and Fusion, and Laminectomy Alone for Multilevel Degenerative Cervical Myelopathy: A Bayesian Network Analysis. Adv Ther 2022; 39:117-139. [PMID: 34812993 DOI: 10.1007/s12325-021-01980-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the comparative effectiveness and safety of open-door laminoplasty (OLP), French-door laminoplasty (FLP), laminectomy and fusion (LF), and laminectomy alone (LA) in treating multilevel degenerative cervical myelopathy (MDCM). METHODS Embase, PubMed, and Cochrane library were searched from their inception date to 7 January 2021. Randomized controlled trials and cohort studies comparing OLP, FLP, LF, and LA were identified to perform a network meta-analysis (NMA). RESULTS A total of 30 studies with 2671 patients were included. Our NMA results showed no significant difference between LF and OLP, but both are superior to LA and FLP in the comparison of JOA (Japanese Orthopaedic Association) score improvement. LF showed a most unsatisfactory outcome in postoperative range of motion (ROM) compared with LA or OLP or with FLP. For the complication outcome, no significant differences were found. The surface under the cumulative ranking curves (SUCRA) for JOA improvement was as follows: LF, OPL, LA, and FLP. For ROM reduction it was LA, OPL, FPL, and LF. For complications it was LF, LA, OLP, and FLP. CONCLUSIONS Considering all the evaluated criteria, none of the procedures showed the best outcome with least complications and optimal efficacy. However, OLP can be most recommended because of its second-ranking spectra in both of JOA improvement and ROM reduction, also with an acceptable incidence of complications, with the third least.
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Uehara M, Ikegami S, Kuraishi S, Oba H, Takizawa T, Munakata R, Hatakenaka T, Takahashi J. Ten-year clinical and radiographic results of computer-assisted cervical pedicle screw fixation combined with laminoplasty. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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11
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Wang Z, Xu JX, Liu Z, Li RY, Wang ZW, Chang HR, Ding WY, Yang DL. Spino cranial angle as a predictor of loss of cervical lordosis after laminoplasty in patients with cervical myelopathy. BMC Surg 2021; 21:291. [PMID: 34118924 PMCID: PMC8199803 DOI: 10.1186/s12893-021-01293-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/07/2021] [Indexed: 01/24/2023] Open
Abstract
Background To explore the relationship between spino cranial angle (SCA) and loss of cervical lordosis (LOCL), and to determine whether SCA has the ability to predict LOCL for patients with cervical myelopathy. Methods A total of 68 consecutive patients with cervical myelopathy who received laminoplasty (LAMP) were selected to the current study. C2–C7 lordosis was defined as a representation of the cervical alignment. Alignment change > 0° was considered LOCL. Multiple linear regression analysis was applied to evaluate the association between LOCL and various sagittal parameters at preoperative, such as SCA, CL, T1s and cSVA. Linear regression analysis was applied to evaluate the relationships between LOCL and preoperative SCA in each subgroup. Results Patients were assigned to three groups depending on the quartile of preoperative SCA. The first quarter of patients were defined as the low SCA group, the last quarter were defined as the high SCA group and the middle half were defined as the middle SCA group. There was no statistically significant difference in age, sex and the type of OPLL among the three groups. Patients in the low SCA group showed more cervical lordosis before surgery and more LOCL after LAMP (p < 0.001). After linear regression analysis for SCA and LOCL, preoperative SCA was negatively correlated with LOCL in the low SCA group (r = − 0.857, p < 0.001) and high SCA group (r = − 0.515, p = 0.034). However, there was no significant correlation between preoperative SCA and LOCL in the middle SCA group (r = 0.027, p = 0.881). Conclusions Patients with lower SCA had more lordosis preoperatively and performed more LOCL after LAMP at 2 years of follow-up. Both too high or low preoperative SCA were negatively correlated with the degree of LOCL, while when the SCA fluctuates in a suitable range, it is easier to compensate for the changes of cervical sagittal alignment.
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Affiliation(s)
- Zheng Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Jia-Xin Xu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Zhen Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Ruo-Yu Li
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Zhi-Wei Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Heng-Rui Chang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Da-Long Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.
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Wang H, Zhang L. Expansion of Spinal Canal with Lift-Open Laminoplasty: A New Method for Compression Cervical Myelopathy. Orthop Surg 2021; 13:1673-1681. [PMID: 34109741 PMCID: PMC8313177 DOI: 10.1111/os.13026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study is to introduce lift-open laminoplasty and verify the increase of the spinal canal area following this surgical technique according to the preoperative anatomical measurement. METHODS There are 82 patients (43 male and 39 female) analyzed in our study from January 2019 to December 2020. The average age was 63.2 ± 3.21 years (from 41 to 84 years). All of them were treated with open-door laminoplasty, with a decompression segment range from C3 to C6. The increase of the spinal canal area after open-door laminoplasty was measured on postoperative CT images of the patients, and the distances between both lamina-facet junctions and lamina length was measured on preoperative CT images. Using the Pythagorean theorem for the equation of calculation area after the expansile open-door laminoplasty. Based on previous measurement parameters, spinous process length, lateral mass width, distance between osteotomy line and lamina-facet junctions line were additionally measured on preoperative CT images. Pythagorean theorem was used for calculating the area after the expansile lift-open laminoplasty. The results were recorded and a statistical analysis was undertaken. Then, there were six patients (five male and one female) treated with lift-open laminoplasty on C6, open-door on C3-C5, who suffer from cervical spondylotic myelopathy from December 2020 to January 2021. The average age was 60.3 ± 1.7 years (from 56 to 71 years). Operation time, blood loss, and Japanese Orthopaedic Association (JOA) score recovery rate were recorded. Intraoperative and postoperative complications were observed. RESULTS The increase of the spinal canal area after open-door laminoplasty measured on postoperative CT images was 123.01 ± 17.06 mm2 and the calculation of the increase of the spinal canal areausing the Pythagorean theorem after open-door laminoplasty was 122.86 ± 15.86 mm2 . A comparison of the actual value with calculative value showed no significant difference (T value = 0.057, P value = 0.955). The calculation of the increase of the spinal canal area after lift-open laminoplasty was 183.57 ± 62.99 mm2 , which was larger than that after open-door laminoplasty (T value = 8.462, P value < 0.001). Mean operation time was 153.3 min and operative blood loss was 600 mL of the six patients treated with lift-open laminoplasty. At 1 month follow-up, all patients had recovered well. JOA score recovery rate was 37.6% and no intraoperative and postoperative complications occurred. CONCLUSION Lift-open laminoplasty could preserve nearly 100% of extensor muscle, avoid damaging C7 paraspinal muscles and C6-7 posterior muscle-ligament complex, reconstruct the spinous process firmly in the midline, and expand adequate spinal canal area after operation. These advantages could reduce the incidence rate of complications and bring better clinical results than traditional laminoplasty.
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Affiliation(s)
- Huan Wang
- Spinal Surgery Unit, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lei Zhang
- Spinal Surgery Unit, Shengjing Hospital of China Medical University, Shenyang, China
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Abstract
STUDY DESIGN Case report. OBJECTIVE To summarize the clinical manifestations and treatment of Factor XI deficiency in a patient with cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA Factor XI deficiency is a rare genetic bleeding disorder caused by reduced levels and insufficient activity of a coagulation factor XI. It is claimed to be associated with prominent bleeding in case of trauma and surgery irrelevant to the FXI level. This is the first ever case of a patient with factor XI deficiency with cervical spondylotic myelopathy. METHODS A case was investigated retrospectively and the relevant literature was reviewed. RESULTS A 66-year-old man with a 2-months history of lack of finger dexterity and gait disturbance was referred to our department. He did not have a history of bleeding or coagulation disorder nor did his family. Magnetic resonance imaging (MRI) of the cervical spine revealed spinal canal stenosis at C3/4 to C5/6 and intramedullary hyperintensity at C3/4 on the :T2 weighted image (T2WI). Preoperative examination revealed no abnormal findings but a severe prolonged activated partial-thromboplastin time (APTT) of 139.8 seconds. Coagulation factor activity assay revealed severe deficiency of factor XI (<0.1%). In accordance with hematologist's recommendation, four units of fresh frozen plasma (FFP) were transfused on the day before surgery and APTT assayed early morning on the day of surgery was 70.5 seconds. An additional four units of FFP were transfused during the surgery and APTT was 60 seconds. The postoperative course was uneventful and the patient was discharged on the postoperative day 14. CONCLUSION Factor XI deficiency patients may develop excessive bleeding after trauma or surgery. Preoperative examination with prolonged APTT should be pursued until a diagnosis of is made. Under diagnosis of Factor XI deficiency, meticulous attentions are required for perioperative bleeding management including postoperative hematoma in spinal surgery.Level of Evidence: 5.
