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Hou BQ, Croft AJ, Vaughan WE, Davidson C, Pennings JS, Bowers MF, Vickery JW, Abtahi AM, Gardocki RJ, Lugo-Pico JG, Zuckerman SL, Stephens BF. Racial and Socioeconomic Disparities in Laminoplasty Versus Laminectomy With Fusion in Patients With Cervical Spondylosis. Spine (Phila Pa 1976) 2024; 49:694-700. [PMID: 38655789 DOI: 10.1097/brs.0000000000004793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/26/2023] [Indexed: 04/26/2024]
Abstract
STUDY DESIGN A retrospective cohort study using prospectively collected data. OBJECTIVE The aim of this study was to investigate preoperative differences in racial and socioeconomic factors in patients undergoing laminoplasty (LP) versus laminectomy and fusion (LF) for degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA DCM is prevalent in the United States, requiring surgical intervention to prevent neurological degeneration. While LF is utilized more frequently, LP is an emerging alternative. Previous studies have demonstrated similar neurological outcomes for both procedures. However, treatment selection is primarily at the discretion of the surgeon and may be influenced by social determinants of health that impact surgical outcomes. MATERIALS AND METHODS The Quality Outcome Database (QOD), a national spine registry, was queried for adult patients who underwent either LP or LF for the management of DCM. Covariates associated with socioeconomic status, pain and disability, and demographic and medical history were collected. Multivariate logistic regression was performed to assess patient factors associated with undergoing LP versus LF. RESULTS Of 1673 DCM patients, 157 (9.4%) underwent LP and 1516 (90.6%) underwent LF. A significantly greater proportion of LP patients had private insurance (P<0.001), a greater than high school level education (P<0.001), were employed (P<0.001), and underwent primary surgery (P<0.001). LP patients reported significantly lower baseline neck/arm pain and Neck Disability Index (P<0.001). In the multivariate regression model, lower baseline neck pain [odds ratio (OR)=0.915, P=0.001], identifying as non-Caucasian (OR=2.082, P<0.032), being employed (OR=1.592, P=0.023), and having a greater than high school level education (OR=1.845, P<0.001) were associated with undergoing LP rather than LF. CONCLUSIONS In DCM patients undergoing surgery, factors associated with patients undergoing LP versus LF included lower baseline neck pain, non-Caucasian race, higher education, and employment. While symptomatology may influence the decision to choose LP over LF, there may also be socioeconomic factors at play. The trend of more educated and employed patients undergoing LP warrants further investigation.
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Affiliation(s)
- Brian Q Hou
- Vanderbilt University School of Medicine, Nashville, TN
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew J Croft
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
| | - Wilson E Vaughan
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
| | - Claudia Davidson
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Jacquelyn S Pennings
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Mitchell F Bowers
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Justin W Vickery
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Amir M Abtahi
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Raymond J Gardocki
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Julian G Lugo-Pico
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Scott L Zuckerman
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Byron F Stephens
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
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van Munster JJCM, Halperin IJY, Ardesch FH, van den Hout WB, van Benthem PPG, Moojen W, Peul WC. Practice variation in surgical treatment for lumbar degenerative disc disease: exploring regional and hospital factors influencing surgical rates. Sci Rep 2024; 14:9273. [PMID: 38653739 DOI: 10.1038/s41598-024-59629-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
The presence of significant, unwarranted variation in treatment suggests that clinical decision making also depends on where patients live instead of what they need and prefer. Historically, high practice variation in surgical treatment for lumbar degenerative disc disease (LDDD) has been documented. This study aimed to investigate current regional variation in surgical treatment for sciatica resulting from LDDD. We conducted a retrospective, cross-sectional analysis of all Dutch adults (>18 years) between 2016 and 2019. Demographic data from Statistics Netherlands were merged with a nationwide claims database, covering over 99% of the population. Inclusion criteria comprised LDDD diagnosis codes and relevant surgical codes. Practice variation was assessed at the level of postal code areas and hospital service areas (HSAs). Multivariable logistic regression analysis was employed to identify variables associated with surgical treatment. Among the 119,148 hospital visitors with LDDD, 14,840 underwent surgical treatment. Practice variation for laminectomies and discectomies showed less than two-fold variation in both postal code and HSAs. However, instrumented fusion surgery demonstrated a five-fold variation in postal code areas and three-fold variation in HSAs. Predictors of receiving surgical treatment included opioid prescription and patient referral status. Gender differences were observed, with males more likely to undergo laminectomy or discectomy, and females more likely to receive instrumented fusion surgery. Our study revealed low variation rates for discectomies and laminectomies, while indicating a high variation rate for instrumented fusion surgery in LDDD patients. High-quality research is needed on the extent of guideline implementation and its influence on practice variation.
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Affiliation(s)
- Juliëtte J C M van Munster
- University Neurosurgical Centre Holland (UNCH), LUMC | HMC | HAGA, Leiden & The Hague, the Netherlands.
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands.
- Department of Neurosurgery, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Ilan J Y Halperin
- University Neurosurgical Centre Holland (UNCH), LUMC | HMC | HAGA, Leiden & The Hague, the Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Frank H Ardesch
- Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands
| | - Wilbert B van den Hout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Wouter Moojen
- University Neurosurgical Centre Holland (UNCH), LUMC | HMC | HAGA, Leiden & The Hague, the Netherlands
| | - Wilco C Peul
- University Neurosurgical Centre Holland (UNCH), LUMC | HMC | HAGA, Leiden & The Hague, the Netherlands
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Ren Y, Nian Y, Sun T. Ultrasonic bone curette-assisted unilateral approach for bilateral decompression with MIS-TLIF for severe lumbar spinal stenosis. BMC Musculoskelet Disord 2024; 25:315. [PMID: 38654251 PMCID: PMC11036630 DOI: 10.1186/s12891-024-07453-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE We aimed to evaluate the clinical efficacy of bilateral decompression with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) assisted by an ultrasonic bone curette (UBC) for treating severe degenerative lumbar spinal stenosis (DLSS) and traditional tool laminectomy decompression MIS-TLIF for treating severe DLSS. METHODS The clinical data of 128 patients with single-segment severe DLSS who were admitted between January 2017 and December 2021 were retrospectively analyzed. Among them, 67 patients were treated with unilateral fenestration and bilateral decompression MIS-TLIF using an ultrasonic bone curette (UBC group), whereas 61 patients were treated with unilateral fenestration and bilateral decompression MIS-TLIF using traditional tools (traditional group, control). A visual analog scale (VAS) was used to evaluate back and lower limb pain before the operation,immediate postoperative, and one week, 3, 6, 12, and 24 months after the operation. Oswestry disability index (ODI) and Zurich claudication score (ZCQ) were employed to evaluate the improvement in low back and lower limb function. At the last follow-up, the Bridwell bone graft fusion standard was utilized to evaluate bone graft fusion. RESULTS The decompression time of laminectomy was significantly shorter in the UBC group than in the traditional group (control group), and the intraoperative blood loss and postoperative drainage volume were significantly less in those in the control group (P < 0.05). The VAS, ODI, and ZCQ scores of the two groups after the operation were significantly improved compared to those before the operation (P < 0.05). The UBC group had better VAS back scores than the control group immediate postoperative and one week after the operation(P < 0.05). The UBC group had better VAS lower limb scores than the control group immediate postoperative (P < 0.05).The incidence of perioperative complications, hospitalization time, dural sac cross-sectional area (CSA), and dural sac CSA improvement rate did not differ significantly between the two groups (P > 0.05). VAS and ODI scores did not differ significantly between the two groups before,three, six months, one year, and two years after surgery (P > 0.05). The ZCQ scores did not differ significantly between the two groups before the operation at one week, six months, one year, and two years after the operation (P > 0.05). According to the Bridwell bone graft fusion standard, bone graft fusion did not occur significantly between the two groups (P > 0.05) at the last follow-up. CONCLUSIONS UBC unilateral fenestration bilateral decompression MIS-TLIF in treating severe DLSS can achieve clinical efficacy as traditional tool unilateral fenestration bilateral decompression MIS-TLIF and reduce intraoperative blood loss and postoperative drainage. It can also shorten the operation time, effectively reduce the work intensity of the operator, and reduce the degree of low back pain during short-term follow-ups. Therefore, this is a safe and effective surgical method.
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Affiliation(s)
- Yuebing Ren
- Department of Spinal Surgery, Dongying People's Hospital(Dongying Hospital of Shandong Provincial Hospital Group), Dongying, Shandong, 257091, China
| | - Ying Nian
- Department of Oncology, Dongying People's Hospital(Dongying Hospital of Shandong Provincial Hospital Group), Dongying, Shandong, 257091, China
| | - Tongxin Sun
- Department of Orthopedics, Dongying People's Hospital(Dongying Hospital of Shandong Provincial Hospital Group), Dongying, Shandong, 257091, China.
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Kim JY, Heo DH. Biportal endoscopic cervical open-door laminoplasty to treat cervical spondylotic myelopathy. Acta Neurochir (Wien) 2024; 166:182. [PMID: 38632148 DOI: 10.1007/s00701-024-06076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Although cervical laminoplasty is a frequently utilized surgical intervention for cervical spondylotic myelopathy, it is primarily performed using conventional open surgical techniques. We attempted the minimally invasive cervical laminoplasty using biportal endoscopic approach. METHODS Contralateral lamina access is facilitated by creating space through spinous process drilling, followed by lamina hinge formation. Subsequently, the incised lamina is elevated from ipsilateral aspect, and secure metal plate fixation is performed. CONCLUSION We successfully performed the cervical open door laminoplasty using biportal endoscopic approach. Biportal endoscopic cervical open-door laminoplasty may be a minimally invasive technique that can prevent complications related with open surgery.
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Affiliation(s)
- Ji Yeon Kim
- Department of Neurosurgery, Spine Center, Seran General Hospital, Seoul, South Korea
| | - Dong Hwa Heo
- Department of Neurosurgery, Endoscopic Spine Surgery Center, Harrison Spinartus Hospital Chungdam, 646 Samseong-ro, Gangnam-gu, Seoul, 06084, South Korea.
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Liu R, He T, Wu X, Tan W, Yan Z, Deng Y. Biomechanical response of decompression alone in lower grade lumbar degenerative spondylolisthesis--A finite element analysis. J Orthop Surg Res 2024; 19:209. [PMID: 38561837 PMCID: PMC10983632 DOI: 10.1186/s13018-024-04681-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Previous studies have demonstrated the clinical efficacy of decompression alone in lower-grade spondylolisthesis. A higher rate of surgical revision and a lower rate of back pain relief was also observed. However, there is a lack of relevant biomechanical evidence after decompression alone for lower-grade spondylolisthesis. PURPOSE Evaluating the biomechanical characteristics of total laminectomy, hemilaminectomy, and facetectomy for lower-grade spondylolisthesis by analyzing the range of motion (ROM), intradiscal pressure (IDP), annulus fibrosus stress (AFS), facet joints contact force (FJCF), and isthmus stress (IS). METHODS Firstly, we utilized finite element tools to develop a normal lumbar model and subsequently constructed a spondylolisthesis model based on the normal model. We then performed total laminectomy, hemilaminectomy, and one-third facetectomy in the normal model and spondylolisthesis model, respectively. Finally, we analyzed parameters, such as ROM, IDP, AFS, FJCF, and IS, for all the models under the same concentrate force and moment. RESULTS The intact spondylolisthesis model showed a significant increase in the relative parameters, including ROM, AFS, FJCF, and IS, compared to the intact normal lumbar model. Hemilaminectomy and one-third facetectomy in both spondylolisthesis and normal lumbar models did not result in an obvious change in ROM, IDP, AFS, FJCF, and IS compared to the pre-operative state. Moreover, there was no significant difference in the degree of parameter changes between the spondylolisthesis and normal lumbar models after undergoing the same surgical procedures. However, total laminectomy significantly increased ROM, AFS, and IS and decreased the FJCF in both normal lumbar models and spondylolisthesis models. CONCLUSION Hemilaminectomy and one-third facetectomy did not have a significant impact on the segment stability of lower-grade spondylolisthesis; however, patients with LDS undergoing hemilaminectomy and one-third facetectomy may experience higher isthmus stress on the surgical side during rotation. In addition, total laminectomy changes the biomechanics in both normal lumbar models and spondylolisthesis models.
