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Merrill RK, Subramanian T, Asada T, Singh S, Lu A, Korsun M, Maayan O, Akosman I, Dowdell J, Huang RC, Iyer S, Albert TJ, Lovecchio F, Kim HJ. Opening Side of Unilateral Open-Door Laminoplasty Does Not Impact Improvement in Arm Pain or Space Available for the Spinal Cord. J Clin Med 2024; 13:3345. [PMID: 38893056 PMCID: PMC11172582 DOI: 10.3390/jcm13113345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/09/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: There exists limited data guiding open-door laminoplasty. The objective of this study is to determine if open-door laminoplasty affects radiographic decompression or arm pain outcomes. Methods: Adult patients who underwent unilateral open-door laminoplasty cervical myelopathy were included. The side opened was dependent on surgeon discretion. We recorded preoperative side of symptoms, side of radiographic compression, arm pain scores, and canal diameter. Patients with open-side ipsilateral or contralateral to dominant symptoms or compression were compared to determine any effect on arm pain outcomes or spinal canal diameter. If the symptoms were equal bilaterally, patients were neutral. Results: A total of 167 patients were included, with an average age of 64 ± 11 years and average follow-up time of 64.5 ± 72 weeks. The average preoperative arm pain visual analog score (VAS) was 2.13 ± 2.86, and the average arm VAS after 6 months was 1.52 ± 2.68. For dominant symptoms, the ipsilateral, contralateral, and neutral groups had a significant improvement in arm VAS at >6 months postoperatively. For dominant compression, the ipsilateral and contralateral groups had a significant improvement in both arm VASs and canal diameter at >6 months postoperatively. No differences were seen between groups for either. We observed a significant correlation between size of plate and change in canal diameter; however, no differences were noted for arm pain. Conclusions: Laminoplasty may be effective in addressing radicular arm pain by increasing the spinal canal's diameter and space available for the cord. The laterality of open-door laminoplasty did not affect arm pain improvement or canal expansion.
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Affiliation(s)
- Robert K. Merrill
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Tejas Subramanian
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
- Weill Cornell Medicine, New York, NY 10021, USA
| | - Tomoyuki Asada
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Sumedha Singh
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Amy Lu
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
- Weill Cornell Medicine, New York, NY 10021, USA
| | - Max Korsun
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Omri Maayan
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
- Weill Cornell Medicine, New York, NY 10021, USA
| | - Izzet Akosman
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
- Weill Cornell Medicine, New York, NY 10021, USA
| | - James Dowdell
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Russel C. Huang
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
- Weill Cornell Medicine, New York, NY 10021, USA
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
- Weill Cornell Medicine, New York, NY 10021, USA
| | - Todd J. Albert
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
- Weill Cornell Medicine, New York, NY 10021, USA
| | - Francis Lovecchio
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Han Jo Kim
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
- Weill Cornell Medicine, New York, NY 10021, USA
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Yan RZ, Chen C, Lin CR, Wei YH, Guo ZJ, Li YK, Zhang Q, Shen HY, Sun HL. Delayed neurological dysfunction following posterior laminectomy with lateral mass screw fixation: A case report and review of literature. World J Clin Cases 2024; 12:1356-1364. [PMID: 38524505 PMCID: PMC10955538 DOI: 10.12998/wjcc.v12.i7.1356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/27/2023] [Accepted: 02/02/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND While most complications of cervical surgery are reversible, some, such as symptomatic postoperative spinal epidural hematoma (SEH), which generally occurs within 24 h, are associated with increased morbidity and mortality. Delayed neurological dysfunction is diagnosed in cases when symptoms present > 3 d postoperatively. Owing to its rarity, the risk factors for delayed neurological dysfunction are unclear. Consequently, this condition can result in irreversible neurological deficits and serious consequences. In this paper, we present a case of postoperative SEH that developed three days after hematoma evacuation. CASE SUMMARY A 68-year-old man with an American Spinal Injury Association (ASIA) grade C injury was admitted to our hospital with neck pain and tetraplegia following a fall. The C3-C7 posterior laminectomy and the lateral mass screw fixation surgery were performed on the tenth day. Postoperatively, the patient showed no changes in muscle strength or ASIA grade. The patient experienced neck pain and subcutaneous swelling on the third day postoperatively, his muscle strength decreased, and his ASIA score was grade A. Magnetic resonance imaging showed hypointense signals on T1 weighted image (T1WI) and T2WI located behind the epidural space, with spinal cord compression. Emergency surgical intervention for the hematoma was performed 12 h after onset. Although hypoproteinemia and pleural effusion did not improve in the perioperative period, the patient recovered to ASIA grade C on day 30 after surgery, and was transferred to a functional rehabilitation exercise unit. CONCLUSION This case shows that amelioration of low blood albumin and pleural effusion is an important aspect of the perioperative management of cervical surgery. Surgery to relieve the pressure on the spinal cord should be performed as soon as possible to decrease neurological disabilities.