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Roberti F, Arsenault KL. Minimally invasive tubular laminectomies in multilevel spine surgery-an illustrative case-based review of techniques and combined approaches. JOURNAL OF SPINE SURGERY 2021; 7:83-99. [PMID: 33834131 DOI: 10.21037/jss-20-635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Minimally invasive techniques have become part of the spine surgeons' armamentarium and are currently utilized to treat many conditions involving the cervical, thoracic, lumbar and sacral spine. Surgical treatment of severe degenerative conditions such as multilevel spinal stenosis, tandem stenosis, combination of stenosis or disk herniation and spondylolisthesis at adjacent spinal levels, as well as extensive infections or hematomas, may require a multilevel tailored approach with all the challenges that such surgical planning entails. Although the use of minimally invasive tubular decompressive procedures has gained widespread popularity in the recent years, the adoption of such techniques during multilevel spine surgery can be at times challenging. A careful tailored selection of the surgical approach that better fits needs and expectations of the patient is therefore consequential to achieve good clinical and radiological outcome without compromising efficiency and results. Many surgical techniques have been described in literature but very few reports on the use of combined tubular approached are currently present. We therefore present an illustrative review of techniques for tubular laminectomies and combined approaches that can be utilized in the surgical treatment of multilevel spinal conditions. Illustrative cases documenting common and less common indications for the use of minimally invasive laminectomies are also presented.
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Affiliation(s)
- Fabio Roberti
- Section of Neurosurgery, Cleveland Clinic Indian River Hospital, Vero Beach, FL, USA.,Department of Neurological Surgery, The George Washington University, Washington, DC, USA
| | - Katie L Arsenault
- Section of Neurosurgery, Cleveland Clinic Indian River Hospital, Vero Beach, FL, USA
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15
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Roberti F. Tailored minimally invasive tubular laminectomies for the urgent treatment of rare holocord spinal epidural abscess: case report and review of technique. JOURNAL OF SPINE SURGERY 2020; 6:729-735. [PMID: 33447675 DOI: 10.21037/jss-20-603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spinal abscesses that involve the full length of the spine, from the cervical to the sacral regions, are rare and account for approximately 1% of spinal epidural infections. Urgent surgical decompression combined with antibiotics treatment is usually recommended in these patients and selection of the most suitable surgical approach is tailored on the extent and location of the fluid collection. We present a rare case of holocord spinal epidural abscess treated with cervico-thoracic-lumbar tandem tubular decompressive laminectomies with alternating incisions, which were tailored on the preoperative sagittal and axial extension of the abscess. This minimally invasive procedure allowed for the successful drainage and decompression of the epidural space in an adult patient presenting with acute worsening tetraparesis. After the surgery the patient's neurological examination improved and follow up radiological studies confirmed the successful decompression of the epidural space. Tailoring not only the level but also the laterality of the tandem tubular approach, may be beneficial in minimizing soft tissues trauma, blood loss, operative time and need for more extensive surgical exposure, while successfully treating rare holospinal epidural infections. Minimally invasive tailored decompression of holocord spinal epidural abscesses should be considered as a surgical option in selected patients presenting with acute neurological symptoms.
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Affiliation(s)
- Fabio Roberti
- Section of Neurosurgery, Cleveland Clinic Indian River Hospital, Vero Beach, FL, USA.,Department of Neurological Surgery, The George Washington University, Washington DC, USA
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Rahmani R, Susa ST, Sandwell SE, Kimmell KT, Maurer PK, Silberstein HJ, Nadler JW, Walter KA. Perioperative Risk of the Sitting Position for Elective Posterior Cervical Spine Surgery: A Retrospective Case Series. NEUROSURGERY OPEN 2020. [DOI: 10.1093/neuopn/okaa009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
BACKGROUND
The sitting cervical position for elective posterior cervical decompression and fusion affords advantages over prone positioning, but remains unpopular due to concerns about venous air embolism (VAE).
OBJECTIVE
To demonstrate the safety and efficacy of sitting cervical surgery in our series and in the literature.
METHODS
To evaluate the incidence of complications, we retrospectively identified all adult patients who underwent elective sitting posterior cervical surgeries at our institution from 2009 to 2014. Using International Classification of Diseases-9 coding, we searched for incidences of air embolism, myocardial infarction, pulmonary embolism, and deep vein thrombosis. Operative time, estimated blood loss, and case type distribution were also recorded. We then calculated the incidence of clinically significant VAE in sitting cervical surgeries.
RESULTS
Between 2009 and 2014, 558 surgeries were performed in the sitting cervical position. No VAE was identified. The average operative time was 1 h 25 min. A total of 30-d perioperative complications among sitting position patients included 3 myocardial infarctions, 1 pulmonary embolism attributed to venous thrombosis, and 2 patients with deep venous thrombosis for a total cardiovascular complication rate of 1.1%. The incidence of clinically significant VAE in the literature is 1.5%.
CONCLUSION
We present the second largest case series to date on the sitting position for cervical surgeries, highlighting its safety and efficacy. This position provides a surgical field with superior visualization, allowing decreased operative time and blood loss. The risk of clinically significant VAE is low. Intraoperative monitoring for these events with less invasive means is safe and effective.
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Affiliation(s)
- Redi Rahmani
- Department of Neurosurgery, University of Rochester, Rochester, New York
| | - Stephen T Susa
- Department of Neurosurgery, University of Rochester, Rochester, New York
| | | | | | - Paul K Maurer
- Department of Neurosurgery, Unity Hospital, Rochester, New York
| | | | - Jacob W Nadler
- Department of Anesthesiology, University of Rochester, Rochester, New York
| | - Kevin A Walter
- Department of Neurosurgery, University of Rochester, Rochester, New York
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Lee YS, Lee S, Ko MJ, Cho DC, Kim KT. Preservation of Deep Cervical Extensor Muscle Volume: Comparison Between Conventional Open-Door and Muscle Preserving Laminoplasty Approaches in the Same Patients. World Neurosurg 2020; 141:e514-e523. [PMID: 32492549 DOI: 10.1016/j.wneu.2020.05.225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical laminoplasty techniques have been developed to reduce cervical kyphosis and postoperative axial neck pain and preserve the posterior cervical extensor muscles. We compared a unilateral conventional open approach (OA) and a contralateral muscle preserving approach (MPA) for laminoplasty in the same patients to determine differences in the preservation of the posterior cervical muscles after the 2 approaches. METHODS This study was a prospective observational study involving 44 patients who underwent laminoplasty with unilateral OA and contralateral MPA for cervical myelopathy from January 2005 to December 2013. The cross-sectional area (CSA) changes in the posterior cervical extensor muscles (multifidus, semispinalis cervicis, and semispinalis capitis muscles) were measured on computed tomography scan, both pre- and postoperatively. RESULTS Using an OA, the multifidus and semispinalis cervicis muscle preservation was 58.2% and 67.0%, but using an MPA, muscle preservation was 97% and 90.8% (P < 0.001 and P = 0.042), respectively. However, the CSA of the semispinalis capitis muscle did not differ significantly between the 2 groups. In terms of the level, conservation of the multifidus muscle was significantly different according to the approach at all levels, and the conservation of the deep extensor muscles was significantly different at the C3-4 level. CONCLUSIONS MPA was effective in preserving the volume of deep cervical extensor muscles and helping minimize postoperative musculoskeletal complications. In addition, muscle preservation was more effective at the C3-4 level.
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Affiliation(s)
- Young-Seok Lee
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Subum Lee
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Myeong Jin Ko
- Department of Neurosurgery, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Dae-Chul Cho
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea.