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Affiliation(s)
- Renfeng Liu
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Tao He
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Xin Wu
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Wei Tan
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Zuyun Yan
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Youwen Deng
- Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China.
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Lindsey MH, Lightsey HM, Xiong GX, Goh B, Simpson AK, Hershman SH. What Happens to Sagittal Alignment Following Laminoplasty Versus Laminectomy and Fusion? World Neurosurg 2024; 184:e211-e218. [PMID: 38266988 DOI: 10.1016/j.wneu.2024.01.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Laminectomy and fusion (LF) and laminoplasty (LP) are 2 sucessful posterior decompression techniques for cervical myelo-radiculopathy. There is also a growing body of evidence describing the importance of cervical sagittal alignment (CSA) and its importance in outcomes. We investigated the difference between pre- and postoperative CSA parameters in and between LF or LP. Furthermore, we studied predictive variables associated with change in cervical mismatch (CM). METHODS This is a retrospective cohort study of adults with cervical myeloradiculopathy in a single healthcare system. The primary outcomes are intra- and inter-cohort comparison of LF versus LP radiographic parameters at pre- and postoperative time points. A secondary multivariable analysis of predictive factors was performed evaluating factors predicting postoperative CM. RESULTS Eighty nine patients were included; 38 (43%) had LF and 51 (57%) underwent LP. Both groups decreased in lordosis (LF 11.4° vs. 4.9°, P = 0.01; LP 15.2° vs. 9.1°, P < 0.001), increased in cSVA (LF 3.4 vs. 4.2 cm, P = 0.01; LP 3.2 vs. 4.2 cm, P < 0.001), and increased in CM (LF 22.0° vs. 28.5°, P = 0.02; LP 16.8° vs. 22.3°, P = 0.002). There were no significant differences in the postoperative CSA between groups. No significant predictors of change in pre- and postoperative CM were found. CONSLUSIONS There were no significant pre-or postoperative differences following the 2 procedures, suggesting radiographic equipoise in well indicated patients. Across all groups, lordosis decreased, cSVA increased, and cervical mismatch increased. There were no predictive factors that led to change in cervical mismatch.
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Affiliation(s)
- Matthew H Lindsey
- Department of Orthopaedic Spine Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Harry M Lightsey
- Department of Spine Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Grace X Xiong
- Department of Spine Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Brian Goh
- Division of Spine Surgery, Emory Orthopaedics & Spine Center, Atlanta, Georgia, USA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stuart H Hershman
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Gülensoy B, Şimşek S. Retrospective Study to Compare the Effectiveness of Minimally Invasive Microscopic Unilateral Laminotomy with Microscopic Bilateral Laminotomy for Bilateral Decompression in the Early Postoperative Period in 142 Patients with Single-Level Lumbar Spinal Stenosis. Med Sci Monit 2024; 30:e943815. [PMID: 38491725 PMCID: PMC10953316 DOI: 10.12659/msm.943815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/19/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND We aimed to compare the effectiveness of microscopic unilateral laminotomy for bilateral decompression (ULBD) and microscopic bilateral laminotomy for bilateral decompression (BLBD) in the early postoperative period among patients with single-level lumbar spinal stenosis (LSS). MATERIAL AND METHODS A retrospective cohort study was conducted on patients with LSS who underwent ULBD or BLBD between January 2020 and December 2023, including 94 patients who underwent ULBD and 58 who underwent BLBD. Patient demographics, comorbidities, smoking status, and data related to LSS were reviewed. Preoperative and postoperative assessments on day 10 included back pain visual analog scale (VAS), walking distance, and Odom criteria. Disability was evaluated using the self-assessment Oswestry Disability Index (ODI) preoperatively and on day 30. Additionally, wound infection, postoperative modified MacNab criteria, and pain (back, leg, and hip) were recorded. RESULTS Age and sex were similar in the 2 groups. Both surgeries significantly reduced low back pain, increased walking distance, and improved Odom category on day 10, compared with baseline (P<0.001 for all). A significant decrease in 30-day ODI, compared with baseline, was observed in both groups (P<0.001 for both). The ULBD group had a significantly higher percentage of patients with wound infection (P=0.014); however, the ODI score among ULBD recipients was significantly lower (better) on day 30 (P=0.047). CONCLUSIONS ULBD may represent a less invasive, more effective, and safer surgical alternative than BLBD and classical laminectomy in patients with single-level LSS, but precautions are essential concerning wound infection.
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Affiliation(s)
- Bülent Gülensoy
- Department of Neurosergury, Lokman Hekim University Faculty of Medicine, Ankara, Turkey
| | - Serkan Şimşek
- Department of Neurosergury, Medipol University Faculty of Medicine, Ankara, Turkey
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LeRoy TE, Ruiz-Cardozo MA, Molina CA. Transdural Ventral Sling Technique for Calcified Thoracic Disk Herniations. World Neurosurg 2024; 183:123-127. [PMID: 38104932 DOI: 10.1016/j.wneu.2023.12.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Surgery for thoracic disc herniations remains an ongoing challenge, with numerous surgical approaches, all with their own inherent risks. Discectomy via a posterior laminectomy was historically the treatment of choice; however, it was deemed very high risk with elevated rates of neurologic injury. The posterior transdural approach is an alternative surgical option for soft and calcified thoracic disc herniations. METHODS A 56-year-old female with many years of numbness/tingling in her hands and difficulty with fine motor tasks presented with progressive weakness and loss of balance in her legs. Imaging revealed a prominent focal central calcified disc herniation at the T5-T6 level causing severe effacement and distortion of the spinal cord. A posterior transdural approach for direct visualization of a large calcified disc herniation was performed, removing the calcified disc without the need for extensive exposure or entry into the thoracic cavity. A ventral sling of the dura was created to allow rotation of the spinal cord while removing the disc. RESULTS Intraoperative ultrasound confirmed complete disc resection, restoring cerebral spinal fluid flow circumferentially without residual impingement or cerebrospinal fluid leaks. At six months postsurgery, the patient's gait imbalance had resolved, and she had full lower extremity strength (5/5). Radiographic evaluation indicated stable implants without subsidence, pullout, fracture, or alignment loss. CONCLUSIONS The transdural approach is less invasive in nature, minimizes surgical exposure, patient morbidity, and provides better intraoperative control of the spinal cord. This constitutes an effective alternative surgical approach to both soft and calcified central thoracic disc herniations.
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Affiliation(s)
- Taryn E LeRoy
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts, USA
| | - Miguel A Ruiz-Cardozo
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Camilo A Molina
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
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Kihara S, Aikawa T, Miyazaki Y, Nishimura M, Muyama H. Thoracic Vertebral Canal Stenosis and Vertebral Instability in a Young Minuet Cat. J Am Anim Hosp Assoc 2024; 60:81-86. [PMID: 38394696 DOI: 10.5326/jaaha-ms-7403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/25/2024]
Abstract
This report describes a unique case of thoracic vertebral canal stenosis and vertebral instability in a 1 yr old Minuet cat. The cat presented with a history of chronic progressive nonambulatory paraparesis. Myelography with neutral and stress positions revealed dynamic compression at T1-4. Computed tomography and MRI revealed multiple sites of vertebral endplate osteolysis, adjacent bone sclerosis, intervertebral disk space narrowing, and spondylotic bridging within the cervical and cranial thoracic vertebral bodies and pedicles, particularly at C6-T4. The cat underwent a right-sided T1-4 hemilaminectomy and C7-T4 vertebral stabilization using positively threaded profile pins and polymethylmethacrylate. The cat fully recovered without any complication. The case highlights the potential for young cats, especially those with a chondrodysplastic condition, to develop vertebral canal stenosis and vertebral instability. The surgical treatment described herein resulted in an excellent outcome.
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Affiliation(s)
- Shuya Kihara
- From Aikawa Veterinary Medical Center, Tokyo, Japan
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Ruan C, Jiang W, Lu W, Wang Y, Hu X, Ma W. Incidence and Risk Factors for the Development of Axial Symptoms Following Posterior Single-Door Laminoplasty: A Retrospective Analysis. World Neurosurg 2024; 183:e603-e612. [PMID: 38185458 DOI: 10.1016/j.wneu.2023.12.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Posterior single-door laminoplasty is a widely practiced clinical procedure, but the occurrence of postoperative axial syndrome (AS) remains a significant concern. The aim of this study was to identify risk factors associated with AS and develop a risk prediction model. METHODS Clinical data from 226 patients who underwent posterior single-door laminoplasty between June 2017 and June 2022 were collected. Through Logistic model analysis, the risk factors of AS are clarified and the intensity of each risk factor is explained in the form of forest plot. Subsequently, we constructed a predictive model and plotted receiver operating characteristic curves to assess the model's predictive value. RESULTS In the end, 87 cases were diagnosed with AS, resulting in an incidence rate of 38.5%. Logistic regression analysis revealed that preoperative encroachment rate of anterior spinal canal (pre-op ERASC), intraoperative facet joints destruction, intraoperative open-door angle, postoperative loss of cervical curvature, and postoperative loss of cervical range of motion were independent risk factors for AS. Conversely, preoperative cervical curvature (pre-op CC) and postoperation early function training were protective factors against AS. The Youden index indicated that the cutoff values for pre-op ERASC and pre-op CC were 26.6°and 16.5, respectively. The risk prediction model for AS was constructed and a nomogram was plotted. The model has high clinical value. CONCLUSIONS Pre-op ERASC, pre-op CC, intraoperative facet joints destruction, intraoperative open-door angle, postoperative loss of cervical curvature, postoperative loss of cervical range of motion, and postoperation early function training are independent influencing factors for AS occurrence. The risk model has good practicability.
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Affiliation(s)
- Chaoyue Ruan
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Weiyu Jiang
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Wenjie Lu
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Yang Wang
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Xudong Hu
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Weihu Ma
- Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China.
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Tomasi SO, Umana GE, Scalia G, Raudino G, Stevanovic V, Krainz H, Kral M, Nicoletti GF, Winkler PA. Lumbar Spinous Process-Splitting Technique for Ligamentum Flavum Cyst Removal. J Neurol Surg A Cent Eur Neurosurg 2024; 85:195-201. [PMID: 34875711 DOI: 10.1055/a-1715-3958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Laminotomy for lumbar stenosis is a well-defined procedure and represents a routine in every neurosurgical department. It is a common experience that the uni- or bilateral paraspinal muscle detachment, together with injury of the supra- and interspinous ligaments, can lead to postoperative pain. In the literature, the application of a minimally invasive technique, the lumbar spinous process-splitting (LSPS) technique, has been reported. METHODS In this study, we present a case series of 12 patients who underwent LSPS from September 2019 to April 2020. Two patients had a cyst of the ligamentum flavum, eight a single-level lumbar canal stenosis (LCS), and two a two-level LCS. Moreover, we propose a novel morphological classification of postoperative muscle atrophy and present volumetric analysis of the decompression achieved. RESULTS There were no complications related to this technique. In all patients, the vertebral canal area was more than doubled by the procedure. The muscle sparing showed grade A, according to our classification. CONCLUSION To our knowledge, this is the first description of this surgical technique and the first LSPSL case series in Europe. Furthermore, cases of ligamentum flavum cyst removal using this safe and effective technique have not yet been reported.
