1
|
Liu F, Liu Y, Hu Y, Ding X, Miao J. Novel Three-Holed Titanium Plate Fixation during Open Door Laminoplasty for Cervical Spondylotic Myelopathy: Comparison with Conventional Titanium Plate. Orthop Surg 2022; 15:197-204. [PMID: 36419321 PMCID: PMC9837288 DOI: 10.1111/os.13551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE For reconstructing the posterior cervical muscular-ligament complex, attachment points and various modified techniques were designed and applied in clinical practice. This study investigated the clinical and radiographic outcomes of open door laminoplasty with modified centerpiece mini-plate fixation and extensor attachment point reconstruction in the treatment of cervical spondylotic myelopathy (CSM). METHODS Sixty-nine patients with CSM who underwent C3-C7 open door laminoplasty at our hospital from January 2016 to May 2018 were divided into two groups: 37 and 32 patients underwent laminoplasty with modified and conventional centerpiece titanium plate fixation (MPF and CPF groups), respectively. Changes in cervical spinal angle (CSA), cervical range of motion (ROM), posterior cervical muscle atrophy, neurological function (Japanese Orthopaedic Association [JOA] score), Neck Disability Index (NDI), and axial symptom severity were compared between the two groups. RESULTS There were no significant differences in operative duration (136.7 ± 23.9 vs 128.3 ± 21.5 min, t = 1.525, p > 0.05), volume of intraoperative blood loss (275.9 ± 33.1 vs 268.2 ± 31.6 ml, t = 0.984, p > 0.05), lamina open angle (41.2° ± 4.5° vs 39.4° ± 4.1°, t = 1.726, p > 0.05), and spinal cord drift distance (2.4 ± 0.3 vs 2.3 ± 0.4 mm, t = 1.184, p > 0.05) between the two groups. After surgery, JOA score significantly increased (p < 0.05), and neurological recovery rates were similar (62.7% vs 63.4%, t = 0.208, p > 0.05). The NDI score was significantly decreased in both the groups (p < 0.05); however, the MPF group recovered to a greater degree than the CPF group (8.3 ± 1.2 vs 9.8 ± 1.4) (t = 4.793, p < 0.05). There was no significant change in cervical ROM postoperatively compared with preoperatively in either group (p > 0.05). CSA decreased from 21.7° ± 2.8° to 18.3° ± 2.1°, and posterior cervical muscle cross-sectional area decreased from 35.2 ± 4.9 cm2 to 31.0 ± 4.1 cm2 in the CPF group (p < 0.05), but no significant change was observed in the MPF group (20.6° ± 2.5° to 20.4° ± 2.6°and 35.9 ± 5.1 to 34.1 ± 4.6 cm2 , respectively) (p > 0.05). Postoperative axial symptom severity was significantly worse in the CPF group than in the MPF group (Z = -2.357, p < 0.05). CONCLUSIONS As an improvement to the conventional titanium plate, the modified centerpiece titanium plate effectively provides an attachment point for the posterior muscle-ligament complex, reducing posterior cervical muscle atrophy and improving neck function, without inflicting additional surgical trauma.