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Nori S, Shiraishi T, Aoyama R. Comparison between muscle-preserving selective laminectomy and laminoplasty for multilevel cervical spondylotic myelopathy. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:160. [PMID: 32309308 PMCID: PMC7154447 DOI: 10.21037/atm.2019.11.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Satoshi Nori
- Department of Orthopedic Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | | | - Ryoma Aoyama
- Department of Orthopedic Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
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Cheung JPY, Cheung PWH, Law K, Borse V, Lau YM, Mak LF, Cheng A, Samartzis D, Cheung KMC. Postoperative Rigid Cervical Collar Leads to Less Axial Neck Pain in the Early Stage After Open-Door Laminoplasty-A Single-Blinded Randomized Controlled Trial. Neurosurgery 2020; 85:325-334. [PMID: 30113664 DOI: 10.1093/neuros/nyy359] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/11/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cervical collars are used after laminoplasty to protect the hinge opening, reduce risks of hinge fractures, and avoid spring-back phenomena. However, their use may lead to reduced range of motion and worse neck pain. OBJECTIVE To investigate the clinical, radiological, and functional outcomes of patients undergoing single-door laminoplasty with or without collar immobilization. METHODS This was a prospective, parallel, single-blinded randomized controlled trial. Patients underwent standardized single-door laminoplasty with mini-plates for cervical myelopathy and were randomly allocated into 2 groups based on the use of collar postoperatively. Clinical assessments included cervical range of motion, axial neck pain (VAS [visual analogue scale]), and objective scores (short-form 36-item, neck disability index, and modified Japanese Orthopaedic Association). All assessments were performed preoperatively and at postoperative 1, 2, 3, and 6 wk, and 3, 6, and 12 mo. Comparative analysis was performed via analysis of variance adjusted by baseline scores, sex, and age as covariates. RESULTS A total of 35 patients were recruited and randomized to collar use (n = 16) and without (n = 19). There were no dropouts or complications. There were no differences between groups at baseline. Subjects had comparable objective scores and range of motion at postoperative time-points. Patients without collar use had higher VAS at postoperative 1 wk (5.4 vs 3.5; P = .038) and 2 wk (3.5 vs 1.5; P = .028) but subsequently follow-up revealed no differences between the 2 groups. CONCLUSION The use of a rigid collar after laminoplasty leads to less axial neck pain in the first 2 wk after surgery. However, there is no additional benefit with regards to range of motion, quality of life, and complication risk.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Karlen Law
- Department of Occupational Therapy, Duchess of Kent Children's Hospital, Sandy Bay, Hong Kong SAR, China
| | - Vishal Borse
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Yuk Ming Lau
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ling Fung Mak
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Aldous Cheng
- Department of Physiotherapy, Duchess of Kent Children's Hospital, Sandy Bay, Hong Kong SAR, China
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Kenneth Man Chee Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Miyazaki M, Ishihara T, Abe T, Kanezaki S, Notani N, Sato S, Kataoka M, Tsumura H. Analysis of the reciprocal changes in upper cervical profile and the risk factors for increasing cervical sagittal vertical axis after laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine. Clin Neurol Neurosurg 2020; 194:105788. [PMID: 32222651 DOI: 10.1016/j.clineuro.2020.105788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to elucidate the reciprocal changes in the upper cervical profile and the risk factors for increasing cervical sagittal vertical axis (cSVA) after laminoplasty for ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. PATIENTS AND METHODS This retrospective study included thirty-nine consecutive patients (30 men and 9 women) with cervical OPLL who underwent cervical laminoplasty. We recorded the operative time, blood loss, Japanese Orthopaedic Association (JOA) score recovery rate. Radiological measurements were performed to analyze the following parameters: pre and 1- year postoperative chin-brow vertical angle (CBVA), McGregor's slope (McGS), occiput to C2 Cobb angle (O-C2 angle), C2-C7 Cobb angle (C2-C7 angle), T1-slope (T1S), C2-C7 sagittal vertical axis (cSVA) and calculated the change (Δ). Patients were divided into two groups according to ΔcSVA: positive (ΔcSVA ≥ 0) and negative (ΔcSVA < 0). RESULTS Postoperative O-C2 angle (P = 0.028), ΔO-C2 angle (P = 0.019), ΔC2-C7 angle (P = 0.030) and T1S (P = 0.009) diff ;ered between the two groups. ΔcSVA showed a positive correlation with ΔO-C2 (R = 0.365, P = 0.022) and T1S (R = 0.472, P = 0.002). ΔO-C2 showed a positive correlation with T1S (R = 0.478, P = 0.002) and a negative correlation with ΔC2-C7 (R=-0.443, P = 0.005). ΔC2-C7 showed a negative correlation with T1S (R=-0.415, P = 0.009). Stepwise multiple linear regression analysis showed that ΔcSVA increased by 0.757 mm for each T1 slope and increased by 0.905 mm for each ΔMcGS. CONCLUSION Increasing the lordosis in the O-C2 segment compensates for the loss of lordosis in the C2-C7 segment after cervical laminoplasty. Higher T1S is a risk factor for increasing cSVA after laminoplasty for OPLL of the cervical spine.
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Affiliation(s)
- Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan.
| | - Toshinobu Ishihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan; Acute Trauma and Critical Care Center, Oita University Hospital, Oita, Japan
| | - Naoki Notani
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan; Acute Trauma and Critical Care Center, Oita University Hospital, Oita, Japan
| | - Shota Sato
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Masashi Kataoka
- Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Jiang F, Wilson JRF, Badhiwala JH, Santaguida C, Weber MH, Wilson JR, Fehlings MG. Quality and Safety Improvement in Spine Surgery. Global Spine J 2020; 10:17S-28S. [PMID: 31934516 PMCID: PMC6947676 DOI: 10.1177/2192568219839699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Review article. OBJECTIVES A narrative review of the literature on the current advances and limitations in quality and safety improvement initiatives in spine surgery. METHODS A comprehensive literature search was performed using Ovid MEDLINE focusing on 3 preidentified concepts: (1) quality and safety improvement, (2) reporting of outcomes and adverse events, and (3) prediction model and practice guidelines. The search was conducted under appropriate subject headings and using relevant text words. Articles were screened, and manuscripts relevant to this discussion were included in the narrative review. RESULTS Quality and safety improvement remains a major research focus attracting investigators from the global spine community. Multiple databases and registries have been developed for the purpose of generating data and monitoring the progress of quality and safety improvement initiatives. The development of various prediction models and clinical practice guidelines has helped shape the care of spine patients in the modern era. With the reported success of exemplary programs initiated by the Northwestern and Seattle Spine Team, other quality and safety improvement initiatives are anticipated to follow. However, despite these advancements, the reporting metrics for outcomes and adverse events remain heterogeneous in the literature. CONCLUSION Constant surveillance and continuous improvement of the quality and safety of spine treatments is imperative in modern health care. Although great advancement has been made, issues with reporting outcomes and adverse events persist, and improvement in this regard is certainly needed.
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Affiliation(s)
- Fan Jiang
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | - Jamie R. F. Wilson
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | - Jetan H. Badhiwala
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jefferson R. Wilson
- University of Toronto, Toronto, Ontario, Canada,St Michael’s Hospital, Toronto, Ontario, Canada
| | - Michael G. Fehlings
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada,Michael G. Fehlings, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T2S8, Canada.
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Bajamal AH, Kim SH, Arifianto MR, Faris M, Subagio EA, Roitberg B, Udo-Inyang I, Belding J, Zileli M, Parthiban JKBC. Posterior Surgical Techniques for Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations. Neurospine 2019; 16:421-434. [PMID: 31607074 PMCID: PMC6790723 DOI: 10.14245/ns.1938274.137] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/15/2019] [Indexed: 12/11/2022] Open
Abstract
Objective This study was conducted to determine and recommend the most up-to-date information on the indications, complications, and outcomes of posterior surgical treatments for cervical spondylotic myelopathy (CSM) on the basis of a literature review.
Methods A comprehensive literature search was performed, using the MEDLINE (PubMed), the Cochrane Register of Controlled Trials, and Web of Science databases, for peer-reviewed articles published in English during the last 10 years.
Results Posterior techniques, which include laminectomy alone, laminectomy with fusion, and laminoplasty, are often used in patients with involvement of 3 or more levels. Posterior decompression for CSM is effective for improving patients’ neurological function. Complications resulting from posterior cervical spine surgery include injury to the spinal cord and nerve roots, complications related to posterior screw fixation or instrumentation, C5 palsy, spring-back closure of lamina, and postlaminectomy kyphosis.
Conclusion It is necessary to consider multiple factors when deciding on the appropriate operation for a particular patient. Surgeons need to tailor preoperative discussions to ensure that patients are aware of these facts. Further research is needed on the cost-to-benefit analysis of various surgical approaches, the comparative efficacy of surgical approaches using various techniques, and long-term outcomes, as current knowledge is deficient in this regard.
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Affiliation(s)
- Abdul Hafid Bajamal
- Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Airlangga University, Surabaya, Indonesia
| | - Se-Hoon Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea
| | - Mohammad Reza Arifianto
- Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Airlangga University, Surabaya, Indonesia
| | - Muhammad Faris
- Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Airlangga University, Surabaya, Indonesia
| | - Eko Agus Subagio
- Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Airlangga University, Surabaya, Indonesia
| | - Ben Roitberg
- Department of Neurosurgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Inyang Udo-Inyang
- Department of Neurosurgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jonathan Belding
- Department of Neurosurgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University Faculty of Medicine, Izmir, Turkey
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Skip laminectomy versus cervical laminectomy, an analysis of patient reported outcomes, spinal alignment and re-operation rates: The Leeds spinal unit experience (2008–2016). INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Fouad W, Elzawawy E. An anatomical study of the different neurosurgical approaches of the cervical spinal cord. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2011.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Wael Fouad
- Department of Neurosurgery Faculty of Medicine, Alexandria University, Egypt
| | - Ehab Elzawawy
- Department of Anatomy Faculty of Medicine, Alexandria University, Egypt
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Oshima Y, Matsubayashi Y, Taniguchi Y, Hayakawa K, Fukushima M, Oichi T, Oka H, Riew KD, Tanaka S. Mental State Can Influence the Degree of Postoperative Axial Neck Pain Following Cervical Laminoplasty. Global Spine J 2019; 9:292-297. [PMID: 31192097 PMCID: PMC6542172 DOI: 10.1177/2192568218793861] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To investigate factors influencing the incidence of moderate to severe postoperative axial neck pain following cervical laminoplasty. METHODS We reviewed 125 patients with cervical myelopathy who underwent double-door laminoplasty. The primary outcomes were the Numerical Rating Scale score (NRS score, 0-10) for neck pain, the Short Form 36 (SF-36) Health Survey score (Physical and Mental Component Summary scores [PCS and MCS, respectively]), and satisfaction. Imaging parameters on plain radiographs and magnetic resonance imaging were also evaluated. Patients with moderate to severe postoperative neck pain (NRS ≥ 5) were compared with those with no or mild neck pain (NRS ≤ 4). RESULTS One hundred and three patients (82%) with complete data were eligible for inclusion. There were 67 men and 36 women, with a mean age of 65 years (32-89 years). Twenty-five patients (23%) had moderate to severe postoperative axial pain (NRS ≥ 5) and were compared with the other 78 patients (NRS ≤ 4), which revealed several predictive factors, including female sex, the presence of preoperative neck pain, low postoperative PCS, low preoperative and postoperative MCS, and satisfaction with the treatment. Multivariable logistic regression analysis revealed that the postoperative MCS (P = .002) was a risk factor for postoperative neck pain, although the preoperative MCS did not reach statistical significance (P = .06). CONCLUSIONS Patients with a low mental state, possibly before surgery, are at a high risk for postoperative axial neck pain. None of the imaging parameters were statistically different.