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Affiliation(s)
| | | | - Gianluca Scalia
- Department of Neurosurgery, National Specialist Hospital Garibaldi, Catania, Italy
| | - Giuseppe Raudino
- Department of Neurosurgery, Humanitas Centre of Oncology of Catania, Catania, Sicilia, Italy
| | - Vlado Stevanovic
- Department of Neuroradiology, Paracelsus Medical Private University, Salzburg, Austria
| | - Herbert Krainz
- Department of Neurosurgery, Paracelsus Medical Private University, Salzburg, Austria
| | - Michael Kral
- Department of Neurosurgery, Paracelsus Medical Private University, Salzburg, Austria
| | | | - Peter A Winkler
- Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria
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Sharma R, Kumarasamy S, Tiwary SK, Kedia S, Sawarkar D, Doddamani R, Laythalling RK. Multiple spinal extradural arachnoid cysts presenting as compressive myelopathy in a teenager: case report and literature review with special emphasis on postoperative spine deformity in the current minimally invasive era. Childs Nerv Syst 2024; 40:729-747. [PMID: 37917405 DOI: 10.1007/s00381-023-06183-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Multiple synchronous spinal extradural arachnoid cysts are extremely rare in children and can lead to cord compression and disability. Multiple spinal extradural arachnoid cysts (SEDACs) in children with immature and growing spine need to be studied separately from multiple SEDACs in adults with mature and fully grown spine because of multiple surgical limitations in children (blood loss, surgery duration, long-term spinal stability after long segment exposure, etc.). MATERIAL AND METHODS We planned a non-systematic literature review of similar cases described in literature to analyse the pattern of presentation, management, and outcome of this surgically curable disease. RESULTS A total of 28 cases of paediatric multiple SEDACs in the age range of 5 months to 17 years and mean age of 11.54 years were analysed. Exposure was achieved by laminectomy in 9, laminoplastic laminotomy in 13, laminectomy in first surgery followed by laminoplasty in second surgery (re-exploration) in 1, hemilaminectomy in 2, and technique "not reported" in 3 children. Complete/near-complete recovery was seen in 27 (96.42%) children. Postoperative spine deformity was reported in 7 (25%) children and was progressive in 2 children during serial follow-up. CONCLUSIONS Symptomatic multiple synchronous SEDACs in children is a rare surgically curable condition. Sincere attempt to find out a dural defect in all cysts is a very important step in multiple SEDAC surgery. Total cyst wall excision with closure of all dural defects is the gold standard treatment for symptomatic cases. Laminoplasty is preferred for excision of multiple SEDACs in children to prevent postoperative spine deformity during long-term follow-up. Long serial follow-up for postoperative spine deformity is necessary.
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Affiliation(s)
- Rajeev Sharma
- Department of Neurosurgery, AIIMS, New Delhi, 110029, India.
| | | | - Shashi Kala Tiwary
- Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Shweta Kedia
- Department of Neurosurgery, AIIMS, New Delhi, 110029, India
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Yu W, Xie B, Fang Z, Yao Z, Zhong Y, Jiang X. What is the Preferable Method for the C3 and C7 Segments in Unilateral Open-Door Laminoplasty for Patients Diagnosed with Cervical Spondylotic Myelopathy? World Neurosurg 2024; 183:e668-e676. [PMID: 38181877 DOI: 10.1016/j.wneu.2023.12.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/30/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Traditional C3-C7 unilateral open-door laminoplasty (UOLP) often leads to various postoperative complications as a result of damage of cervical posterior muscles and nuchal ligaments. We aimed to thoroughly evaluate postoperative outcomes after our modified UOLP versus traditional UOLP in treating multilevel cervical spondylotic myelopathy (MCSM). METHODS Seventy-six patients with MCSM who underwent the modified UOLP with C3 laminectomy and C7 upper hemilaminectomy (40 patients) or traditional C3-C7 UOLP (36 patients) were included. Preoperative and postoperative cervical radiologic parameters, as well as clinical and surgical outcomes, were evaluated. RESULTS Postoperatively, Japanese Orthopaedic Association scores improved significantly more in the modified UOLP group than in the traditional UOLP group (P = 0.028), whereas visual analog scale scores and Neck Disability Index improved similarly in both groups. Follow-up scores for Japanese Orthopaedic Association, Neck Disability Index, and visual analog scale were not significantly different between the 2 groups. At the final follow-up, the C2-C7 sagittal vertical axis and T1 slope increased in the traditional UOLP group and did not change in the modified UOLP group and were unchanged in the modified UOLP group. The C2-C7 Cobb angle decreased significantly in the traditional UOLP group and did not change in the modified UOLP group. The modified UOLP group lost less cervical posterior muscle area compared with the traditional UOLP group (3.72% ± 3.54% vs. 6.67% ± 2.81%; P < 0.001). The range of motion in the modified UOLP group was significantly greater than in the traditional UOLP group at the final follow-up (P < 0.001). Also, the modified UOLP group experienced a notable reduction in operative time, blood loss volume, and postoperative hospital stay. CONCLUSIONS We recommend performing our modified UOLP with C3 laminectomy and C7 upper hemilaminectomy instead of traditional C3-C7 UOLP.
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Affiliation(s)
- Weibo Yu
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China; Department of Spinal Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Bin Xie
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Zhichao Fang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Zhensong Yao
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Yuanming Zhong
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Xiaobing Jiang
- Department of Spinal Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.
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Yamato Y, Nagata K, Kawamura N, Higashikawa A, Takeshita Y, Tozawa K, Fukushima M, Urayama D, Ono T, Hara N, Okamoto N, Azuma S, Iwai H, Sugita S, Yoshida Y, Hirai S, Masuda K, Jim Y, Ohtomo N, Nakamoto H, Kato S, Taniguchi Y, Tanaka S, Oshima Y. Comparative Analysis of Microendoscopic and Open Laminectomy for Single-Level Lumbar Spinal Stenosis at L1-L2 or L2-L3. World Neurosurg 2024; 183:e408-e414. [PMID: 38143029 DOI: 10.1016/j.wneu.2023.12.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Several reports have highlighted comparable surgical outcomes between microendoscopic laminectomy (MEL) and open laminectomy (open) for lumbar spinal stenosis. However, the unilateral approach in MEL may present challenges for the upper lumbar levels, where facet joints are located deeper inside. Our objective was to compare surgical outcomes and radiographic evaluations for single-level decompression cases at L1-L2 or L2-L3 between MEL and open laminectomy. METHODS We analyzed patients who underwent single-level decompression for upper lumbar spinal stenosis at 12 distinguished spine centers from April 2017 to September 2021. Baseline demographics, preoperative, and 1-year postoperative patient-reported outcomes, along with imaging parameters, were compared between the MEL and open groups. To account for potential confounding, patients' backgrounds were adjusted using the inverse probability weighting method based on propensity scores. RESULTS Among the 2487 patients undergoing decompression surgery, 118 patients (4.7%) underwent single-level decompression at L1-L2 or L2-L3. Finally, 80 patients (51 in the MEL group, 29 in the open group) with postoperative data were deemed eligible for analysis. The MEL group exhibited significantly improved postoperative EuroQol 5-Dimension values compared to the open group. Additionally, the MEL group showed a lower facet preservation rate according to computed tomography examination, whereas the open group had a higher incidence of retrolisthesis. CONCLUSIONS Although overall surgical outcomes were similar, the MEL group demonstrated potential advantages in enhancing EuroQol 5-Dimension scores. The MEL group's lower facet preservation rate did not translate into a higher postoperative instability rate.
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Affiliation(s)
- Yukimasa Yamato
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan
| | - Kosei Nagata
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan
| | - Naohiro Kawamura
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Shibuya City, Tokyo, Japan
| | - Akiro Higashikawa
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Yujiro Takeshita
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Orthopedic Surgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Keiichiro Tozawa
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Spine Center, Toranomon Hospital, Minato City, Tokyo, Japan
| | - Masayoshi Fukushima
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Spine Center, Toranomon Hospital, Minato City, Tokyo, Japan
| | - Daiki Urayama
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, Shinjuku City, Tokyo, Japan
| | - Takashi Ono
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, Shinjuku City, Tokyo, Japan
| | - Nobuhiro Hara
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Musashino, Tokyo, Japan
| | - Naoki Okamoto
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Orthopedic Surgery, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Seiichi Azuma
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Orthopedic Surgery, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Hiroki Iwai
- Inanami Spine and Joint Hospital, Shinagawa City, Tokyo, Japan
| | - Shurei Sugita
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Orthopedic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo City, Tokyo, Japan
| | - Yuichi Yoshida
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Spine Center, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Shima Hirai
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Spine Center, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Kazuhiro Masuda
- University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan; Department of Orthopedic Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Yu Jim
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan.
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Wang X, Liao X, Zhang H, Xu Z, Yan Z, Li Y, Wei M, Wang X, She L, Dong L. Surgical treating lumbar intraspinal tumor through a para-split laminotomy. Br J Neurosurg 2024; 38:45-48. [PMID: 35132931 DOI: 10.1080/02688697.2021.1872772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 01/04/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND to explore the feasibility and effectiveness of para-split laminotomy in the treatment of lumbar intraspinal tumors. METHODS We retrospectively review the clinical data of 15 patients suffering lumbar intraspinal tumors, who underwent tumor resection using the para-split laminotomy, from October 2016 to May 2018. Observation indicators were as follows: (1) surgical and postoperative recovery situations; (2) the neurological function of the spinal cord and the follow-up situations. RESULTS Mean blood loss was 95.3 ± 58.2 ml, and the mean duration of the surgical procedure was 176.7 ± 35.2 min. All lumbar intraspinal tumors were resected completely. There were no operative complications. The postoperative CT scans showed no pedicle or vertebral fractures. During the follow-up period of 6-18 months (average 10.8 ± 3.9 months), no tumor recurrence or spinal deformation was found according to the imaging examination. CT 3D reconstructions showed that the split laminae tended to heal. The average preoperative JOA score was 15.5 ± 4.9 and the average postoperative JOA score improved to 24.0 ± 3.5 (average improvement rate 65.9 ± 19.6%). CONCLUSION The para-split laminotomy could reduce the damage to the posterior spinal tension band and help to protect the stability of the spine. It is feasible and effective to apply the para-split laminotomy to the operation of a lumbar intraspinal tumor, and this technique may be a promising option when considering surgical methods for some multilevel well-circumscribed intraspinal tumors.
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Affiliation(s)
- Xiaodong Wang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xiongfei Liao
- Department of Neurosurgery, Xiangya Medical College of Central South University, Changsha, China
| | - Hengzhu Zhang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Zhiwen Xu
- Department of Neurosurgery, Nanjing Tongren Hospital, Nanjing, China
| | - Zhengcun Yan
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yuping Li
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Min Wei
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xingdong Wang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Lei She
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Lun Dong
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
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Chen Z, Lv G, Zhang O, Li Y, Wang X, He H, Yuan H, Pan C, Kuang L. Risk factors of instrumentation failure after laminectomy and posterior cervical fusions (PCF). BMC Musculoskelet Disord 2024; 25:1. [PMID: 38166792 PMCID: PMC10759594 DOI: 10.1186/s12891-023-07116-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND For patients with multilevel degenerative cervical myelopathy, laminectomy and posterior cervical fusions (PCF) with instrumentation are widely accepted techniques for symptom relief. However, hardware failure is not rare and results in neck pain or even permanent neurological lesions. There are no in-depth studies of hardware-related complications following laminectomy and PCF with instrumentation. METHODS The present study was a retrospective, single centre, observational study. Patients who underwent laminectomy and PCF with instrumentation in a single institution between January 2019 and January 2021 were included. Patients were divided into hardware failure and no hardware failure group according to whether there was a hardware failure. Data, including sex, age, screw density, end vertebra (C7 or T1), cervical sagittal alignment parameters (C2-C7 cervical lordosis, C2-C7 sagittal vertical axis, T1 slope, Cervical lordosis correction), regional Hounsfield units (HU) of the screw trajectory and osteoporosis status, were collected and compared between the two groups. RESULTS We analysed the clinical data of 56 patients in total. The mean overall follow-up duration was 20.6 months (range, 12-30 months). Patients were divided into the hardware failure group (n = 14) and no hardware failure group (n = 42). There were no significant differences in the general information (age, sex, follow-up period) of patients between the two groups. The differences in fusion rate, fixation levels, and screw density between the two groups were not statistically significant (p > 0.05). The failure rate of fixation ending at T1 was lower than that at C7 (9% vs. 36.3%) (p = 0.019). The regional HU values of the pedicle screw (PS) and lateral mass screw (LMS) in the failure group were lower than those in the no failure group (PS: 267 ± 45 vs. 368 ± 43, p = 0.001; LMS: 308 ± 53 vs. 412 ± 41, p = 0.001). The sagittal alignment parameters did not show significant differences between the two groups before surgery or at the final follow-up (p > 0.05). The hardware failure rate in patients without osteoporosis was lower than that in patients with osteoporosis (14.3% vs. 57.1%) (p = 0.001). CONCLUSIONS Osteoporosis, fixation ending at C7, and low regional HU value of the screw trajectory were the independent risk factors of hardware failure after laminectomy and PCF. Future studies should illuminate if preventive measures targeting these factors can help reduce hardware failure and identified more risk factors, and perform long-term follow-up.