Collapse
Affiliation(s)
- Fa‐jing Liu
- Present address:
Department of Spine SurgeryTianjin HospitalTianjinChina
| | - Yan‐cheng Liu
- Present address:
Department of Spine SurgeryTianjin HospitalTianjinChina,Department of Bone and Soft Tissue OncologyTianjin HospitalTianjinChina
| | - Yong‐cheng Hu
- Department of Bone and Soft Tissue OncologyTianjin HospitalTianjinChina
| | - Xiao‐kun Ding
- Present address:
Department of Spine SurgeryTianjin HospitalTianjinChina
| | - Jun Miao
- Present address:
Department of Spine SurgeryTianjin HospitalTianjinChina
| |
Collapse
|
2
|
Liu FJ, Ding XK, Chai Y, Qi SH, Li PF. Influence of fixed titanium plate position on the effectiveness of open-door laminoplasty for cervical spondylotic myelopathy. J Orthop Surg Res 2022; 17:297. [PMID: 35659017 PMCID: PMC9166363 DOI: 10.1186/s13018-022-03188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During open-door laminoplasty, the position of the bone gutter is not fixed, and when the gutter migrates inward, the outer end of the titanium plate must be fixed on the lamina edge. It is unclear whether this will affect the clinical efficacy. This study aimed to observe the influence of the titanium plate fixation position on the effectiveness of open-door laminoplasty for cervical spondylotic myelopathy (CSM). METHODS A total of 98 patients with CSM who underwent open-door laminoplasty from August 2016 to October 2019 were included in this retrospective study. Fifty-five patients had the titanium plate fixed on the lateral mass (lateral mass group), and 43 patients had the titanium plate fixed on the lamina edge (lamina group). The opening angle, opening width, occurrence of hinge fracture, spinal cord drift distance, cervical curvature index (CCI), neurological function recovery (JOA score), neck function (NDI), C5 palsy and severity of axial symptoms were observed and compared between the two groups. RESULTS The opening angle in the lamina group was significantly larger than that in the lateral mass group, while the opening width and the spinal cord drift distance were significantly smaller than those in the lateral mass group (P < 0.05). The occurrence of hinge fracture in the lamina group was significantly higher than that in the lateral group (25.6% and 9.1%, respectively) (P < 0.05). The CCI was maintained well in both groups (P > 0.05), and there was no significant difference between the groups (P > 0.05). After surgery, the JOA score significantly increased in both groups (P < 0.05), and the neurological recovery rates were similar between the two groups (62.6% vs. 64.5%). The NDI score significantly decreased in both groups (P < 0.05), but the lateral mass group recovered to a greater degree than the lamina group (P < 0.05). The occurrence of C5 palsy was 2.3% in the lamina group and 14.5% in the lateral mass group, and there was a significant difference between the groups (P < 0.05). Postoperative axial symptom severity was significantly worse in the lamina group than in the lateral mass group (P < 0.05). CONCLUSIONS In open-door laminoplasty, it is feasible to fix the titanium plate on the lateral mass or to the lamina due to the same neurological function recovery. However, fixing it to the lamina will increase the opening angle and decrease the opening width, making the hinge prone to fracture and increasing the severity of postoperative axial symptoms.
Collapse
Affiliation(s)
- Fa-Jing Liu
- Department of Spine Surgery, Tianjin Hospital, No. 406, Jiefang Road, Hexi District, Tianjin, 300000, China.
| | - Xiao-Kun Ding
- Department of Internal Medicine of Traditional Chinese Medicine, Tianjin Hospital, Tianjin, 300000, China
| | - Yi Chai
- Department of Orthopedics, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, 050013, China
| | - Su-Hong Qi
- Department of Spine Surgery, Tianjin Hospital, No. 406, Jiefang Road, Hexi District, Tianjin, 300000, China
| | - Peng-Fei Li
- Department of Orthopedics, The People's Hospital of Hengshui City, Hengshui, 053000, China
| |
Collapse
|
3
|