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Affiliation(s)
- Yasushi Oshima
- The University of Tokyo, Tokyo, Japan,Yasushi Oshima, Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Yin M, Wang H, Ma J, Huang Q, Sun Z, Yan W, Ye J, Mo W. Radiological Characteristics and Surgical Outcome of Patients with Long Ossification of the Posterior Longitudinal Ligament Resulting in Ossified Lesions in the Upper Cervical Spine. World Neurosurg 2019; 127:e299-e310. [PMID: 30954753 DOI: 10.1016/j.wneu.2019.03.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Designing surgical strategies for ossified lesions in the upper cervical spine is challenging owing to the complex anatomic structures. The present study aimed to clarify the prevalence of ossified lesions in the upper cervical spine in patients with ossification in the posterior longitudinal ligament and illustrate the clinical features, radiological findings, and surgical outcomes of this abnormality. METHODS Demographic and clinical data were collected for all patients preoperatively and included age, gender, body mass index, alcohol and tobacco use, history of diabetes, visual analog score, and Japanese Orthopaedic Association score. The cervical angle, morphology of ossification in the posterior longitudinal ligament, K-line, occupation ratio, space available for the spinal cord, high-intensity zone, and compression ratio of the spinal cord were calculated. The operative approach, technique used, and complications were recorded. RESULTS A total of 38 patients were enrolled. The upper cervical segment in 23 patients was not surgically addressed. In the group with the upper cervical segment addressed surgically, 10 patients were treated with C3-C6 open-door laminoplasty and C2 partial laminectomy, 1 with C1-C7 laminoplasty, 1 with C2-C7 laminoplasty, 2 with C3-C6 total and C2 partial laminectomy, and 1 with C1-C5 laminectomy and occipitocervical fusion. CONCLUSIONS The development of ossified lesions in the upper cervical spine has a high incidence. Decompressive surgery for upper cervical spine segments should be recommended for patients with severe narrowing of the spinal canal and a high signal intensity that extends to the upper cervical segment of the spinal cord. We hope that the findings from the present study will aid in clinical decision-making and provide useful information that can be incorporated into future guidelines.
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Affiliation(s)
- Mengchen Yin
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongshen Wang
- Division of Spine Center, Second Affiliated Hospital of Guangzhou University of Chinese Medicine and Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Junming Ma
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Quan Huang
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhengwang Sun
- Department of Musculoskeletal Oncology, Fudan University Cancer Center, Shanghai, China
| | - Wangjun Yan
- Department of Musculoskeletal Oncology, Fudan University Cancer Center, Shanghai, China
| | - Jie Ye
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen Mo
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Yuan X, Wei C, Xu W, Gan X, Cao S, Luo J. Comparison of laminectomy and fusion vs laminoplasty in the treatment of multilevel cervical spondylotic myelopathy: A meta-analysis. Medicine (Baltimore) 2019; 98:e14971. [PMID: 30921202 PMCID: PMC6456105 DOI: 10.1097/md.0000000000014971] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The purpose of this study is to evaluate the clinical safety and efficacy between laminectomy and fusion (LF) versus laminoplasty (LP) for the treatment of multi-level cervical spondylotic myelopathy (CSM). METHODS The authors searched electronic databases using PubMed, MEDLINE, Embase, Cochrane Controlled Trial Register, and Google Scholar for relevant studies that compared the clinical effectiveness of LF and LP for the treatment of patients with multilevel CSM. The following outcome measures were extracted: the Japanese Orthopaedic Association (JOA) scores, cervical curvature index (CCI), visual analog scale (VAS), Nurich grade, reoperation rate, complications, rate of nerve palsies. Newcastle Ottawa Quality Assessment Scale (NOQAS) was used to evaluate the quality of each study. Data analysis was conducted with RevMan 5.3. RESULTS A total of 14 studies were included in our meta-analysis. No significant difference was observed in terms of postoperative Japanese Orthopaedic Association score (P = .29), visual analog scale neck pain (P = .64), cervical curvature index (P = .24), Nurich grade (P = .16) and reoperation rate (P = .21) between LF and LP groups. Compared with LP group, the total complication rate (OR 2.60, 95% CI 1.85, 3.64, I = 26%, P < .00001) and rate of nerve palsies (OR 3.18, 95% CI 1.66, 6.11, I = 47%, P = .0005) was higher in the LF group. CONCLUSIONS Our meta-analysis reveals that surgical treatments of multilevel CSM are similar in terms of most clinical outcomes using LF and LP. However, LP was found to be superior than LF in terms of nerve palsy complications. This requires further validation and investigation in larger sample-size prospective and randomized studies.
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Affiliation(s)
| | - Chunmei Wei
- Department of Obstetrics and Gynecology, People's Hospital of Yichun City, Yichun
| | | | | | | | - Jiaquan Luo
- Department of Orthopaedic Surgery, The First Affiliated Hospital Of Gannan Medical University, Ganzhou, PR China
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Nagoshi N, Tsuji O, Okada E, Fujita N, Yagi M, Tsuji T, Nakamura M, Matsumoto M, Watanabe K. Clinical indicators of surgical outcomes after cervical single open-door laminoplasty assessed by the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. Spinal Cord 2019; 57:644-651. [DOI: 10.1038/s41393-019-0258-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/19/2019] [Accepted: 01/24/2019] [Indexed: 11/09/2022]
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Comparison of Health-related Quality of Life Between Double-door Laminoplasty and Selective Laminoplasty for Degenerative Cervical Myelopathy, With a Minimum Follow-up of 5 Years. Spine (Phila Pa 1976) 2019; 44:E211-E218. [PMID: 30059486 DOI: 10.1097/brs.0000000000002814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective analysis of prospectively collected multicenter observational data. OBJECTIVE The aim of this study was to compare the health-related quality of life (HR-QOL) of double-door laminoplasty (DDL) and selective laminoplasty (SL) in patients with degenerative cervical myelopathy (DCM) in two institutions, with a minimum follow-up of 5 years. SUMMARY OF BACKGROUND DATA No study has compared DDL and SL regarding postoperative HR-QOL with a follow-up of more than 5 years. METHODS One-hundred ninety patients who underwent DDL (n = 77) or SL (n = 113) participated in this study. Short-form 36 (SF-36), Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), Neck Disability Index (NDI), and visual analog scale (VAS) values were compared between the groups. RESULTS Thirty-seven DDL and 52 SL patients were evaluated. The mean follow-up period was 8 years and the follow-up rate was 46.8%. No significant differences were found regarding age and JOA score at baseline. At the follow-up, there were no significant differences in SF-36, JOACMEQ, and VAS score, while the NDI score for headache and sleeping were higher in the SL group. After dividing the SL group into short and long SL subgroups, the long SL subgroup showed a significantly lower score in bodily pain in SF-36, lower and bladder function in JOACMEQ, and pain intensity, personal care, headaches, and sleeping in NDI compared with the other groups. CONCLUSION No significant differences were found in SF-36, JOA score, and NDI, except for the NDI subscale of headache and sleeping. The subgroup analysis showed that the long SL group showed a decreased QOL compared with the short SL and DDL groups. LEVEL OF EVIDENCE 3.