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Affiliation(s)
- Zejun Chen
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Guohua Lv
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Ou Zhang
- California University of Science and Medicine, Colton, CA, USA
| | - Yunchao Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Xiaoxiao Wang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Haoyu He
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Hui Yuan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Changyu Pan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Lei Kuang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
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He BL, Zhu ZC, Lin LQ, Sun JF, Huang YH, Meng C, Sun Y, Zhang GC. Comparison of biportal endoscopic technique and uniportal endoscopic technique in Unilateral Laminectomy for Bilateral Decomprssion (ULBD) for lumbar spinal stenosis. Asian J Surg 2024; 47:112-117. [PMID: 37331857 DOI: 10.1016/j.asjsur.2023.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/29/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
OBJECTIVE Unilateral laminotomy for bilateral decompression (ULBD) has been adopted widely to treat lumbar spinal stenosis (LSS). The objective of the study is to investigate clinical and radiological outcomes of the biportal endoscopic ULBD (BE-ULBD) and uniportal endoscopic ULBD (UE-ULBD). METHODS We collected retrospectively 65 patients' data who met the inclusion criteria (July 2019-June 2021). 33 patients underwent BE-ULBD surgery, and 32 patients underwent the UE-ULBD surgery, and were followed up for at least 1 year. The following preoperative and postoperative outcomes were compared between groups: the visual analog scale (VAS) for pain, the Oswestry disability index (ODI) for nerve function, and modified Macnab criteria for satisfaction, the cross-sectional area of the dural sac (DSCSA), the mean angle of facetectomy. RESULTS Age, BMI, gender, levels of involvement and duration of symptoms were not significantly different at baseline in this study. Clinical data showed that postoperative ODI, VAS scores and Modified Macnab Criteria were not statistically different between the two groups. The BE-ULBD group had a shorter operation time than the UE-ULBD group (P < 0.001). Patients in the BE-ULBD group had a larger postoperative expansion of DSCSA expansion postoperatively (85.58 ± 3.16 mm2 VS 71.43 ± 3.35 mm2, P < 0.001) and a larger contralateral facetectomy angle (63.95 ± 3.34° vs 57.80 ± 3.43°, P < 0.001) compared with patients in the UE-ULBD group. There were no statistical differences in the incidence of postoperative complications between the two groups. CONCLUSION Both the BE-ULBD and the UE-ULBD yielded clinical improvement in terms of pain and stenosis symptoms. The BE-ULBD technique has the advantages of the shorter operation time, larger DSCSA expansion and larger contralateral facetectomy angle.
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Affiliation(s)
- Bang-Lin He
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Zhi-Cheng Zhu
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Li-Qun Lin
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Ji-Fu Sun
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China.
| | - Yong-Hui Huang
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Chen Meng
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Yan Sun
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Guang-Cheng Zhang
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
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Harland TA, Staudt MD, Bandlamuri S, Juneja A, Pilitsis JG, Sukul VV. Predictors of Skip Laminotomy for Placement of Paddle Leads for Spinal Cord Stimulation. Neuromodulation 2024; 27:183-187. [PMID: 37632516 DOI: 10.1016/j.neurom.2023.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVES Placement of a standard paddle lead for spinal cord stimulation (SCS) requires a laminotomy for positioning of the lead within the epidural space. During initial placement, an additional laminotomy or laminectomy, termed a "skip" laminotomy, may be necessary at a higher level to pass the lead to the appropriate midline position. Patient and radiographic factors that predict the need for a skip laminotomy have yet to be identified. MATERIALS AND METHODS Participants who underwent SCS paddle placement at Albany Medical Center between 2016 and 2017 were identified. Operative reports were reviewed to identify the paddle type, level of initial laminotomy, target level, and skip laminotomy level. Preoperative thoracic magnetic resonance images (MRIs) were reviewed, and spinal canal diameter, interpedicular distance, and dorsal cerebral spinal fluid thickness were measured for each participant when available. RESULTS A total of 106 participants underwent thoracic SCS placement. Of these, 97 had thoracic MRIs available for review. Thirty-eight participants required a skip laminotomy for placement of the paddle compared with 68 participants who did not. There was no significant difference in demographic features including age, sex, body mass index, and surgical history. Univariate analyses that suggested trends were selected for further analysis using binary logistic regression. Level of initial laminotomy (odds ratio [OR] = 1.51, p = 0.028), spinal canal diameter (OR = 0.71, p = 0.015), and dorsal cerebrospinal fluid thickness (OR = 0.61, p = 0.011) were correlated with skip laminotomy. Target level (OR = 1.27, p = 0.138) and time from trial (1.01, p = 0.117) suggested potential association. The multivariate regression was statistically significant, X2(10) = 28.02, p = 0.002. The model explained 38.3% of the variance (Nagelkerke R2) and predicted skip laminectomy correctly in 73.3% of cases. However, for the multivariate regression, only a decrease in spinal canal diameter (OR = 0.59, p = 0.041) was associated with a greater odds of skip laminotomy. CONCLUSIONS This study aims to characterize the patient and radiographic factors that may predict the need to perform a skip laminotomy during the initial placement of SCS paddles. Here, we show that radiographic and anatomic variables, primarily spinal canal diameter, play an important role in predicting the need for a skip laminotomy. Furthermore, we suggest that target level for placement and level of initial laminotomy also may contribute. Further investigation of the predictive factors for performing a skip laminotomy would help optimize surgical planning and preoperative patient selection and counseling.
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Affiliation(s)
- Tessa A Harland
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Michael D Staudt
- Department of Neurosurgery, Beaumont Neuroscience Center, Royal Oak, MI, USA
| | - Sruti Bandlamuri
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Ankit Juneja
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Vishad V Sukul
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
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Li J, Deng Z, Wang L, Wang L, Yang H, Yang X, Song Y. The Quality of Life of the Patients with Thoracic Ossification of the Ligamentum Flavum after Surgery Using EQ-5D-5L. Orthop Surg 2024; 16:57-71. [PMID: 38010864 PMCID: PMC10782254 DOI: 10.1111/os.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE There is a lack of studies on the quality of life (QoL) after posterior laminectomy in patients with thoracic ossification of the ligamentum flavum (TOLF), and risk factors associated with poor prognosis remain controversial. Therefore, the present study was conducted to illustrate the QoL for TOLF patients after surgery and determine its relationship with their demographic, surgery-related, clinical characteristics and imaging data. METHODS One hundred and eighteen patients diagnosed with thoracic myelopathy because of TOLF were enrolled in this retrospective study. They all underwent posterior decompressive laminectomy from August 2010 to January 2022. The QoL was evaluated based on the EQ-5D-5L. Collecting gender, age, number of operations, compressed segments, Frankel grade, complications, body mass index (BMI), symptoms and duration, modified Japanese Orthopaedic Association (mJOA) score (preoperative), follow-up time and type of ossification, increased signal on Sagittal T2-weighted Images (ISST2I), occupancy rate and analyzing by Mann-Whitney U-test, Kruskal-Wallis test, the χ2 -test, and logistic regression tests. RESULTS Average follow-up 70.8 months (18-149), the mean age was 59.74 ± 9.81 years and the mean score for the QoL based on the EQ-5D-5 L and visual analogue scale (VAS) score were 0.71 ± 0.28 and 78.88 ± 10.21 at the final follow-up. Moderate and severe problems were found in the pain/discomfort in 22.0% of the patients. These mobility and usual activities numbers were slightly higher (24.6% and 30.4%, respectively). The mean scores for QoL and VAS were significantly higher in patients with mild and moderate neurological impairment, normal BMI, <60 years of age, no dural tears, symptom relief at hospital discharge, unilateral and bilateral ossification on axial CT scan, ≤ 50% spinal canal occupancy on CT and MRI, and none or fuzzy on ISST2I. CONCLUSION QoL after posterior laminectomy in TOLF patients is generally satisfactory compared to preoperative levels. Preoperative mJOA score, Age, comorbid diabetes, the major symptom is activity limitation, BMI, ISST2I, Intraoperative dural tears and spinal canal occupancy rate correlate significantly with the corresponding dimensions and are predictive. Age, spinal canal occupancy rate, ISST2I, preoperative mJOA score, BMI are significantly associated with and have predictive value for overall postoperative QoL.
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Affiliation(s)
- Junhu Li
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Zhipeng Deng
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Linnan Wang
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Lei Wang
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Hailing Yang
- Program in Cellular and Molecular Physiology, Graduate School of Biomedical Sciences, Tufts UniversityBostonMassachusettsUSA
| | - Xi Yang
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Yuemin Song
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
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Feigenbaum F, Parks SE, Martin MP, Chapple KM. Surgical Intervention is Associated with Improved Outcomes in Patients with Symptomatic Cervical Spine Tarlov Cysts: Results from a Prospective Cohort Study. World Neurosurg 2024; 181:e405-e410. [PMID: 37866779 DOI: 10.1016/j.wneu.2023.10.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Tarlov cysts are known contributors to radiculopathy but are often misdiagnosed and mismanaged due to a paucity of information. This is particularly true of cervical spine Tarlov cysts because most attention has been focused on sacral cysts. In this study, we describe our longitudinal experience with patients who underwent surgery for cervical spine Tarlov cysts. We hypothesized that patients undergoing surgical treatment for cervical spine Tarlov cysts would report improvement following surgery. METHODS We conducted a prospective study of patients who underwent surgical treatment for cervical Tarlov cysts between 2010 and 2021. The Short-Form 36-item survey (SF-36) was administered at the preoperative and follow-up visits. Repeated measures analyses were used to assess changes from preoperatively to postoperatively. RESULTS A total of 37 patients with cervical spine cysts were included in the study. Follow-up data were available for 27 patients with a median follow-up of 1 year. Of the cohort, 97.3% were women, with an average age of 47.5 ± 10.3 years. Patients reported statistically significant improvement in 2 of the 4 SF-36 physical health domains (physical function, P< 0.001; and bodily pain, P < 0.001) and 2 of the 4 mental health domains (vitality/energy, P < 0.003; and social functioning, P = 0.007). Patients also reported less interference in work, education, and retirement activities at follow-up (P = 0.017). CONCLUSIONS Our longitudinal series consisted of patients with symptomatic cervical spine Tarlov cysts, which, to the best of our knowledge, is the largest series described. Significant improvements in the SF-36 domains were documented, indicating these patients can be successfully treated surgically.