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Affiliation(s)
- Rui-Zhong Yan
- Department of Orthopedics, Taiyuan Central Hospital, Taiyuan 030009, Shanxi Province, China
| | - Chao Chen
- Department of Orthopedics, Taiyuan Central Hospital, Taiyuan 030009, Shanxi Province, China
| | - Chu-Ran Lin
- Department of Orthopedics, Graduate School Shanxi University of Traditional Chinese Medicine, Taiyuan 030024, Shanxi Province, China
| | - Yan-Hui Wei
- Department of Orthopedics, Taiyuan Central Hospital, Taiyuan 030009, Shanxi Province, China
| | - Zhi-Jian Guo
- Department of Orthopedics, Taiyuan Central Hospital, Taiyuan 030009, Shanxi Province, China
| | - Ya-Kun Li
- Department of Orthopedics, Taiyuan Central Hospital, Taiyuan 030009, Shanxi Province, China
| | - Quan Zhang
- Department of Orthopedics, Taiyuan Central Hospital, Taiyuan 030009, Shanxi Province, China
| | - He-Yi Shen
- Department of Orthopedics, Taiyuan Central Hospital, Taiyuan 030009, Shanxi Province, China
| | - Hao-Lin Sun
- Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
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Zhong H, Xu C, Wang R, Wu X, Wu H, Sun B, Wang X, Chen H, Shen X, Yuan W. Anterior cervical discectomy and fusion, open-door laminoplasty, or laminectomy with fusion: Which is the better treatment for four-level cervical spondylotic myelopathy? Front Surg 2023; 9:1065103. [PMID: 36713671 PMCID: PMC9879003 DOI: 10.3389/fsurg.2022.1065103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/29/2022] [Indexed: 01/11/2023] Open
Abstract
Four-level cervical spondylotic myelopathy (CSM) is a common disease affecting a large number of people, with the optimal surgical strategy remaining controversial. This study compared the clinical outcomes, radiological parameters, and postoperative complications of primarily performed surgical procedures such as anterior cervical discectomy and fusion (ACDF), open-door laminoplasty (LAMP), and laminectomy with fusion (LF) in treating four-level CSM. A total of 116 patients who received ACDF (38 cases), LAMP (45 cases), and LF (33 cases) were followed up for a minimum of 24 months were enrolled in this study and retrospectively analyzed. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) scoring system, the Neck Disability Index (NDI), and the Visual Analogue Scale (VAS). Changes in the curvature of the cervical spine were determined using the cervical curvature index (CCI) and the C2-C7 Cobb angle. Cervical mobility was evaluated using the C2-C7 range of motion (ROM) and active cervical ROM (aROM). Complications were recorded and compared among the three groups. All patients achieved significant improvement in JOA, NDI, and VAS scores at the final follow-up (P < 0.05), whereas no remarkable difference was found among the groups (P > 0.05). In addition, both C2-7 ROM and aROM were significantly reduced in the three groups and LAMP showed the least reduction relatively. As for complications, LAMP showed the lowest overall incidence of postoperative complications, and patients in the ACDF group were more susceptible to dysphagia, pseudoarthrosis than LAMP and LF. Considering improvements in clinical symptoms and neurological function, no remarkable difference was found among the groups. Nevertheless, LAMP had advantages over the other two surgical procedures in terms of preserving cervical mobility and reducing postoperative complications.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Wen Yuan
- Correspondence: Xiaolong Shen Wen Yuan
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Chen X, Shan T, Li Y. Prognostic effect of increased postoperative MRI T2WI high signal intensity in degenerative cervical myelopathy. Spine J 2022; 22:1964-1973. [PMID: 35878755 DOI: 10.1016/j.spinee.2022.07.097] [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] [Received: 04/02/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT High cord signals (HCS) are common in patients undergoing surgery for degenerative cervical myelopathy (DCM). Few studies have investigated the prognostic effects of postoperative HCS changes. PURPOSE To investigate whether different changes in the postoperative magnetic resonance imaging (MRI) T2-weighted images (T2WIs) signal intensity ratio (SIR) is related to patient outcomes, predictors of unsatisfactory recovery, and the factors associated with changes in postoperative SIR. STUDY DESIGN A retrospective chart review at a single institution. PATIENT SAMPLE The study population included all consecutive patients who showed HCS in preoperative MRI T2WIs and underwent double-door laminoplasty for DCM from December 2017 to December 2020. OUTCOME MEASURES Patient self-reported measures included the Japanese Orthopedic Association (JOA) score, 36-Item Short Form Survey (SF-36) physical component score, and SF-36 mental component score. Imaging measures included SIR, length of HCS, and canal narrowing ratio (CNR). METHODS We reviewed patient records and analyzed the statistical associations of MRI T2WI measures with the JOA score, SF-36 physical, and mental component scores. RESULTS Fifty-three patients were categorized into three groups based on the postoperative HCS changes, identified from MRI T2WI before and after surgery: reduced (Group A, N=26); unchanged (Group B, N=12); and increased (Group C, N=15). The neurological recovery rates 12 months after surgery were 67.72%±17.45% in Group A, 51.53%±16.00% in Group B, and 13.35%±21.35% in Group C (p<.001). Significant differences across the three groups were found in symptom duration, postoperative SIR and length of HCS, pre- and postoperative CNR, recovery rate, JOA, SF-36 scores, with patients in Group C having the worst outcomes. Longer DCM symptom duration, greater preoperative CNR, and increased postoperative HCS were prognostic factors for a recovery rate<50%. Preoperative CNR, with an optimal threshold of 57.303%, was an independent risk factor for increased postoperative HCS. CONCLUSIONS Less than one-third of DCM patients with preoperative HCS exhibited an increase in HCS after double-door laminoplasty and reported worse outcomes at the 12-month follow-up when compared to patients with decreased or unchanged postoperative HCS.