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Luo W, Li Y, Zhao J, Zou Y, Gu R, Li H. Skip Laminectomy Compared with Laminoplasty for Cervical Compressive Myelopathy: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 120:296-301. [DOI: 10.1016/j.wneu.2018.08.231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
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The Feature of Clinical and Radiographic Outcomes in Elderly Patients With Cervical Spondylotic Myelopathy: A Prospective Cohort Study on 1025 Patients. Spine (Phila Pa 1976) 2018; 43:817-823. [PMID: 29016440 DOI: 10.1097/brs.0000000000002446] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE The purpose of this study was to compare the surgical outcomes between nonelderly and elderly patients with cervical spondylotic myelopathy (CSM) and to characterize the preoperative symptoms and postoperative residual symptoms in elderly patients. SUMMARY OF BACKGROUND DATA Age at the time of surgery influences the surgical outcome. However, no report has elucidated residual symptoms after surgery in elderly patients with CSM. We designed a large-scale cohort study examining the surgical outcomes of CSM in elderly patients from a single surgery. METHODS A total of 1025 consecutive patients with CSM (642 men and 383 women; mean age, 64.4 yr; range, 23-93 yr) who underwent laminoplasty were included. Patients were divided into three groups based on age: nonelderly (<65 yr), young-old (65-74 yr), and old-old (≥75 yr), and the number of patients in each group was 488, 329, and 208, respectively. The pre- and postoperative neurological statuses were evaluated using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. The recovery rate (RR) of each function was compared among the three groups. Radiographic data including alignment and range of motion were also assessed. RESULTS The mean preoperative JOA scores of motor function of the lower extremity in nonelderly, young-old, and old-old groups were 2.8, 2.2, and 1.6, respectively (P < 0.0001). Elderly patients showed significantly lower JOA scores for bladder function than nonelderly patients (2.7, 2.5, and 2.2, P < 0.0001). Cervical lordosis in the neutral position increased gradually with age. Total range of motion decreased with increasing age. After surgery, the mean RRs of motor function of the lower extremity were 57.7%, 38.6%, and 24.0%, respectively. Gait disturbance significantly increased with age (P < 0.0001). CONCLUSION Postoperative gait disturbance persisted more than other symptoms in elderly patients than in nonelderly patients. LEVEL OF EVIDENCE 2.
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Abstract
Cervical laminoplasty was initially described for the management of cervical myelopathy resulting from multilevel stenosis secondary to ossification of the posterior longitudinal ligament. The general concepts are preservation of the dorsal elements, preservation of segmental motion, and expansion of the spinal canal via laminar manipulation. No clear evidence suggests that laminoplasty is superior to either posterior laminectomy or anterior cervical diskectomy and fusion. However, laminoplasty has its own advantages, indications, and complications. Surgeons have refined the technique to decrease complication rates and improve efficacy. Recent efforts have highlighted less invasive approaches that are muscle sparing and associated with less postoperative morbidity. Although the long-term outcomes suggest that cervical laminoplasty is safe and effective, continued research on the development of novel modifications that decrease common complications, such as C5 nerve palsy, axial neck pain, and loss of lordosis, is required.
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Miyazaki M, Ishihara T, Notani N, Kanezaki S, Tsumura H. Relationship of T1 slope with loss of lordosis and surgical outcomes after laminoplasty for cervical ossification of the posterior longitudinal ligament. Clin Neurol Neurosurg 2018; 164:19-24. [DOI: 10.1016/j.clineuro.2017.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/30/2017] [Accepted: 11/11/2017] [Indexed: 11/15/2022]
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Abduljabbar FH, Teles AR, Bokhari R, Weber M, Santaguida C. Laminectomy with or Without Fusion to Manage Degenerative Cervical Myelopathy. Neurosurg Clin N Am 2018; 29:91-105. [DOI: 10.1016/j.nec.2017.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Yang SD, Zhu YB, Yan SZ, Di J, Yang DL, Ding WY. Anterior cervical discectomy and fusion surgery versus total disc replacement: A comparative study with minimum of 10-year follow-up. Sci Rep 2017; 7:16443. [PMID: 29180636 PMCID: PMC5703962 DOI: 10.1038/s41598-017-16670-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/16/2017] [Indexed: 02/06/2023] Open
Abstract
Based on long-term follow-ups, this study was designed to investigate the incidence and risk factors for postoperative adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF) or total disc replacement (TDR) in treating cervical degenerative diseases. Between January 2000 and December 2005, 108 cases undergoing ACDF and 78 undergoing TDR, were enrolled into this study. All medical records were retrospectively collected. Every patient was followed up at least 10 years. Outcome assessment included visual analogue scale (VAS) score, Neck Disability Index (NDI) score, Japanese Orthopaedic Association (JOA) score, and radiographic parameters. Consequently, thirty-eight (35.2%) of 108 cases suffered from ASD in ACDF group, and 26 (33.3%) of 78 cases in TDR group. There was no statistical difference between the two groups regarding ASD incidence, VAS/NDI/JOA score, recovery rate. Logistic regression analysis showed that age (OR = 2.86, 95% CI, 1.58-4.14) and preoperative segmental lordosis (OR = 1.90, 95% CI, 1.05-3.20) were risk factors associated with increased odds of ASD regardless of surgical procedures. On the other hand, preoperative overall lordosis (OR = 0.54, 95% CI, 0.26-0.82) was most likely protective. In conclusion, advanced age and preoperative segmental lordosis were identified as risk factors for postoperative ASD, while preoperative overall lordosis proves to be a protective factor.
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Affiliation(s)
- Si-Dong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Yan-Bo Zhu
- Laboratory of Molecular Biology, Center of Experimental Animals, Hebei Medical University, Shijiazhuang, 050017, China
| | - Suo-Zhou Yan
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Jun Di
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Da-Long Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China. .,Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, 050051, China.
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Wilson JR, Tetreault LA, Kim J, Shamji MF, Harrop JS, Mroz T, Cho S, Fehlings MG. State of the Art in Degenerative Cervical Myelopathy: An Update on Current Clinical Evidence. Neurosurgery 2017; 80:S33-S45. [PMID: 28350949 DOI: 10.1093/neuros/nyw083] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/22/2016] [Indexed: 01/14/2023] Open
Abstract
Degenerative cervical myelopathy (DCM) is a common cause of spinal cord dysfunction that confronts clinicians on a daily basis. Research performed over the past few decades has provided improved insight into the diagnosis, evaluation, and treatment of this disorder. We aim to provide clinicians with an update regarding the state of the art in DCM, focusing on more recent research pertaining to pathophysiology, natural history, treatment, consideration of the minimally symptomatic patient, surgical outcome prediction, and outcome measurement. Current concepts of pathophysiology focus on the combination of static and dynamic elements leading to breakdown of the blood-spinal cord barrier at the site of compression resulting in local inflammation, cellular dysfunction, and apoptosis. With respect to treatment, although there is a dearth of high-quality studies comparing surgical to nonoperative treatment, several large prospective studies have recently associated surgical management with clinically and statistically significant improvement in functional, disability, and quality of life outcome at long-term follow-up. When selecting the specific surgical intervention for a patient with DCM, anterior (discectomy, corpectomy, hybrid discectomy/corpectomy), posterior (laminectomy and fusion, laminoplasty), and combined approaches may be considered as options depending on the specifics of the patient in question; evidence supporting each of these approaches is reviewed in detail. Recently developed clinical prediction models allow for accurate forecasting of postoperative outcomes, permitting enhanced communication and management of patient expectations in the preoperative setting. Finally, an overview of outcome measures recommended for use in the assessment of DCM patients is provided.
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Affiliation(s)
- Jefferson R Wilson
- Department of Surgery, Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Lindsay A Tetreault
- Department of Surgery, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Jun Kim
- Department of Orthopedic Surgery, Icahn School of Medicine, New York, New York
| | - Mohammed F Shamji
- Department of Surgery, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - James S Harrop
- Division of Neurosurgery and Orthopedics, Thomas Jefferson University Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Thomas Mroz
- Division of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Samuel Cho
- Department of Orthopedic Surgery, Icahn School of Medicine, New York, New York
| | - Michael G Fehlings
- Department of Surgery, Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
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Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients of different ages: a retrospective study. Spinal Cord 2017; 56:7-13. [PMID: 28809390 DOI: 10.1038/sc.2017.91] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 04/18/2017] [Accepted: 06/22/2017] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective chart audit. OBJECTIVES This study aims to compare the clinical features and surgical outcomes in patients with cervical spondylotic myelopathy (CSM) among different age groups. SETTING The first Affiliated Hospital of Anhui Medical University, China. METHODS A total of 460 patients with CSM who were surgically treated over the period of 1995-2009 were investigated. Considering the peak age (40-60 years old) for the onset of symptoms, we divided the patients into three groups by age: young (<40), middle-aged (40-60), and old (>60). The differences in symptoms, symptom durations, involved levels, surgical approaches and outcomes were evaluated. RESULTS The number of symptoms and involved levels, symptom duration and posterior approach significantly increased with increasing age, whereas preoperative Japanese Orthopedic Association score decreased among the three groups. Spinal cord function improved after surgery in all groups. The highest degree of recovery occurred during the first 6 months after surgery, especially within the first week, and then reached a plateau. After 6 months, however, recovery continuously improved, stabilized and declined in the young, middle-aged, old groups, respectively. The recovery rate was not significantly different at an immediate period (1 week) after operation among the three groups, but was significantly different at later periods (3 or more months postoperatively). Three groups showed no difference in postoperative complication rates. CONCLUSION The severity of CSM increased with increasing age. Age was inversely correlated with recovery, and recovery decreased as age increased. Six months post operation was the prime time for the recovery of spinal cord function.