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Affiliation(s)
- Frank Feigenbaum
- Department of Neurosurgery, Feigenbaum Neurosurgery, Dallas, Texas, USA.
| | - Susan E Parks
- Department of Neurosurgery, Feigenbaum Neurosurgery, Dallas, Texas, USA
| | - Madelene P Martin
- Department of Neurosurgery, Feigenbaum Neurosurgery, Dallas, Texas, USA
| | - Kristina M Chapple
- Department of Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
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Uri O, Alfandari L, Folman Y, Keren A, Smith W, Paz I, Behrbalk E. Acute disc herniation following surgical decompression of lumbar spinal stenosis: a retrospective comparison of mini-open and minimally invasive techniques. J Orthop Surg Res 2023; 18:974. [PMID: 38111077 PMCID: PMC10726635 DOI: 10.1186/s13018-023-04457-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Disc herniation following decompression of lumbar spinal stenosis is a less familiar surgical complication. Previous studies suggested that open lumbar decompression techniques, associated with relative segmental instability especially in the presence of degenerated disc in older patients, are more likely to result in disc herniation compared to minimally invasive techniques. The current study compares the incidence of acute disc herniation following mini-open and minimally invasive decompression of lumbar spinal stenosis. METHODS This was a retrospective study reviewing 563 patients who underwent spinal decompression for symptomatic lumbar stenosis by mini-open bilateral partial laminectomy technique or minimally invasive laminotomy utilizing a tubular system. Demographic and clinical data were collected and compared between the groups. RESULTS Postoperative disc herniation rate was significantly lower in the minimally invasive group with 2 of 237 cases (0.8%) versus 19 of 326 cases (5.8%) in the mini-open group (p = 0.002). This finding was more noticeable following multi-level procedures with no case of postdecompression disc herniation in the minimally invasive group compared to 8 of 39 cases (20.5%) in the mini-open group (p = 0.003). CONCLUSION The incidence of postoperative disc herniation following spinal decompression for symptomatic lumbar stenosis was 5.8% following mini-open bilateral partial laminectomy compared to only 0.8% after minimally invasive laminotomy (p = 0.002). These findings highlight the more extensive nature of mini-open surgery associated with relative segmental instability that poses a greater risk for postoperative disc herniation.
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Affiliation(s)
- Ofir Uri
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - Liad Alfandari
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel.
| | - Yoram Folman
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - Amit Keren
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - William Smith
- Department of Neurosurgery, University Medical Center, Las Vegas, NV, USA
| | - Inbar Paz
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - Eyal Behrbalk
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
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Zhang Q, Guo R, Fang S, Tong S, Fan Y, Wang J. The clinical efficacy of laminectomy fusion fixation and posterior single open-door laminoplasty in the treatment of multilevel cervical ossification of the posterior longitudinal ligament (OPLL): a retrospective study. BMC Surg 2023; 23:380. [PMID: 38093252 PMCID: PMC10720063 DOI: 10.1186/s12893-023-02289-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND To compared the clinical efficacy of two surgical methods, posterior laminectomy fusion fixation, and posterior single open-door laminoplasty, in treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL). METHODS The study retrospectively included 102 patients treated between December 2016 and December 2020. The patients were included into an observation group (56 cases) treated with total laminectomy and lateral screw fixation, and a control group (46 cases) treated with single open-door laminoplasty. RESULTS After 24 months, both groups showed significant improvement in Japanese Orthopaedic Association (JOA) scores and Visual Analogue Scale (VAS) scores, indicating better clinical symptoms and functional recovery. There was no significant difference in preoperative JOA and VAS scores between the two groups (P > 0.05). At 24 months after surgery, there was no significant difference in JOA and VAS scores between the two groups (P > 0.05). However, the observation group had a significantly higher cervical curvature index (CCI) and lower range of motion (ROM) of the cervical spine compared to the control group (P < 0.05). The CCI in control group was lower than before surgery, while the CCI in observation group was higher than before surgery, and CCI in the control group was considerably lower than that in the observation group (P < 0.05). The complication rate was lower in the control group, with fewer cases of axial symptoms, fifth cervical nerve root palsy, and overall complications. The overall complication rate was 25.0% (14/56) in the observation group and 10.8% (5/46) in the control group (P < 0.05). CONCLUSIONS Both posterior laminectomy fusion fixation and posterior single open-door laminoplasty yield positive outcomes in improving clinical neurological function, cervical curvature, range of motion of the cervical spine, and cervical sagittal balance. Although open-door laminoplasty is less effective than total laminectomy in maintaining CCI and sagittal balance, it excels in preserving cervical range of motion, less surgical trauma and complications. Thus, open-door laminoplasty may be a suitable first-choice treatment for multi-segmental cervical OPLL, especially for patients with lordotic cervical spine physiological curvature.
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Affiliation(s)
- Qian Zhang
- Department of Orthopedics, Lanxi People's Hospital, No.1359 Xishan Road, Lanxi City, Jinhua City, 321000, Zhejiang Province, China
| | - Rudan Guo
- Department of Orthopedics, Lanxi People's Hospital, No.1359 Xishan Road, Lanxi City, Jinhua City, 321000, Zhejiang Province, China.
| | - Sanhua Fang
- Department of Orthopedics, Lanxi People's Hospital, No.1359 Xishan Road, Lanxi City, Jinhua City, 321000, Zhejiang Province, China
| | - Shunyi Tong
- Department of Orthopedics, Lanxi People's Hospital, No.1359 Xishan Road, Lanxi City, Jinhua City, 321000, Zhejiang Province, China
| | - Yuan Fan
- Department of Orthopedics, Lanxi People's Hospital, No.1359 Xishan Road, Lanxi City, Jinhua City, 321000, Zhejiang Province, China
| | - Jun Wang
- Department of Orthopedics, Lanxi People's Hospital, No.1359 Xishan Road, Lanxi City, Jinhua City, 321000, Zhejiang Province, China
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El-Hajj VG, Singh A, Pham K, Edström E, Elmi-Terander A, Fletcher-Sandersjöö A. Long-term outcomes following surgical treatment of spinal arachnoid cysts: a population-based consecutive cohort study. Spine J 2023; 23:1869-1876. [PMID: 37604309 DOI: 10.1016/j.spinee.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/12/2023] [Accepted: 08/13/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND CONTEXT Spinal arachnoid cysts (SACs) are rare, cerebrospinal fluid-filled sacs lined by an arachnoid membrane in the spinal canal. Symptoms can develop due to pressure on the spinal cord or adjacent spinal nerves by the cyst itself or by interrupted flow of cerebrospinal fluid. If noninvasive management fails or neurological deterioration occurs, surgical treatment is recommended. However, data is lacking on long-term outcomes after surgery. PURPOSE To determine long-term outcomes in patients surgically treated for SACs. STUDY DESIGN Population-based cohort-study. PATIENT SAMPLE All consecutive patients treated for either intra- or extradural SACs with surgery between 2005 and 2020 at the author's institution were included. OUTCOME MEASURES American Spinal Injury Association Impairment Scale (AIS) and modified Japanese Orthopedic Association score (mJOA). METHODS Data was primarily extracted from electronic patient medical notes. Telephone interviews were performed to assess long-term postoperative outcomes. All analyses were conducted using the statistical software program R version 4.0.5. Statistical significance was set at p<.05. RESULTS Thirty-four patients were included. Cyst excision was performed in 11 (32%) cases, and fenestration in the remaining 23 (68%). The median follow-up time was 8.0 years. Surgery resulted in a significant long-term improvement in both AIS (p=.012) and mJOA (p=.005). Sensory deficit was the symptom that most often improved (81%), followed by pain (74%) and motor function (64%). AIS deteriorated in two patients, of which one case was attributed to a surgical complication. Local cyst recurrence requiring reoperation was seen in 4 (12%) cases, all of them following cyst fenestration. One patient (3%) required reoperation for progression of the cyst progression at a different level. CONCLUSION This study reports outcomes of surgically treated SACs with the longest follow-up time to date. Microsurgical cyst excision or fenestration were safe treatment options, and the neurological improvements seen in the immediate postoperative phase were maintained at long-term follow-up.
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Affiliation(s)
| | - Aman Singh
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kim Pham
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands-Väsby, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands-Väsby, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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Shelby T, Mills ES, Kang HP, Ton A, Hah RJ, Alluri RK. Preoperative Epidural Steroid Injection Does Not Increase Infection Risk Following Posterior Cervical Surgery. Spine (Phila Pa 1976) 2023; 48:1658-1662. [PMID: 36972151 DOI: 10.1097/brs.0000000000004647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 01/15/2023] [Indexed: 06/18/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The purpose of this study was to characterize the infection risk of preoperative epidural steroid injection (ESI) in patients undergoing posterior cervical surgery. SUMMARY OF BACKGROUND DATA ESI is a helpful tool for alleviating pain and is often used as a diagnostic tool before cervical surgery. However, a recent small-scale study found that ESI before cervical fusion was associated with an increased risk of postoperative infection. MATERIALS AND METHODS Patients from 2010 to 2020 with cervical myelopathy, spondylosis, and radiculopathy who underwent posterior cervical procedure including laminectomy, laminoforaminotomy, fusion, or laminoplasty were queried from the PearlDiver database. Patients who underwent revision or fusion above C2 or who had a diagnosis of neoplasm, trauma, or preexisting infection were excluded. Patients were divided on whether they received an ESI within 30 days before the procedure and subsequently matched by age, sex, and preoperative comorbidities. The χ 2 analysis was used to calculate the risk of postoperative infection within 90 days. Logistic regression controlling for age, sex, Elixhauser Comorbidity Index, and operated levels was conducted within the unmatched population to assess infection risk for injected patients across procedure subgroups. RESULTS Overall, 299,417 patients were identified with 3897 having received a preoperative ESI and 295,520 who did not. Matching resulted in 975 in the injected group and 1929 in the control group. There was no significant difference in postoperative infection rate in those who received an ESI within 30 days preoperatively and those who did not (3.28% vs. 3.78%, odds ratio=0.86, 95% CI: 0.57-1.32, P =0.494). Logistic regression accounting for age, sex, Elixhauser Comorbidity Index, and levels operated demonstrated that injection did not significantly increase infection risk in any of the procedure subgroups. CONCLUSIONS The present study found no association between preoperative ESI within 30 days before surgery and postoperative infection in patients undergoing posterior cervical surgery.
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Affiliation(s)
- Tara Shelby
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Emily S Mills
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Hyunwoo P Kang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Andy Ton
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Raymond J Hah
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Ram K Alluri
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Tan H, Yu L, Xie X, Liu N, Zhang G, Li X, Yang Y, Zhu B. Consecutive Case Series of Uniportal Full-endoscopic Unilateral Laminotomy for Bilateral Decompression in Lumbar Spinal Stenosis: Relationship between Decompression Range and Functional Outcomes. Orthop Surg 2023; 15:3153-3161. [PMID: 37853983 PMCID: PMC10693994 DOI: 10.1111/os.13928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE Uniportal full-endoscopic unilateral laminotomy for bilateral decompression (UFE-ULBD) has been used to treat lumbar spinal stenosis (LSS) with satisfactory outcomes. However, a limited number of studies have investigated the relationship between decompression range and clinical outcomes. This study aimed to investigate the efficacy of UFE-ULBD for single-segment LSS and to explore the relationship between the decompression range and functional outcomes. METHODS Single-segment LSS patients who had undergone UFE-ULBD using an interlaminar approach between November 2021 and February 2023 were retrospectively analyzed. Patient demographics, visual analogue scale (VAS) scores for leg and back pain, Oswestry disability index (ODI) scores, modified MacNab grades, and radiological outcomes, including the decompression ratio of the disc-flava ligament space and osseous lateral recess, the enlargement ratio of superior articular process interval, lamina interval dural sac cross-sectional area (DSCA), were collected. The independent sample t-tests, paired sample t-tests, chi-square tests, Fisher's exact tests, and Pearson's and Spearman's correlation analyses were used. RESULTS Forty patients (23 males, and 17 females) were retrospectively enrolled in this study. The mean follow-up period was 12 months. At the last follow-up, VAS scores for leg pain and back pain decreased from 6.0 ± 0.8 to 1.0 ± 1.9 (p < 0.001), and from 6.0 ± 0.8 to 1.2 ± 1.8 (p < 0.001) respectively; ODI score decreased from 71.7 ± 6.2 to 24.3 ± 21.3 (p < 0.001). According to the modified MacNab criteria, the results were excellent in 28 (70%), good in 5 (12.5%), fair in 6 (15%), and poor in 1 (2.5%), with an excellent-good rate of 82.5%. The postoperative DSCA enlarged from 57.69 ± 21.86 to 150.75 ± 39.33 mm2 (p < 0.001), with an enlargement ratio of 189.43 ± 107.83%. No difference in clinical or radiological parameters was detected between patients with excellent, good, fair, or poor outcomes based on the modified MacNab criteria. CONCLUSION UFE-ULBD can provide satisfactory clinical and radiological outcomes in single-segment LSS patients. With sufficient exposure to the dural sac boundary, the functional outcome was not related to the radiological decompression range in LSS patients who had undergone UFE-ULBD.