Yang Y, Wang Y, Cao J, Lei T, Yang Z, Xia H. Laminoplasty and simultaneous C2 semi-laminectomy with internal fixation in treating ossification of the posterior longitudinal ligament in cervical discs at C2 segment. Am J Transl Res 2022; 14:2419-2427. [PMID: 35559397 PMCID: PMC9091121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore the effect of open-door laminoplasty and simultaneous C2 semi-laminectomy with lateral mass screw fixation (LSLF) in treating ossification of the posterior longitudinal ligament (OPLL) in cervical discs at C2 segment. METHODS In this retrospective study, 76 patients diagnosed with OPLL in cervical discs at C2 segment from November 2016 to May 2019 were included. These patients were assigned into a LSLF group (n=41, LSLF surgery) and LF group (n=35, laminectomy and lateral mass screw fixation) according to the treatment they received. The surgery time and intraoperative blood loss were recorded. Improvements in neurological function (JOA score), cervical curvature index (CCI), spinal cord drift distance, cross-sectional area (CSA) of the posterior muscles from cervical spine, occurrence of C5 palsy, and severity of axial symptoms were evaluated between LSLF group and LF group. RESULTS Compared with LF group, the operative time was longer and blood loss volume was higher in LSLF group (P<0.05). No statistical difference was found in decompression width between LSLF group and LF group, while the drift distance of spinal cord in LSLF group was larger than that in LF group (P<0.05). No obvious differences were observed in anteroposterior dural sac diameter after the surgery between LSLF group and LF group. CSA in LF group decreased more than that in LSLF group (P<0.05). No remarkable difference was obtained in CCI at the final follow-up between LSLF group and LF group. The NDI score after surgery in the LSLF group was significantly decreased compared to LF group (P<0.05), while no differences were observed in JOA scores or the neurological recovery rate between LSLF group and LF group. The occurrence of C5 palsy in the LSLF group was 4.9%, which was less than that of LF group (20.0%). In contrast to LF group, postoperative axial symptoms in LSLF group were decreased (P<0.05). CONCLUSION Compared to LF, LSLF could better improve neck functions, and reduce the severity of axial symptoms and the occurrence of C5 palsy for patients with OPLL at C2 segment.
Collapse
Affiliation(s)
- Yipeng Yang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University Shijiazhuang 050035, Hebei Province, China
| | - Yu Wang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University Shijiazhuang 050035, Hebei Province, China
| | - Junming Cao
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University Shijiazhuang 050035, Hebei Province, China
| | - Tao Lei
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University Shijiazhuang 050035, Hebei Province, China
| | - Zongyou Yang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University Shijiazhuang 050035, Hebei Province, China
| | - Hehuan Xia
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University Shijiazhuang 050035, Hebei Province, China
| |
Collapse
|
4
|
Lockey SD, Trent SM, Kalantar SB. Cervical Myelopathy: An Update on Posterior Decompression. Clin Spine Surg 2022; 35:E87-E93. [PMID: 34379613 DOI: 10.1097/bsd.0000000000001126] [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: 05/13/2020] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a narrative review. OBJECTIVE The aim was to discuss current methods and review updated outcome studies regarding posterior decompression in the management of cervical myelopathy. SUMMARY OF BACKGROUND DATA Progressive myelopathy in the cervical segments is an indication for urgent surgical management. Although nonoperative treatment is an option in mild to moderate cases, the majority of patients will experience deterioration in neurological function requiring surgical decompression. METHODS A review of the literature was performed using PubMed to provide updated information regarding posterior cervical decompression in the management of myelopathy. RESULTS There are numerous studies comparing outcome data between cervical laminectomy and fusion with laminoplasty. While each technique has advantages and disadvantages, both provide adequate decompression and good long-term outcomes in patients meeting appropriate criteria. CONCLUSIONS Posterior decompression is an important approach for spine surgeons to have in their toolkits when treating cervical myelopathy.