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Zadegan SA, Rahimi-Movaghar V. There is no evidence that laminoplasty results in improved outcomes compared with laminectomy in cervical spinal cord injury without instability. Asian J Neurosurg 2017; 12:347. [PMID: 28761503 PMCID: PMC5532910 DOI: 10.4103/1793-5482.175640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Shayan Abdollah Zadegan
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Characteristics of Residual Symptoms After Laminoplasty in Diabetic Patients With Cervical Spondylotic Myelopathy: A Prospective Cohort Study. Spine (Phila Pa 1976) 2017; 42:E708-E715. [PMID: 27792116 DOI: 10.1097/brs.0000000000001947] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE The purpose of this study was to compare cervical laminoplasty outcomes between diabetic and nondiabetic patients with cervical spondylotic myelopathy (CSM), and to characterize residual symptoms of diabetic patients. SUMMARY OF BACKGROUND DATA Diabetes is one of the most frequent comorbidities in CSM patients. However, no report has elucidated residual symptoms following surgery in diabetic patients with CSM. METHODS .: A total of 505 consecutive patients with CSM (331 males, 189 females; mean age, 66.6 years; age range, 41-91 years; >1-year follow up after laminoplasty) were enrolled and divided into diabetic group (n = 105) and nondiabetic group (n = 400). The Japanese Orthopedic Association (JOA) scores and recovery rate (RR) of each function were compared between the groups. To quantitatively assess performance, the 10-s grip and release (G&R) test and the 10-s step test were evaluated. RESULTS There was no significant difference in the mean RRs of upper extremity motor function between diabetic and nondiabetic patients (59.2% vs. 60.5%, respectively; P = 0.789). The RR of lower extremity motor function was lower in the diabetic group than in the nondiabetic group (36.1% vs. 43.4%, respectively; P = 0.047); the RR of upper extremity sensory function also was lower (36.8% vs. 49.6%, respectively; P = 0.006). However, the mean RRs of sensory functions of lower extremities were 59.7% (diabetic) and 59.2% (nondiabetic) (P = 0.953). There was no significant difference in the mean RRs of trunk sensory function between the groups (69.3% vs. 74.1%, respectively; P = 0.303). The mean RRs of urinary bladder function were 42.1% (diabetic) and 53.7% (nondiabetic) (P = 0.035). The preoperative mean number of the 10-s step test was lower in the diabetic group than in the nondiabetic group, and the postoperative mean number also was significantly lower in the diabetic group. CONCLUSION Gait disturbance, hand numbness, and bladder dysfunction after surgery persisted more than other symptoms in the diabetic than in the nondiabetic patients. LEVEL OF EVIDENCE 2.
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Abstract
STUDY DESIGN Prospective randomized controlled study. OBJECTIVES To determine the effect of collar-aided fixation on outcomes after laminoplasty for cervical compressive myelopathy. SUMMARY OF BACKGROUND DATA Patients are often placed in a Philadelphia collar for weeks after cervical laminoplasty. However, the benefit of postoperative collar use remains controversial. We hypothesized that treatment outcomes in postoperative pain in patients without collars would not be inferior to the outcomes in patients using Philadelphia collars for 2 weeks. METHODS This trial analyzed 74 patients (52 males, 22 females, mean age 72.7 years) with cervical compressive myelopathy who had undergone double-door laminoplasty. Before surgery, we randomly assigned patients to the collar-fixation (CF) group (postoperative Philadelphia collar for 2 weeks) or the no-collar (NC) group. The primary outcome was the visual analog scale (VAS) for cervical pain up to 1 year after surgery. Secondary outcomes were Japanese Orthopedics Association score, Short Form 36 score (SF-36), cervical range of motion (ROM), lordotic angle, and complications. RESULTS VAS scores up to 1 year after operation were similar with or without collar fixation (P = 0.487, two-way ANOVA). JOA scores improved significantly in both groups (P = 0.002 in CF, P < 0.001 in NC). There was no statistically significant difference between groups with regard to the improvement of JOA scores (54.9% in CF, 47.0% in NC, P = 0.80). The improvement in SF-36 was similar in both groups. Loss of ROM and lordotic angle of the cervical spine did not differ between groups (P = 0.61 in CF, P = 0.82 in NC). The incidence of complications was similar in both groups. CONCLUSION The VAS scores of cervical pain with the postoperative treatment without collar fixation were not inferior to those when using Philadelphia collars for 2 weeks. Moreover, other outcomes such as JOA scores, SF-36, ROM, lordotic angle, and complications were similar in both groups. LEVEL OF EVIDENCE 2.
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Multivariate analysis of factors associated with kyphotic deformity after laminoplasty in cervical spondylotic myelopathy patients without preoperative kyphotic alignment. Sci Rep 2017; 7:43443. [PMID: 28240309 PMCID: PMC5327484 DOI: 10.1038/srep43443] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/23/2017] [Indexed: 11/23/2022] Open
Abstract
The risk factors of post-laminoplasty kyphosis in patients with cervical spondylotic myelopathy (CSM) without preoperative kyphotic alignment are not well known. This study aimed to compare clinical and radiological data between patients with or without post-laminoplasty kyphosis and to investigate the factors associated with post-laminoplasty kyphosis in CSM patients without preoperative kyphotic alignment. Patients (n = 194) who received unilateral expansive open-door cervical laminoplasty with miniplate fixation and completed a 1-year follow-up were enrolled. Patients were grouped according to whether they suffered from postoperative kyphosis (P) or not (NP). Postoperative kyphosis was observed in 21 (10.8%) patients. The recovery rates of the Japanese Orthopaedic Association scores at the 1-year follow-up in the P group were inferior to those in the NP group (31.9% vs. 65.2%, P < 0.001). Logistic regression with post-laminoplasty kyphosis as the dependent variable showed independent risks associated with an increased C2–7 sagittal vertical axis (SVA, odds ratio [OR] = 1.085, 95% confidence interval [CI] = 1.025–1.203, P = 0.015), destroyed facet joints (OR = 1.132, 95% CI = 1.068–1.208, P < 0.001), and cephalad vertebral level undergoing laminoplasty (CVLL, OR = 2.860, 95% CI = 1.164–6.847, P = 0.021). These findings suggest that CVLL, C2–7 SVA, and destroyed facet joints are associated with kyphosis after laminoplasty in CSM patients without preoperative kyphotic alignment.
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Zhang JT, Li JQ, Niu RJ, Liu Z, Tong T, Shen Y. Predictors of cervical lordosis loss after laminoplasty in patients with cervical spondylotic myelopathy. 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 2017; 26:1205-1210. [DOI: 10.1007/s00586-017-4971-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/16/2016] [Accepted: 01/22/2017] [Indexed: 11/30/2022]
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Laminectomy and fusion vs laminoplasty for multi-level cervical myelopathy: a systematic review and meta-analysis. 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 2016; 26:94-103. [PMID: 27342611 DOI: 10.1007/s00586-016-4671-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 06/10/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Surgical approaches for multi-level cervical spondylotic myelopathy (CSM) include posterior cervical surgery via laminectomy and fusion (LF) or expansive laminoplasty (EL). The relative benefits and risks of either approach in terms of clinical outcomes and complications are not well established. A systematic review and meta-analysis was conducted to address this topic. METHODS Electronic searches were performed using six databases from their inception to January 2016, identifying all relevant randomized controlled trials (RCTs) and non-RCTs comparing LF vs EL for multi-level cervical myelopathy. Data was extracted and analyzed according to predefined endpoints. RESULTS From 10 included studies, there were 335 patients who underwent LF compared to 320 patients who underwent EL. There was no significant difference found postoperatively between LF and EL groups in terms of postoperative JOA (P = 0.39), VAS neck pain (P = 0.93), postoperative CCI (P = 0.32) and Nurich grade (P = 0.42). The total complication rate was higher for LF compared to EL (26.4 vs 15.4 %, RR 1.77, 95 % CI 1.10, 2.85, I 2 = 34 %, P = 0.02). Reoperation rate was found to be similar between LF and EL groups (P = 0.52). A significantly higher pooled rate of nerve palsies was found in the LF group compared to EL (9.9 vs 3.7 %, RR 2.76, P = 0.03). No significant difference was found in terms of operative time and intraoperative blood loss. CONCLUSIONS From the available low-quality evidence, LF and EL approaches for CSM demonstrates similar clinical improvement and loss of lordosis. However, a higher complication rate was found in LF group, including significantly higher nerve palsy complications. This requires further validation and investigation in larger sample-size prospective and randomized studies.