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Affiliation(s)
- Xuan Chen
- Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Boulevard, Changchun, 130033, China
| | - Tiyong Shan
- Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Boulevard, Changchun, 130033, China
| | - Ye Li
- Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Boulevard, Changchun, 130033, China.
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Chen N, Yu L, Liu X, Chen G, Li Y, Zou X, He D, Yang J, Cui S, Wang L, Liu S, Wei F. A Novel Method of Making Hinges Using a Newly Designed Sharp Rongeur to Enhance Radiological and Clinical Outcomes in French-Door Cervical Expansive Laminoplasty. Orthop Surg 2022; 14:3349-3357. [PMID: 36349782 PMCID: PMC9732589 DOI: 10.1111/os.13505] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Although the lamina open angle of making hinges is closely related to the outcomes of French-door laminoplasty (FDL) for treatment of cervical spondylosis, there have been no methods to predict the lamina open angle preoperatively as yet. The aim of this study was to investigate the accuracy of predicting the laminal open angle using our newly designed sharp rongeur, and to compare the postoperative outcomes and complications between the methods of making hinges using the newly designed sharp rongeur and the traditional high-speed micro-drill during the FDL. METHODS This was a single-center retrospective study. Following the approval of the institutional ethics committee, a total of 39 patients (Male: 28; Female: 11) diagnosed with cervical spondylos who underwent FDL in our institution between January 2018 and May 2019 were enrolled. Patients were divided into two groups based on the method of making hinges (sharp rongeur: 22 cases; high-speed micro-drill: 17 cases). The average age at surgery was 59.1 years (range: 16-85 years). The radiological parameters, clinical outcomes, modified Japanese Orthopaedic Association (mJOA) scale score, and the recovery rate of mJOA were recorded and compared between the groups, respectively. The radiological parameters and clinical measurements at pre- and post-operation stages were compared using the paired-sample t-test, the Wilcoxon signed-rank test, and the Friedman's test, and variables in the two groups were analyzed using an unpaired Student's t-test or a Mann-Whitney U test. RESULTS The average follow-up period was 20.4 months (range: 14.0-25.9 months), the postoperative open angle was 60.13° ± 3.69° in the rongeur group with 22.78° ± 4.34° of angular enlargement, which was significantly lower than that of 68.96° ± 1.00° in the micro-drill group with 32.75° ± 4.22° of angular enlargement (U = 19.000, p < 0.001). The rongeur group showed a higher fusion rate (34.1% vs 14.7%, χ2 = 11.340, p = 0.001), and a lower fracture rate of the lamina (7.8% vs 25.5%, χ2 = 14.185, p < 0.001) at 1-month post-surgery, compared to the micro-drill group. There were no significant differences in the clinical outcomes and postoperative complications between the two groups (p > 0.05), except in the recovery rate of mJOA scores (0.836 ± 0.138 vs 0.724 ± 0.180, U = 115.000, p = 0.042) and neck disability index (NDI) at the final follow-up (7.55 ± 10.65 vs 14.71 ± 8.72, U = 94.000, p = 0.008). CONCLUSIONS The special sharp rongeur with a tip angle of 20° could be a preferred method to make hinges during FDL, which can predict the laminal open angle accurately and enlarge it to about 23°, thus reducing the fracture rate and accelerating the bony fusion of hinges compared with the outcomes of the traditional micro-drill method.