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Affiliation(s)
- Haining Tan
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Lingjia Yu
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Xuehu Xie
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Ning Liu
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Guoqiang Zhang
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Xiang Li
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Yong Yang
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Bin Zhu
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
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Ogden M, Karagedik MI, Ozdemir A, Bulut IU, Erdogan AM, Bakar B. Investigation of the Efficacy of Bilateral Osteoligamentous Decompression via Hemilaminectomy in Cervical Spondylotic Myelopathy: A Clinical Study. World Neurosurg 2023; 180:e560-e578. [PMID: 37778625 DOI: 10.1016/j.wneu.2023.09.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Cervical stability may deteriorate and kyphotic spinal deformities may develop in cervical spondylotic myelopathy (CSM) after laminectomy or laminoplasty. This study aimed to investigate the therapeutic efficacy of the "bilateral osteoligamentous decompression via unilateral hemilaminectomy approach (UHBOLD)" technique in CSM patients. METHODS The study included 34 adult patients who underwent UHBOLD surgery for CSM between 2016 and 2022. A record was made for all patients of age, gender, number of operated levels, preoperative and postoperative long-term follow-up VAS scores, Nurick grade values and mJOA scores, kyphosis angles measured on X-ray, and spinal canal areas measured on T2-weighted MR axial images. RESULTS Preoperative VAS scores of the patients were 6 (4-9), Nurick grade values were 3 (2-5), mJOA scores were 10.50 ± 3.42, kyphosis angles were -13.34 ± 13.69° and spinal canal areas were 87.11 ± 28.30 mm2. In postoperative long-term follow-up of these patients, VAS scores were 2 (1-5), Nurick grade values were 1 (0-5), mJOA scores were 13.94 ± 3.09, kyphosis angles were -15.07 ± 12.78° and spinal canal areas were 149.65 ± 42.57 mm2. A statistically significant difference was determined between the preoperative and the postoperative long-term follow-up VAS scores, Nurick grade values, mJOA scores, and spinal canal areas (P < 0.001). Kyphosis angles were not different (P = 0.198), and no instability was observed in any patient in long-term follow-up. CONCLUSIONS The UHBOLD technique performed in multilevel CSM patients did not cause any change in cervical lordosis angle in long-term follow-up, did not cause cervical kyphotic deformity or cervical instability, and significantly improved Nurick grade values, and VAS and mJOA scores.
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Affiliation(s)
- Mustafa Ogden
- Department of Neurosurgery, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey.
| | | | - Alemiddin Ozdemir
- Department of Neurosurgery, Iskenderun State Hospital, Hatay, Turkey
| | - Ibrahim Umud Bulut
- Department of Neurosurgery, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Ahmet Melih Erdogan
- Department of Neurosurgery, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Bulent Bakar
- Department of Neurosurgery, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
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Matsuoka H, Ohashi S, Narikiyo M, Nogami R, Hashimoto K, Wade M, Nagasaki H, Tsuboi Y. Optimal Treatment of C3 Lamina in Cervical Laminoplasty. World Neurosurg 2023; 180:e618-e623. [PMID: 37793608 DOI: 10.1016/j.wneu.2023.09.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023]
Abstract
STUDY DESIGN Results of C4-C6 laminoplasty with C3 laminectomy and C3-C6 laminoplasty were compared retrospectively. OBJECTIVES To clarify the difference between C3 laminectomy and C3 laminoplasty in cervical laminoplasty. SUMMARY OF BACKGROUND DATA Intraoperative damage to the semispinalis cervicis has been shown to lead to postoperative axial symptoms and reduced range of motion (ROM). To prevent this event, C3 laminectomy in cervical laminoplasty is considered superior to C3 laminoplasty. METHODS A total of 36 patients were included in this study: 20 patients (GroupA) of C3 laminectomy, C4-C6 laminoplasty compared with 16 patients (GroupB) of C3-C6 laminoplasty. We collected patient's background data, operative time, Japanese Orthopaedic Association (JOA) score, VAS score, and radiologic findings such as C2-C7 Cobb angle, ROM, C2 inter-spinous angle, and use of postoperative PRN medication were compared. RESULTS There was no statistically significant difference in the C2-C7 Cobb angles between the 2 groups before and after surgery (P = 0.315). In ROM, there was a 17.7% decrease from 31.5 preoperatively to 25.9 postoperatively in Group A, and a 6.1% decrease from 29.3 preoperatively to 27.5 postoperatively in Group B. There was no statistically significant difference in ROM (P = 0.683). Postoperative neck pain (VAS) was significantly lower in Group A than in Group B both at 1 week (P = 0.015) and 1 month (P = 0.035) after surgery. The C2 inter-spinous angle was statistically significantly smaller in Group A than in Group B (P = 0.004). Clinical outcomes and surgical outcomes did not differ significantly between groups. CONCLUSIONS If the C2 interspinous angle is wide and intraoperative semispinalis capitis damage can be minimized, it is worth trying C3 laminoplasty, but if the C2 inter-spinous angle is narrow, C3 laminectomy is recommended from the beginning.
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Affiliation(s)
- Hidenori Matsuoka
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa, Japan.
| | - So Ohashi
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa, Japan
| | - Michihisa Narikiyo
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa, Japan
| | - Ryo Nogami
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa, Japan
| | - Keita Hashimoto
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa, Japan
| | - Minami Wade
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa, Japan
| | - Hirokazu Nagasaki
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa, Japan
| | - Yoshifumi Tsuboi
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa, Japan
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Algarni N, Al-Amoodi M, Marwan Y, Bokhari R, Addar A, Alshammari A, Alaseem A, Albishi W, Alshaygy I, Alabdullatif F. Unilateral laminotomy with bilateral spinal canal decompression: systematic review of outcomes and complications. BMC Musculoskelet Disord 2023; 24:904. [PMID: 37990183 PMCID: PMC10662450 DOI: 10.1186/s12891-023-07033-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Unilateral laminotomy with bilateral spinal canal decompression has gained popularity recently. AIM To systematically review the literature of unilateral laminotomy with bilateral spinal canal decompression for lumbar spinal stenosis (LSS) aiming to assess outcomes and complications of the different techniques described in literature. METHODS On August 7, 2022, Pubmed and EMBASE were searched by 2 reviewers independently, and all the relevant studies published up to date were considered based on predetermined inclusion and exclusion criteria. The subject headings "unilateral laminotomy", "bilateral decompression" and their related key terms were used. The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles. RESULTS A total of seven studies including 371 patients were included. The mean age of the patients was 69.0 years (range: 55-83 years). The follow up duration ranged from 1 to 3 years. Rate of postoperative pain and functional improvement was favorable based on VAS, JOA, JOABPEQ, RMDW, ODI and SF-36, for example improved from a range of 4.2-7.5 preoperatively on the VAS score to a range of 1.4-3.0 postoperatively at the final follow up. Insufficient decompression was noted in 3% of the reported cases. The overall complication rate was reported at 18-20%, with dural tear at 3.6-9% and hematoma at 0-4%. CONCLUSION Unilateral laminotomy with bilateral decompression has favorable short- and mid-term pain and functional outcomes with low recurrence and complication rates. This, however, needs to be further confirmed in larger, long-term follow-up, prospective, comparative studies between open, and minimally invasive techniques.
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Affiliation(s)
- Nizar Algarni
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Al-Amoodi
- Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada
| | - Yousef Marwan
- Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Rakan Bokhari
- Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah Addar
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alshammari
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Abdulrahman Alaseem
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Waleed Albishi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Alshaygy
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Alabdullatif
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Hebda PW, Majewski O. Minimally invasive fenestration for decompression of C2-C3 spinal stenosis. BMJ Case Rep 2023; 16:e254174. [PMID: 37963660 PMCID: PMC10649468 DOI: 10.1136/bcr-2022-254174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Conventional techniques in neurosurgery such as laminectomy have been extensively displaced by minimally invasive types, owing to the character of complexity of cervical spinal region. Spinal canal stenosis at C2-C3 level is documented in the literature with the majority being caused by intervertebral disc herniations.This case reports a patient who presented with classical myelopathy symptoms and significant thickening of ligamentum flavum, while minimal spondylosis was detected at C2-C3 level. The decompression was performed from posterior approach and limited to the removal of ligamentum flavum with minimal resection of adjacent laminae, no fixation and no disc evacuation. After surgery, there was a significant improvement with preserved spinal stability.Although the anterior approach is more common for cervical spine, universal access site has not been defined in literature. We suggest that minimal decompression produces desirable effects with no need for fusion and preserving adequate stability of spinal complex.
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Affiliation(s)
- Patrycja Weronika Hebda
- Neurosurgery, Queen Elizabeth University Hospital, Glasgow, UK
- Neurosurgery, Szpital Specjalistyczny im Edmunda Biernackiego w Mielcu, Mielec, Poland
| | - Olaf Majewski
- Neurosurgery, Szpital Specjalistyczny im Edmunda Biernackiego w Mielcu, Mielec, Poland
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Adelhoefer SJ, Berger J, Mykolajtchuk C, Gujral J, Boadi BI, Fiani B, Härtl R. Ten-step minimally invasive slalom unilateral laminotomy for bilateral decompression (sULBD) with navigation. BMC Musculoskelet Disord 2023; 24:860. [PMID: 37919696 PMCID: PMC10621193 DOI: 10.1186/s12891-023-06940-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/06/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Unilateral laminotomy for bilateral decompression (ULBD) is a MIS surgical technique that offers safe and effective decompression of lumbar spinal stenosis (LSS) with a long-term resolution of symptoms. Advantages over conventional open laminectomy include reduced expected blood loss, muscle damage, mechanical instability, and less postoperative pain. The slalom technique combined with navigation is used in multi-segmental LSS to improve the workflow and effectiveness of the procedure. METHODS We outline ten technical steps to achieve a slalom unilateral laminotomy for bilateral decompression (sULBD) with navigation. In a retrospective case series, we included patients with multi-segmental LSS operated in our institution using the sULBD between 2020 and 2022. The primary outcome was a reduction in pain measured by Visual Analogue Scale (VAS) for back pain and leg pain and Oswestry Disability Index (ODI). RESULTS In our case series (N = 7), all patients reported resolution of initial symptoms on an average follow-up of 20.71 ± 9 months. The average operative time and length of hospital stay were 196.14 min and 1.67 days, respectively. On average, VAS (back pain) was 4.71 pre-operatively and 1.50 on long-term follow-up of an average of 19.05 months. VAS (leg pain) decreased from 4.33 to 1.21. ODI was reported as 33% pre-operatively and 12% on long-term follow-up. CONCLUSION The sULBD with navigation is a safe and effective MIS surgical procedure and achieves the resolution of symptoms in patients presenting with multi-segmental LSS. Herein, we demonstrate the ten key steps required to perform the sULBD technique. Compared to the standard sULBD technique, the incorporation of navigation provides anatomic localization without exposure to radiation to staff for a higher safety profile along with a fast and efficient workflow.