Collapse
Affiliation(s)
- Stephen D Lockey
- Department of Orthopaedic Surgery, Medstar Georgetown University Hospital
| | | | - Seyed Babak Kalantar
- Department of Orthopaedic Surgery, Spine Surgery Division, Medstar Georgetown University Hospital, Washington, DC
| |
Collapse
|
5
|
Hou SB, Sun XZ, Liu FY, Gong R, Zhao ZQ, Lu K, Liu YB. Relationship of Change in Cervical Curvature after Laminectomy with Lateral Mass Screw Fixation to Spinal Cord Shift and Clinical Efficacy. J Neurol Surg A Cent Eur Neurosurg 2021; 83:129-134. [PMID: 34634827 DOI: 10.1055/s-0041-1723807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND STUDY AIMS Although laminectomy with lateral mass screw fixation (LCSF) is an effective surgical treatment for cervical spondylotic myelopathy (CSM), loss of cervical curvature may result. This study aimed to investigate the effect of cervical curvature on spinal cord drift distance and clinical efficacy. PATIENTS AND METHODS We retrospectively analyzed 78 consecutive CSM patients with normal cervical curvature who underwent LCSF. Cervical curvature was measured according to Borden's method 6 months after surgery. Study patients were divided into two groups: group A, reduced cervical curvature (cervical lordosis depth 0-7mm; n = 42); and group B, normal cervical curvature (cervical lordosis depth 7-17mm; n = 36). Spinal cord drift distance, laminectomy width, neurologic functional recovery, axial symptom (AS) severity, and incidence of C5 palsy were measured and compared. RESULTS Cervical lordosis depth was 5.1 ± 1.2 mm in group A and 12.3 ± 2.4 mm in group B (p < 0.05). Laminectomy width was 21.5 ± 2.6 mm in group A and 21.9 ± 2.8 mm in group B (p > 0.05). Spinal cord drift distance was significantly shorter in group A (1.9 ± 0.4 vs. 2.6 ± 0.7 mm; p < 0.05). The Japanese Orthopaedic Association (JOA) score significantly increased after surgery in both groups (p < 0.05). Neurologic recovery rate did not differ between the two groups (61.5 vs. 62.7%; p > 0.05). AS severity was significantly higher in group A (p < 0.05). C5 palsy occurred in three group A patients (7.1%) and four group B patients (11.1%), but the difference was not significant (p > 0.05). CONCLUSION After LCSF, 53.8% of the patients developed loss of cervical curvature. A smaller cervical curvature resulted in a shorter spinal cord drift distance. Loss of cervical curvature was related to AS severity but not improvement of neurologic function or incidence of C5 palsy.
Collapse
Affiliation(s)
- Shu-Bing Hou
- Department of Spine Surgery, The Third Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Xian-Ze Sun
- Department of Spine Surgery, The Third Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Feng-Yu Liu
- Department of Spine Surgery, The Third Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Rui Gong
- Department of Spine Surgery, The Third Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Zheng-Qi Zhao
- Department of Spine Surgery, The Third Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Kuan Lu
- Department of Spine Surgery, The Third Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Yan-Bing Liu
- Department of Spine Surgery, The Third Hospital of Shijiazhuang City, Shijiazhuang, China
| |
Collapse
|
6
|
Liu Y, Zhou XZ, Li N, Xu TG. Relationship between cervical curvature and spinal cord drift distance after laminectomy via lateral mass screw fixation and its effect on clinical efficacy. Medicine (Baltimore) 2021; 100:e26220. [PMID: 34516486 PMCID: PMC8428723 DOI: 10.1097/md.0000000000026220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 05/17/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Laminectomy with lateral mass screw fixation (LCS) is considered an effective surgical procedure for cervical spondylotic myelopathy. However, varying degrees of loss of the cervical curvature were noted in some patients postoperatively. The aim of this study was to observe the relationship between cervical curvature and spinal drift distance after LCS and to determine its effect on neurological function, axial symptoms, and C5 palsy. METHODS A total of 117 consecutive cervical spondylotic myelopathy patients with normal cervical curvature underwent LCS from April 2015 to May 2017 in our institution. Of these patients, 90 patients who accepted to undergo an integrated follow-up were enrolled in this study. The patients were divided into 3 groups based on their postoperative cervical curvature. In group A (28 patients), the cervical curvature became straight postoperatively (0°≤cervical spine angle≤5°); in group B (36 patients), the cervical curvature decreased (5°<cervical spine angle≤16.5°); and in group C (26 patients), the cervical curvature remained normal (cervical spine angle>16.5°). Spinal drift distance, neurological recovery, axial symptoms, and C5 palsy in the patients were recorded and analyzed. RESULTS Postoperative measurements showed that there was no significant difference in laminectomy width between the groups (P > .05). The cervical spine angle was 2.7° ± 0.5° in group A, 11.2° ± 2.6° in group B, and 20.8° ± 4.1° in group C (P < .05), while the spinal drift distance was 1.2 ± 0.2 mm, 1.8 ± 0.4 mm, and 3.0 ± 0.5 mm, respectively (P < .05). The postoperative Japanese Orthopedic Association score was significantly increased in all groups (P < .05), and there was no significant difference between the groups at different time points (P > .05). However, significant differences were noted between the groups in axial symptoms (P < .05), which were analyzed via the visual analog scale score. The occurrence of C5 palsy in groups A, B, and C was 7.1% (2/28), 8.3% (3/36), and 11.5% (3/26), respectively (P > .05). CONCLUSION In LCS, the cervical curvature should be maintained at the normal angle to obtain a good spinal cord drift distance and a lower incidence of axial symptoms.