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Surgical Treatment Assessment of Cervical Laminoplasty Using Quantitative Performance Evaluation in Elderly Patients: A Prospective Comparative Study in 505 Patients With Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976) 2016; 41:757-63. [PMID: 26583475 DOI: 10.1097/brs.0000000000001313] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE The purpose of this study was to compare surgical outcomes between non-elderly and elderly patients with cervical spondylotic myelopathy (CSM) who underwent laminoplasty. SUMMARY OF BACKGROUND DATA Since age at the time of surgery influences the surgical outcome, we designed a large-scale cohort study to examine the surgical outcome for CSM from a single operative procedure used exclusively in elderly patients. METHODS A total of 505 consecutive patients with CSM (311 men; 194 women) were prospectively enrolled. The mean age was 66.6 years (range, 41-91), and the average postoperative follow-up period was 26.5 ± 12.5 months. Patients were divided into three groups according to age: non-elderly (<65 yr, n = 201), young-old (65-74 yr, n = 186), and old-old (≥75 yr, n = 118). Pre- and postoperative neurological status was evaluated using the Japanese Orthopaedic Association scoring system for cervical myelopathy (JOA score) and quantifiable tests-the 10-s grip and release test (10-s G&R test) and the 10-s step test. RESULTS Mean achieved JOA scores in non-elderly, young-old, and old-old groups were 3.1, 3.2, and 3.0, respectively, with no significant difference among three groups (P = 0.5735). Mean preoperative 10-s G&R test results were 17.3, 14.4, and 13.0, respectively, indicating a significant decrease with increasing age, whereas postoperative results significantly improved in all groups (21.0, 17.9, and 16.3, respectively). Similarly, the 10-s step test significantly decreased with age, with preoperative scores of 14.3, 11.5, and 8.6, respectively, whereas postoperative scores improved to 17.3, 14.9, and 12.5, respectively. The three groups showed no significant difference in the rate of postoperative complications. CONCLUSION Elderly patients adequately recovered from laminoplasty in terms of achieved JOA score, the 10-s G&R test, and the 10-s step test. Therefore, laminoplasty for CSM is beneficial in elderly patients. LEVEL OF EVIDENCE 2.
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Kim B, Yoon DH, Ha Y, Yi S, Shin DA, Lee CK, Lee N, Kim KN. Relationship between T1 slope and loss of lordosis after laminoplasty in patients with cervical ossification of the posterior longitudinal ligament. Spine J 2016; 16:219-25. [PMID: 26523967 DOI: 10.1016/j.spinee.2015.10.042] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/15/2015] [Accepted: 10/22/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Laminoplasty is a major surgical method used to treat patients with cervical ossification of the posterior longitudinal ligament (OPLL). Sometimes, patients with cervical OPLL demonstrate postoperative kyphosis despite sufficient preoperative lordosis. Recently, the impact of T1 slope has emerged as a predictor of kyphotic alignment change after laminoplasty. However, the relationship between T1 slope and postoperative cervical alignment change is not yet fully established. PURPOSE The goals of the present study were to investigate the relationship between T1 slope and loss of cervical lordosis (LCL), and to identify the role of T1 slope as a predictor of postoperative kyphosis after laminoplasty in patients with OPLL. STUDY DESIGN This is a retrospective case study. PATIENT SAMPLE Between January 2011 and January 2012, 64 consecutive patients who underwent cervical laminoplasty for OPLL were enrolled (male:female ratio=47:17; mean age=55.9 years). Cervical spine lateral radiographs in neutral, flexion, and extension were taken before surgery and at 2-year follow-up. OUTCOME MEASURES The C2-C7 Cobb angle, cervical range of motion (ROM), T1 slope, neck tilt, and C2-C7 sagittal vertical axis (SVA) were measured from lateral radiographs of the cervical spine preoperatively and postoperatively at 2-year follow-up. METHODS Patients were divided into two groups according to preoperative T1 slope, and the postoperative cervical alignment change was compared between the groups. Postoperative kyphosis and LCL incidence were also evaluated at 2-year follow-up. The relationships between postoperative cervical alignment change and preoperative variables, including age, T1 slope, cervical ROM, C2-C7 SVA, and T1 slope minus C2-C7 Cobb angle (T1S-CL), were investigated. RESULTS Patients were divided into two groups above and below median preoperative T1 slope (23.2°). There were no differences in age, sex, type of OPLL, or operation level between the two groups. Patients with higher preoperative T1 slope demonstrated significantly more lordotic preoperative cervical alignment (p=.001). Patients with higher preoperative T1 slope were more likely to exhibit postoperative LCL (p=.03), and when it occurred the degree of LCL was greater (p=.06). In multiple linear regression analysis, higher T1 slope (B=0.414, p=.04) and lower T1S-CL (B=-0.412, p=.03) were significantly associated with more postoperative LCL. In spite of these results, postoperative kyphosis did not occur more frequently in patients with higher T1 slope (p=.64). CONCLUSIONS Patients with higher T1 slope had more lordotic curvature before surgery and demonstrated more LCL at 2-year follow-up. Cervical alignment was compromised after laminoplasty, and the degree of LCL was correlated with preoperative T1 slope. After laminoplasty for cervical OPLL, patients with higher T1 slope tended to exhibit a greater LCL yet did not drift into frank postoperative kyphosis.
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Affiliation(s)
- Byeongwoo Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Do Heum Yoon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Chang Kyu Lee
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Nam Lee
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
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Duetzmann S, Cole T, Ratliff JK. Cervical laminoplasty developments and trends, 2003-2013: a systematic review. J Neurosurg Spine 2015; 23:24-34. [PMID: 25909270 DOI: 10.3171/2014.11.spine14427] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Despite extensive clinical experience with laminoplasty, the efficacy of the procedure and its advantages over laminectomy remain unclear. Specific clinical elements, such as incidence or progression of kyphosis, incidence of axial neck pain, postoperative cervical range of motion, and incidence of postoperative C-5 palsies, are of concern. The authors sought to comprehensively review the laminoplasty literature over the past 10 years while focusing on these clinical elements. METHODS The authors conducted a literature search of articles in the Medline database published between 2003 and 2013, in which the terms "laminoplasty," "laminectomy," and "posterior cervical spine procedures" were used as key words. Included was every single case series in which patient outcomes after a laminoplasty procedure were reported. Excluded were studies that did not report on at least one of the above-mentioned items. RESULTS A total of 103 studies, the results of which contained at least 1 of the prespecified outcome variables, were identified. These studies reported 130 patient groups comprising 8949 patients. There were 3 prospective randomized studies, 1 prospective nonrandomized alternating study, 15 prospective nonrandomized data collections, and 84 retrospective reviews. The review revealed a trend for the use of miniplates or hydroxyapatite spacers on the open side in Hirabayashi-type laminoplasty or on the open side in a Kurokawa-type laminoplasty. Japanese Orthopaedic Association (JOA) scoring was reported most commonly; in the 4949 patients for whom a JOA score was reported, there was improvement from a mean (± SD) score of 9.91 (± 1.65) to a score of 13.68 (± 1.05) after a mean follow-up of 44.18 months (± 35.1 months). The mean preoperative and postoperative C2-7 angles (available for 2470 patients) remained stable from 14.17° (± 0.19°) to 13.98° (± 0.19°) of lordosis (average follow-up 39 months). The authors found significantly decreased kyphosis when muscle/posterior element-sparing techniques were used (p = 0.02). The use of hardware in the form of hydroxyapatite spacers or miniplates did not influence the progression of deformity (p = 0.889). An overall mean (calculated from 2390 patients) of 47.3% loss of range of motion was reported. For the studies that used a visual analog scale score (totaling 986 patients), the mean (cohort size-adjusted) postoperative pain level at a mean follow-up of 29 months was 2.78. For the studies that used percentages of patients who complained of postoperative axial neck pain (totaling 1249 patients), the mean patient number-adjusted percentage was 30% at a mean follow-up of 51 months. The authors found that 16% of the studies that were published in the last 10 years reported a C-5 palsy rate of more than 10% (534 patients), 41% of the studies reported a rate of 5%-10% (n = 1006), 23% of the studies reported a rate of 1%-5% (n = 857), and 12.5% reported a rate of 0% (n = 168). CONCLUSIONS Laminoplasty remains a valid option for decompression of the spinal cord. An understanding of the importance of the muscle-ligament complex, plus the introduction of hardware, has led to progress in this type of surgery. Reporting of outcome metrics remains variable, which makes comparisons among the techniques difficult.