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Affiliation(s)
- Siegfried J Adelhoefer
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Jessica Berger
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Catherine Mykolajtchuk
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Jaskeerat Gujral
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Blake I Boadi
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Brian Fiani
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA.
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Finneran MM, Johnson R, Guglielmi G, Nardone E. Minimally Invasive Bilateral Decompressive Lumbar Laminectomy with Unilateral Approach Among Obese versus Nonobese Patients. World Neurosurg 2023; 179:e81-e89. [PMID: 37572832 DOI: 10.1016/j.wneu.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE Decompressive lumbar laminectomy (DLL) is a common procedure for lumbar stenosis. A unilateral approach, unlike the traditional open approach, spares the posterior elements to mitigate the risk of iatrogenic instability associated with a DLL. Various minimally invasive techniques have been described but little attention has been aimed toward this specific microsurgical approach, particularly regarding obese patients. We aimed to compare operative details, perioperative outcomes, and complication profiles between obese and nonobese patients. METHODS One hundred and ninety-four patients who underwent bilateral laminectomy with a unilateral approach by the study surgeon from July 2013 to June 2018 were included. Of these patients, 105 were classified as obese, with body mass index (BMI) ≥30.0 kg/m2, and 89 were nonobese, with BMI <30.0 kg/m2. The obese and nonobese groups were compared; operative time, blood loss, and complications were assessed. RESULTS Operative time was nonsignificantly increased in the obese group (177 vs. 166 minutes; P = 0.21) and estimated blood loss was nonsignificantly lower (91 mL vs. 97 mL; P = 1.00) in the obese group. Durotomy rates (3 [2.9%] obese vs. 2 [2.2%] nonobese; P = 0.789) and postoperative wound drainage rates (4 [3.8%] obese vs. 2 [3.8%] nonobese; P = 0.92) did not significantly differ between the 2 groups. Length of stay was significantly longer in the obese group (1.5 vs. 1.0 days; P = 0.0005). CONCLUSIONS Compared with the nonobese group, the obese group had significantly longer length of hospitalization, as well as nonsignificantly increased length of operation and decreased blood loss. The 2 groups had similar perioperative complication rates.
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Affiliation(s)
- Megan M Finneran
- Department of Neurosurgery, Carle BroMenn Medical Center, Normal, Illinois, USA.
| | - Ryan Johnson
- Department of Neurosurgery, Carle BroMenn Medical Center, Normal, Illinois, USA
| | - Gina Guglielmi
- Department of Neurosurgery, Carle BroMenn Medical Center, Normal, Illinois, USA
| | - Emilio Nardone
- Department of Neurosurgery, Carle BroMenn Medical Center, Normal, Illinois, USA
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Yang E, Mummaneni PV, Chou D, Bydon M, Bisson EF, Shaffrey CI, Gottfried ON, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya CD, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Michalopoulos GD, Sherrod BA, Agarwal N, Haid RW, Chan AK. Cervical laminoplasty versus laminectomy and posterior cervical fusion for cervical myelopathy: propensity-matched analysis of 24-month outcomes from the Quality Outcomes Database. J Neurosurg Spine 2023; 39:671-681. [PMID: 37728378 DOI: 10.3171/2023.6.spine23345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/08/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Compared with laminectomy with posterior cervical fusion (PCF), cervical laminoplasty (CL) may result in different outcomes for those operated on for cervical spondylotic myelopathy (CSM). The aim of this study was to compare 24-month patient-reported outcomes (PROs) for laminoplasty versus PCF by using the Quality Outcomes Database (QOD) CSM data set. METHODS This was a retrospective study using an augmented data set from the prospectively collected QOD Registry Cervical Module. Patients undergoing laminoplasty or PCF for CSM were included. Using the nearest-neighbor method, the authors performed 1:1 propensity matching based on age, operated levels, and baseline modified Japanese Orthopaedic Association (mJOA) and visual analog scale (VAS) neck pain scores. The 24-month PROs, i.e., mJOA, Neck Disability Index (NDI), VAS neck pain, VAS arm pain, EQ-5D, EQ-VAS, and North American Spine Society (NASS) satisfaction scores, were compared. Only cases in the subaxial cervical region were included; those that crossed the cervicothoracic junction were excluded. RESULTS From the 1141 patients included in the QOD CSM data set who underwent anterior or posterior surgery for cervical myelopathy, 946 (82.9%) had 24 months of follow-up. Of these, 43 patients who underwent laminoplasty and 191 who underwent PCF met the inclusion criteria. After matching, the groups were similar for baseline characteristics, including operative levels (CL group: 4.0 ± 0.9 vs PCF group: 4.2 ± 1.1, p = 0.337) and baseline PROs (p > 0.05), except for a higher percentage involved in activities outside the home in the CL group (95.3% vs 81.4%, p = 0.044). The 24-month follow-up for the matched cohorts was similar (CL group: 88.4% vs PCF group: 83.7%, p = 0.534). Patients undergoing laminoplasty had significantly lower estimated blood loss (99.3 ± 91.7 mL vs 186.7 ± 142.7 mL, p = 0.003), decreased length of stay (3.0 ± 1.6 days vs 4.5 ± 3.3 days, p = 0.012), and a higher rate of routine discharge (88.4% vs 62.8%, p = 0.006). The CL cohort also demonstrated a higher rate of return to activities (47.2% vs 21.2%, p = 0.023) after 3 months. Laminoplasty was associated with a larger improvement in 24-month NDI score (-19.6 ± 18.9 vs -9.1 ± 21.9, p = 0.031). Otherwise, there were no 3- or 24-month differences in mJOA, mean NDI, VAS neck pain, VAS arm pain, EQ-5D, EQ-VAS, and distribution of NASS satisfaction scores (p > 0.05) between the cohorts. CONCLUSIONS Compared with PCF, laminoplasty was associated with decreased blood loss, decreased length of hospitalization, and higher rates of home discharge. At 3 months, laminoplasty was associated with a higher rate of return to baseline activities. At 24 months, laminoplasty was associated with greater improvements in neck disability. Otherwise, laminoplasty and PCF shared similar outcomes for functional status, pain, quality of life, and satisfaction. Laminoplasty and PCF achieved similar neck pain scores, suggesting that moderate preoperative neck pain may not necessarily be a contraindication for laminoplasty.
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Affiliation(s)
- Eunice Yang
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Praveen V Mummaneni
- 2Department of Neurosurgery, University of California, San Francisco, California
| | - Dean Chou
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Mohamad Bydon
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Erica F Bisson
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | | | - Oren N Gottfried
- 5Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Anthony L Asher
- 6Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 6Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 7Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 8Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 9Department of Neurosurgery, University of Miami, Florida
| | - Kai-Ming Fu
- 10Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 10Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 12Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag D Upadhyaya
- 13Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 14Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 14Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 15Barrow Neurological Institute, Phoenix, Arizona
| | | | - Brandon A Sherrod
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Nitin Agarwal
- 16Department of Neurosurgery, University of Pittsburgh, Pennsylvania; and
| | - Regis W Haid
- 17Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Andrew K Chan
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
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Ural P, Albayrak HK, Gürcan O, Kazanci A, Gürçay AG, Özateş MÖ. Histopathological Study of the Effects of Dura Adhesive Agents Used in Spinal Surgery Practice on Spinal Epidural Fibrosis in Experimental Animal Model. Neurol India 2023; 71:1177-1182. [PMID: 38174454 DOI: 10.4103/0028-3886.391384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Objective Histopathological examination of the effects of Tisseel, Cova, Glubran and Coseal, which are used for sealing purposes in spinal surgery practice, on epidural fibrosis is aimed. Methods Forty Sprague Dawley rats were randomly divided into five groups in our study as Group 1 (n=8) control group (Laminectomy); Group 2 (n=8) Cova group (Laminectomy + Cova); Group 3 (n=8) Tissel group (Laminectomy + Tisseel); Group 4 (n=8) Coseal group (Laminectomy + Coseal); and Group 5 Glubrane group (Laminectomy + Glubrane). Control group was only applied laminectomy. After laminectomy to other groups, Cova was applied to the 2nd group, Tissel to the 3rd group, Coseal to the 4th group and Glubran to the 5th group in surgical fields. After the rats were monitored in separate cages for 6 weeks after the operation, the relevant spinal level was extracted and the samples were examined histopathologically and the results were evaluated statistically. Results It was found that there was a statistically significant difference in Tisseel and Glubran groups in terms of fibrosis grading compared to the control group, and this had a positive effect on fibrosis. Compared to the control group, there was no statistically significant difference on fibrosis in Cova and Coseal groups. Conclusion As dura adhesive agents used in spinal surgery practice did not increase spinal epidural fibrosis statistically significantly, we concluded that these products can be used safely during spinal surgery if necessary.
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Affiliation(s)
- Pinar Ural
- Department of Neurosurgery, Çaycuma Public Hospital, Zonguldak, Turkey
| | | | - Oktay Gürcan
- Department of Neurosurgery, Ankara City Hospital, Ankara, Turkey
| | - Atilla Kazanci
- Faculty of Medicine, Department of Neurosurgery, Yıldırım Beyazıt University Ankara, Turkey
| | - Ahmet G Gürçay
- Faculty of Medicine, Department of Neurosurgery, Yıldırım Beyazıt University Ankara, Turkey
| | - Mehmet Ö Özateş
- Department of Neurosurgery, Ankara City Hospital, Ankara, Turkey
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Byvaltsev VA, Polkin RA, Kalinin AA, Belykh E, Riew KD. Laminectomy with Laminar Reconstruction for Resection of Intradural Tumors at the Thoracolumbar Junction: A Technical Note. World Neurosurg 2023; 179:104-108. [PMID: 37611800 DOI: 10.1016/j.wneu.2023.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To introduce a new laminar reconstruction technique to treat primary spinal cord tumors. METHODS Laminectomy and laminoplasty techniques have been used to treat intradural spinal tumors. The advantage of laminectomy is its superior exposure of the spinal cord, whereas the advantage of laminoplasty is the reconstruction of the dorsal roof of the spine. In this technical note, we present a technique that combines a full laminectomy to maximize exposure, with a reconstructive technique to repair the lamina. This technique restores the posterior ligamentous complex to preserve spinal biomechanics. RESULTS In this illustrative case, a 55-year-old woman with severe back pain radiating to the right lower extremity was found to have an intradural tumor at the T12-L1 spinal level. Given the transitional level of the spine and potentially high biomechanical stresses on the posterior support structures, we used a T12 laminectomy to resect the tumor, followed by reconstruction using miniplates. The patient tolerated the surgery well, without any complications. She was discharged home and was doing well during the 3 months follow-up visit. Appropriate patient consent was obtained. CONCLUSIONS Laminectomy and laminar reconstruction allow maximum visualization and manipulation of the tumor, followed by restoration of the dorsal roof of the spinal ring, and is an effective technique for treating spinal cord tumors.