Collapse
Affiliation(s)
- Yong Liu
- Department of Orthopedics, The People's Hospital of Suzhou New District, Suzhou, Jiangsu
| | - Xiao-Zhe Zhou
- Department of Orthopedics, Affiliated Hospital of Hebei University, Baoding
| | - Ning Li
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Tong-Guang Xu
- Department of Orthopedics, The People's Hospital of Suzhou New District, Suzhou, Jiangsu
| |
Collapse
|
7
|
Yang HY, Zhang YG, Zhao D, Sun GM, Ma Y, Hao YH, Yang Q. A New Posterior Extensor Attachment-Point Reconstruction Technique for Cervical Spondylotic Myelopathy Involving C2 Segment: Clinical Outcome and Safety. J Neurol Surg A Cent Eur Neurosurg 2020; 82:169-175. [PMID: 33352613 DOI: 10.1055/s-0040-1719102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND STUDY AIM Cervical spondylotic myelopathy (CSM) is a common degenerative disease that mainly occurs in elder patients, leading to different degrees of neurological dysfunction. Spinal cord involvement is mainly distributed at the C3-C7 segments, but it may also involve up to the C2 level. This study aimed to assess the clinical efficacy and safety of open-door laminoplasty using a new extensor attachment-point reconstruction technique for treating CSM involving the C2 segment. PATIENTS AND METHODS Fifty-nine patients with CSM involving the C2 segment and undergoing open-door laminoplasty were included in this retrospective study. Based on the titanium plate used in the operation, patients were divided into two groups, a reconstructed titanium plate fixation (RPF) group (n = 28) and a conventional titanium plate fixation (CPF) group (n = 31). Improvements in neurological function, cervical range of motion (ROM), cervical curvature index (CCI), preservation of posterior cervical muscle mass, and axial symptoms were compared between the two groups. RESULTS There were no significant differences in operative time and intraoperative blood loss between the groups (p > 0.05). The Japanese Orthopaedic Association (JOA) score significantly increased in both groups postsurgery (p < 0.05); the neurological recovery rate was similar between the two groups (64.1 ± 13.3% vs. 65.9 ± 14.7%, p > 0.05). There was no significant loss of cervical ROM in either group (p > 0.05). The anteroposterior dural sac diameter at the C2 level was significantly enlarged in both groups (p < 0.05). Alternatively, CCI was significantly reduced in the CRP group (p < 0.05) but unchanged in the RPF group (p > 0.05). The cross-sectional area of the posterior cervical muscles was also significantly reduced in the CPF group (p < 0.05) but maintained in the RPF group (p > 0.05). Finally, axial symptoms were more severe in the CPF group than in the RPF group (p < 0.05). CONCLUSION Laminoplasty is an effective surgical procedure for CSM involving the C2 segment. The reconstructed titanium plate achieved superior maintenance of cervical curvature and reduced both muscle atrophy and severity of axial symptoms compared with titanium conventional plates.
Collapse
Affiliation(s)
- Hai-Yun Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Yun-Ge Zhang
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Dong Zhao
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Gui-Ming Sun
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Yi Ma
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Yong-Hong Hao
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| |
Collapse
|