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Affiliation(s)
- Ningning Chen
- Department of Orthopaedic SurgeryThe Seventh Affiliated Hospital of Sun Yat‐sen UniversityShenzhenChina
| | - Lanzhe Yu
- Department of Orthopaedic SurgeryZhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University)ZhuhaiChina
| | - Xizhe Liu
- Department of Spine SurgeryThe First Affiliated Hospital and Orthopedic Research Institute of Sun Yat‐sen UniversityGuangzhouChina
| | - Guoliang Chen
- Department of Orthopaedic SurgeryThe Seventh Affiliated Hospital of Sun Yat‐sen UniversityShenzhenChina
| | - Yanrun Li
- Department of Orthopaedic SurgeryThe Seventh Affiliated Hospital of Sun Yat‐sen UniversityShenzhenChina
| | - Xuenong Zou
- Department of Spine SurgeryThe First Affiliated Hospital and Orthopedic Research Institute of Sun Yat‐sen UniversityGuangzhouChina
| | - Dacheng He
- Department of Orthopaedic SurgeryThe Seventh Affiliated Hospital of Sun Yat‐sen UniversityShenzhenChina
| | - Jiaming Yang
- Department of Orthopaedic SurgeryThe Seventh Affiliated Hospital of Sun Yat‐sen UniversityShenzhenChina
| | - Shangbin Cui
- Department of Spine SurgeryThe First Affiliated Hospital and Orthopedic Research Institute of Sun Yat‐sen UniversityGuangzhouChina
| | - Le Wang
- Department of Spine SurgeryThe First Affiliated Hospital and Orthopedic Research Institute of Sun Yat‐sen UniversityGuangzhouChina
| | - Shaoyu Liu
- Department of Orthopaedic SurgeryThe Seventh Affiliated Hospital of Sun Yat‐sen UniversityShenzhenChina,Department of Spine SurgeryThe First Affiliated Hospital and Orthopedic Research Institute of Sun Yat‐sen UniversityGuangzhouChina
| | - Fuxin Wei
- Department of Orthopaedic SurgeryThe Seventh Affiliated Hospital of Sun Yat‐sen UniversityShenzhenChina
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Chen T, Zhang X, Meng F, Zhang T, Zhao Y, Yan J, Xu G, Zhao W. Open-Door versus French-Door Laminoplasty for Patients with Multisegmental Cervical Spondylotic Myelopathy: A Systematic Review and Meta-analysis. World Neurosurg 2021; 155:82-93. [PMID: 34425291 DOI: 10.1016/j.wneu.2021.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to evaluate the superiority of open-door versus French-door posterior cervical laminoplasty in the treatment of multisegmental cervical spondylotic myelopathy by comparing the intraoperative parameters and clinical and radiologic outcomes of these 2 procedures. PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, the Wanfang database, the Weipu database, and China Biology Medicine disk were searched. Articles were retrieved from database establishment through May 22, 2020. Data analysis was carried out on the retrieved articles using RevMan 5.3 software. This meta-analysis included 14 studies involving 1010 patients, among which 6 were randomized controlled trials and 8 were retrospective analyses. Comparing the open-door and French-door groups, no statistically significant differences were found in operative time (weighted mean difference [WMD] = -4.47, 95% CI [-17.85, 8.92], P = 0.51), postoperative Japanese Orthopaedic Association score (WMD= -0.24, 95% CI [-0.87, 0.38], P = 0.45), recovery rate (WMD= -0.58, 95% CI [-3.61, 2.45], P = 0.71), postoperative cervical lordosis (WMD= -0.15, 95% CI [-1.93, 1.63], P = 0.87), cervical range of motion (WMD = -3.04, 95% CI [-8.68, 2.59], P = 0.29), sagittal diameter of the spinal canal (WMD = -0.24, 95% CI [-0.54, 0.07], P = 0.13), incidence of C5 palsy (OR = 1.78, 95% CI [0.64, 4.93], P = 0.27), or incidence of cerebrospinal fluid leakage (OR = 1.51, 95% CI [0.48, 4.71], P = 0.48). However, the French-door group was associated with less intraoperative bleeding (WMD = 54.96, 95% CI [21.37, 88.55], P = 0.001) and a lower incidence of axial symptoms (OR = 2.50, 95% CI [1.32, 4.72], P = 0.005). This analysis suggests that both methods can achieve good postoperative outcomes. However, less intraoperative bleeding and a lower incidence of postoperative axial symptoms were found in the French-door group. This requires further validation and investigation in larger sample-size and well-designed randomized controlled studies.
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Affiliation(s)
- Tiantian Chen
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xun Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fanchao Meng
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tingxin Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yibo Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jinglong Yan
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Gongping Xu
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
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