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Affiliation(s)
- Stephan Duetzmann
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Tyler Cole
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - John K Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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Pohl PHI, Tamaoki MJ, Rodrigues LM, Radcliff KE, Yurube T, Kang JD, Belloti JC. Posterior surgical approach procedures for cervical myelopathy. Hippokratia 2015. [DOI: 10.1002/14651858.cd011553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Pedro HI Pohl
- ABC Medical School; Discipline of Orthopaedic Surgery and Traumatology / Spine Surgery Group; 321 Dr. Henrique Calderazzo ST 5th Floor São Paulo Brazil 09190-615
| | - Marcel Jun Tamaoki
- Universidade Federal de São Paulo; Department of Orthopaedics and Traumatology; Rua das Rosas, 126 apto 73 São Paulo Brazil
| | - Luciano M Rodrigues
- ABC Medical School; Discipline of Orthopaedic Surgery and Traumatology / Spine Surgery Group; 321 Dr. Henrique Calderazzo ST 5th Floor São Paulo Brazil 09190-615
| | - Kristen E Radcliff
- Thomas Jefferson University; Rothman Institute, Department of Orthopedic Surgery; 2500 English Creek Avenue Egg Harbor NJ USA 08234
| | - Takashi Yurube
- Kobe University Graduate School of Medicine; Department of Orthopaedic Surgery; 7-5-1 Kusunoki-cho, Chuo-ku Kobe Japan 650-0017
| | - James D Kang
- University of Pittsburgh Medical Center; Orthopaedic Department; Pittsburgh PA USA
| | - João Carlos Belloti
- Universidade Federal de São Paulo; Department of Orthopaedics and Traumatology; Rua das Rosas, 126 apto 73 São Paulo Brazil
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Ito K, Yukawa Y, Ito K, Machino M, Kanbara S, Nakashima H, Hida T, Ishiguro N, Imagama S, Kato F. Dynamic changes in the spinal cord cross-sectional area in patients with myelopathy due to cervical ossification of posterior longitudinal ligament. Spine J 2015; 15:461-6. [PMID: 25463397 DOI: 10.1016/j.spinee.2014.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 08/04/2014] [Accepted: 10/07/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Dynamic changes in the spinal cord cross-sectional area due to cervical ossification of the posterior longitudinal ligament (C-OPLL) are unknown, but dynamic multidetector-row computed tomography (MDCT) may be a useful tool. PURPOSE The purpose of this study was to evaluate the influence of dynamic factors on the spinal cord in patients with C-OPLL using MDCT during flexion and extension after myelography. STUDY DESIGN/SETTING This was a prospective cohort study. PATIENT SAMPLE Participants included 107 prospectively enrolled consecutive patients with C-OPLL and myelopathy. OUTCOME MEASURE The outcome measure was the extension/flexion ratio at the spinal cord cross-sectional area at the most stenotic cervical level (SCASL). METHODS Dynamic MDCT was performed, and the SCASL was measured. Patients were divided into the kyphosis group or lordosis group according to C2-C7 alignment. They were divided further into the K-line (-) group or K-line (+) group. The Japanese Orthopedic Association (JOA) score was used to determine myelopathy severity. RESULTS All patients with C-OPLL had myelopathy, with a mean JOA score of 10.7 and mean disease duration of 16.7 months. The average extension/flexion ratio at all disc levels was less than 100%, suggesting that the spinal cord was compressed more during extension. In the kyphosis group, the spinal cord was compressed slightly more during flexion than during extension. In the K-line (-) group, the spinal cord was compressed more during flexion, although C2-C7 alignment was slightly lordotic on average. Large changes in the spinal cord cross-sectional area during extension-flexion and disease duration significantly influenced the severity of myelopathy. CONCLUSIONS Dynamic MDCT was useful for evaluating dynamic changes in the spinal cord. At the most stenotic level, the spinal cord became narrower during extension at all disc levels. In the kyphosis group and K-line (-) group, it became narrower during flexion. Cervical flexion may induce greater spinal cord compression in patients with kyphosis and K-line (-).
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Affiliation(s)
- Kenyu Ito
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan; Department of Orthopaedic Surgery, Nagoya University Hospital, Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya-city, Aichi 466-8550, Japan.
| | - Yasutsugu Yukawa
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan
| | - Keigo Ito
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan
| | - Shunske Kanbara
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Hospital, Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya-city, Aichi 466-8550, Japan
| | - Tetsuro Hida
- Department of Orthopaedic Surgery, Nagoya University Hospital, Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya-city, Aichi 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Hospital, Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya-city, Aichi 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Hospital, Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya-city, Aichi 466-8550, Japan
| | - Fumihiko Kato
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan
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Comparison of the Japanese orthopaedic association score and the Japanese orthopaedic association cervical myelopathy evaluation questionnaire scores: time-dependent changes in patients with cervical spondylotic myelopathy and posterior longitudinal ligament. Asian Spine J 2015; 9:47-53. [PMID: 25705334 PMCID: PMC4330218 DOI: 10.4184/asj.2015.9.1.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 05/12/2014] [Accepted: 05/20/2014] [Indexed: 11/08/2022] Open
Abstract
Study Design Prospective cohort study. Purpose To identify differences in time-dependent perioperative changes between the Japanese Orthopaedic Association (JOA) score and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) score in patients with cervical spondylotic myelopathy (CSM) and posterior longitudinal ligament (OPLL) who underwent cervical laminoplasty. Overview of Literature The JOA score does not take into consideration patient satisfaction or quality of life. Accordingly, the JOACMEQ was designed in 2007 as a patient-centered assessment tool. Methods We studied 21 patients who underwent cervical laminoplasty. We objectively evaluated the time-dependent changes in JOACMEQ scores and JOA scores for all patients before surgery and at 2 weeks, 3 months, 6 months, and 1 year after surgery. Results The average total JOA score and the recovery rate improved significantly after surgery in both groups, with a slightly better recovery rate in the OPLL group. Cervical spine function improved significantly in the CSM group but not in the OPLL group. Upper- and lower-extremity functions were more stable in the CSM group than in the OPLL group. The effectiveness rate of the JOACMEQ for measuring quality of life was quite low in both groups. In both groups, the Spearman contingency coefficients were dispersed widely except for upper- and lower-extremity function. Conclusions Scores for upper- and lower-extremity function on the JOACMEQ correlated well with JOA scores. Because the JOACMEQ can also assess cervical spine function and quality of life, factors that cannot be assessed by the JOA score alone, the JOACMEQ is a more comprehensive evaluation tool.
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Mori E, Ueta T, Maeda T, Yugué I, Kawano O, Shiba K. Effect of preservation of the C-6 spinous process and its paraspinal muscular attachment on the prevention of postoperative axial neck pain in C3-6 laminoplasty. J Neurosurg Spine 2014; 22:221-9. [PMID: 25525962 DOI: 10.3171/2014.11.spine131153] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Axial neck pain after C3-6 laminoplasty has been reported to be significantly lesser than that after C3-7 laminoplasty because of the preservation of the C-7 spinous process and the attachment of nuchal muscles such as the trapezius and rhomboideus minor, which are connected to the scapula. The C-6 spinous process is the second longest spinous process after that of C-7, and it serves as an attachment point for these muscles. The effect of preserving the C-6 spinous process and its muscular attachment, in addition to preservation of the C-7 spinous process, on the prevention of axial neck pain is not well understood. The purpose of the current study was to clarify whether preservation of the paraspinal muscles of the C-6 spinous process reduces postoperative axial neck pain compared to that after using nonpreservation techniques. METHODS The authors studied 60 patients who underwent C3-6 double-door laminoplasty for the treatment of cervical spondylotic myelopathy or cervical ossification of the posterior longitudinal ligament; the minimum follow-up period was 1 year. Twenty-five patients underwent a C-6 paraspinal muscle preservation technique, and 35 underwent a C-6 nonpreservation technique. A visual analog scale (VAS) and VAS grading (Grades I-IV) were used to assess axial neck pain 1-3 months after surgery and at the final follow-up examination. Axial neck pain was classified as being 1 of 5 types, and its location was divided into 5 areas. The potential correlation between the C-6/C-7 spinous process length ratio and axial neck pain was examined. RESULTS The mean VAS scores (± SD) for axial neck pain were comparable between the C6-preservation group and the C6-nonpreservation group in both the early and late postoperative stages (4.1 ± 3.1 vs 4.0 ± 3.2 and 3.8 ± 2.9 vs 3.6 ± 3.0, respectively). The distribution of VAS grades was comparable in the 2 groups in both postoperative stages. Stiffness was the most prevalent complaint in both groups (64.0% and 54.5%, respectively), and the suprascapular region was the most common site in both groups (60.0% and 57.1%, respectively). The types and locations of axial neck pain were also similar between the groups. The C-6/C-7 spinous process length ratios were similar in the groups, and they did not correlate with axial neck pain. The reductions of range of motion and changes in sagittal alignment after surgery were also similar. CONCLUSIONS The C-6 paraspinal muscle preservation technique was not superior to the C6-nonpreservation technique for preventing postoperative axial neck pain.
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Affiliation(s)
- Eiji Mori
- Department of Orthopaedic Surgery, Spinal Injuries Center, Iizuka, Fukuoka, Japan
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