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Affiliation(s)
- Vadim A Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia; Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia; Department of Traumatology, Orthopedic and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.
| | - Roman A Polkin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia; Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Andrei A Kalinin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia; Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Evgenii Belykh
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA; Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
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Chang HS, Sano F, Sorimachi T. Modified Unilateral Approach for Ventrally Located Spinal Tumors. Neurol Med Chir (Tokyo) 2023; 63:443-449. [PMID: 37495522 PMCID: PMC10687673 DOI: 10.2176/jns-nmc.2022-0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 05/24/2023] [Indexed: 07/28/2023] Open
Abstract
Surgery on spinal tumors becomes challenging when the tumor is ventral to the spinal cord. Conventionally, we approach it posteriorly through bilateral laminectomy and rotate the cord after sectioning the dentate ligament and nerve roots. However, manipulating the cord can be hazardous, and a long bilateral laminectomy can be invasive. Meanwhile, a narrow operative field and a limited lateral viewing angle in a unilateral approach constrained the surgeon. To overcome these problems, we previously reported a technique of modified unilateral approach where we incised the skin and the fascia horizontally and placed a pair of retractors longitudinally.The current article reports our experience applying this approach in 15 patients with ventrally located spinal tumors. The approach was performed on 10 schwannomas, 2 meningiomas, and 3 others. We evaluated paraspinal muscle atrophy on postoperative magnetic resonance imaging.The modified unilateral approach provided an excellent surgical field for removing ventrally located tumors. Gross total removal was achieved in 11 patients (92% of benign tumors). No neurological complications occurred except for one case of transient weakness. We encountered no wound-related late complications such as pain or deformity. The reduction of the cross-sectional area of the paraspinal muscles on the approach side (compared to the nonapproach side) was 0.93 (95% confidence interval: 0.72-1.06), indicating 7% atrophy (statistically nonsignificant, p = 0.48).We believe this simple technique can be useful for removing spinal tumors located ventral to the spinal cord.
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Affiliation(s)
| | - Fumiya Sano
- Department of Neurosurgery, Tokai University
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Wu PH, Chin BZJ, Kim HS, Sim SI, Jang IT. Uniportal Thoracic Endoscopic Unilateral Laminotomy with Bilateral Decompression of Thoracic Ossification of Ligamentum Flavum: A Systematic Review of Current Literature. World Neurosurg 2023; 178:340-350.e2. [PMID: 37480986 DOI: 10.1016/j.wneu.2023.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Thoracic ossification of ligamentum flavum (TOLF) is a rare disease that often results in worsening neurologic sequelae if left untreated. Although the gold standard treatment for TOLF is open posterior laminectomy, it is often accompanied by high rates of complications and perioperative morbidity. There have been studies looking into feasibility of endoscopic posterior decompression for TOLF, citing potential for lower perioperative morbidity and achieving similar functional outcomes to its open laminectomy counterparts. We provide an up-to-date systematic review of clinical outcomes after endoscopic posterior decompression for TOLF from the latest assemblage of evidence. METHODS A systematic review of the technique was conducted from May 2000 to May 2023. Articles were selected based on PRISMA guidelines. Eligibility of studies was independently by 2 reviewers, with disagreements resolved by a third author. RESULTS Nineteen primary references comprising 337 patients with TOLF who underwent endoscopic posterior decompression were included in the systematic review. Mean follow-up time across all studies ranged from 8.9 to 65.3 months. Mean age ranged from 51.2 to 63 years, with mean intraoperative blood loss ranging from 15 to 62 mL. There is significant improvement in visual analog scale (VAS) score, VAS back, VAS leg, modified Japanese Orthopaedic Association score, and Oswestry Disability Index compared with preoperative recorded values across all studies, with low rates of complications reported. CONCLUSIONS Endoscopic posterior spinal decompression is a safe and effective technique for treatment of TOLF, with a low rate of complications and improvement in pain and function.
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Affiliation(s)
- Pang Hung Wu
- Achieve Spine And Orthopaedic Centre, Mount Elizabeth Hospital, Singapore; National University Health System, Jurong Health Campus, Orthopaedic Surgery, Singapore
| | - Brian Zhao Jie Chin
- National University Health System, Jurong Health Campus, Orthopaedic Surgery, Singapore; National University Health System, Kent Ridge Campus, Orthopaedic Surgery, Singapore
| | - Hyeun Sung Kim
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Republic of South Korea.
| | - Seth Ian Sim
- National University Health System, Kent Ridge Campus, Orthopaedic Surgery, Singapore
| | - Il-Tae Jang
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Republic of South Korea
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Hu Y, Dong Y, Qi J, Chen Z, Li W, Tian Y, Sun C. Learning Curve and Clinical Outcomes of Ultrasonic Osteotome-based En Bloc Laminectomy for Thoracic Ossification of the Ligamentum Flavum. Orthop Surg 2023; 15:2318-2327. [PMID: 37403615 PMCID: PMC10475665 DOI: 10.1111/os.13804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/13/2023] [Accepted: 05/21/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE Despite rapid advances in minimally invasive surgery, en bloc laminectomy remains the most common surgical approach for treating thoracic ossification of the ligamentum flavum (TOLF). However, the learning curve of this risky operation is rarely reported. Therefore, we aimed to describe and analyze the learning curve of ultrasonic osteotome-based en bloc laminectomy for TOLF. METHODS Among 151 consecutive patients with TOLF who underwent en bloc laminectomy performed by one surgeon between January 2012 and December 2017, we retrospectively analyzed their demographic data, surgical parameters, and neurological function. Neurological outcome was evaluated with the modified Japanese Orthopaedic Association (mJOA) scale, and the Hirabayashi method was used to calculate the neurological recovery rate. The learning curve was assessed with logarithmic curve-fitting regression analysis. Univariate analysis methods were used for statistical analysis, including t-test, rank sum test, and chi-square test. RESULTS A total of 50% of learning milestones could be reached in approximately 14 cases, and the asymptote in 76 cases. Therefore, 76 of the 151 enrolled patients were defined as the "early group," and the remaining 75 were delimitated as the "late group" for comparison. There was a significant intergroup difference in the corrected operative time (94.80 ± 27.77 vs 65.93 ± 15.67 min, P < 0.001) and the estimated blood loss (median 240 vs 400 mL, P < 0.001). The overall follow-up was 83.1 ± 18.5 months. The mJOA significantly increased from a median of 5 (IQR: 4-5) before the surgery to 10 (IQR: 9-10) at the last follow-up (P < 0.001). The overall complication rate was 37.1%, and no significant intergroup difference was found, except for the incidence of dural tears (31.6% vs 17.3%, p = 0.042). CONCLUSION Initially, mastering the en bloc laminectomy technique using ultrasonic osteotome for TOLF treatment can be challenging, but the surgeon's experience improves as the operative time and blood loss decrease. Improved surgical experience reduced the risk of dural tears but was not associated with the overall complication rate or long-term neurological function. Despite the relatively long learning curve, en bloc laminectomy is a secure and valid technique for TOLF treatment.
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Affiliation(s)
- Yuanyu Hu
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yanlei Dong
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Junbo Qi
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Zhongqiang Chen
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Weishi Li
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yun Tian
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Chuiguo Sun
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
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Lin A, Meng S, Wang C, Zhao X, Han S, Zhang H, Shen Y, Zhu K, Zhou D, Su K, Ma X, Zhou C. Severe Symptomatic Epidural Hematoma Following Percutaneous Endoscopic Unilateral Laminectomy for Bilateral Decompression (Endo-ULBD)-Series Report and Management Strategies. Orthop Surg 2023; 15:2342-2353. [PMID: 37427671 PMCID: PMC10475654 DOI: 10.1111/os.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/16/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVES Severe symptomatic epidural hematoma (SSEH) is one of the most severe complications following percutaneous endoscopic unilateral laminectomy for bilateral decompression (Endo-ULBD). Considering that this technique has been performed for a short time, no detailed reports have been recently published. Thus, it is critical to gain a better understanding of SSEH occurring in its postoperative period with regard to its incidence, possible causes, outcome, etc., in order to identify relevant management strategies. METHODS Patients with spinal stenosis who had undergone Endo-ULBD in our department from May 2019 to May 2022 were retrospectively analyzed. Of which, patients with postoperative epidural hematoma were followed-up. The preoperative and postoperative physical conditions of each patient were recorded, and the information related to hematoma removal surgery was recorded in detail. Clinical outcomes were assessed using the visual analogue scale (VAS) and Oswestry disability index (ODI), and the results were classified into "excellent," "good," "fair," or "poor" based on the modified MacNab criteria. The incidence of hematoma with different factors was calculated, and a bar graph was used to compare the difference of the indexes related to hematoma removal between cases, and a line graph was used to reflect the trend of the outcome of each patient within 6 months to evaluate the effect of the treatment. RESULTS A total of 461 patients with spinal stenosis who underwent Endo-ULBD were enrolled in the study. SSEH occurred in four cases, with an incidence rate of 0.87% (4/461). All these four patients underwent decompression of multiple segments, and three of them had a history of hypertension comorbid with diabetes. Notably, one patient had a past history of hypertension and coronary artery disease and was on postoperative low molecular heparin due to lower extremity venous thrombosis. According to the conditions of the four patients, three types of treatment were used. And with timely treatment, all patients recovered well. CONCLUSION Despite being a minimally invasive technique, postoperative epidural hematoma remains a severe complication of Endo-ULBD. Therefore, during percutaneous endoscopic surgery, it is essential to enhance the comprehensive perioperative management of patients with Endo-ULBD. Signs related to postoperative hematoma must be recognized and promptly managed. If necessary, satisfactory results can be achieved by using percutaneous endoscopy along the original surgical channel to remove the hematoma.
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Affiliation(s)
- Antao Lin
- Department of Spinal SurgeryThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Shengwei Meng
- Department of Spinal SurgeryThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Chao Wang
- Department of Spinal SurgeryThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Xiaodan Zhao
- Department of Medical ImagingAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Shuo Han
- Department of Spinal SurgeryThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Hao Zhang
- Department of Spinal SurgeryThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Yanqing Shen
- Operating RoomAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Kai Zhu
- Department of Spinal SurgeryThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Dan Zhou
- Department of Spinal SurgeryThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Kunpeng Su
- Department of Spinal SurgeryThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Xuexiao Ma
- Department of Spinal SurgeryThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Chuanli Zhou
- Department of Spinal SurgeryThe Affiliated Hospital of Qingdao UniversityQingdaoChina
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Tawil ME, Chryssikos T, Rechav Ben-Natan A, Ambati VS, Guney E, Shah V, Abla AA, Mummaneni PV. Resection of a Thoracic Intradural Extramedullary Cavernoma Using Real-Time Intraoperative Ultrasound: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e174. [PMID: 37306964 PMCID: PMC10637418 DOI: 10.1227/ons.0000000000000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/06/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Michael E. Tawil
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Timothy Chryssikos
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Alma Rechav Ben-Natan
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Vardhaan S. Ambati
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Ekin Guney
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Vinil Shah
- Department of Radiology, University of California San Francisco, San Francisco, California, USA
| | - Adib A. Abla
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Praveen V. Mummaneni
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
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Núñez RYG, Córdova KRG, de Carvalho YK. Tridimensional models and radiographic study of dorsal laminectomy and thoracolumbar hemilaminectomy in dogs. Acta Cir Bras 2023; 38:e382623. [PMID: 37556719 PMCID: PMC10403244 DOI: 10.1590/acb382623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/07/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE To create three-dimensional anatomical models of the thoracic and lumbar portions of the canine spine that reproduce the vertebral surgical approaches of dorsal laminectomy and hemilaminectomy, and to perform the respective radiographic evaluations of each approach. METHODS In a digital archive of the canine spine, digitally replicate the dorsal laminectomy and hemilaminectomy in the thoracic and lumbar portions and, then, make tridimensional prints of the vertebral models and obtain radiographs in three dorsoventral, ventrodorsal and laterolateral projections. RESULTS The anatomical models of the surgical spinal canal accesses of the thoracic and lumbar portions showed great fidelity to the natural bones. The created accesses have the proper shape, location and size, and their radiographic images showed similar radiodensities. CONCLUSIONS The replicas of the dorsal laminectomy and hemilaminectomy developed in the anatomical models in the thoracic and lumbar portions are able to represent the technical recommendations of the specialized literature, as well as their respective radiographic images, which have certain radiological properties that allow to make a deep radiological study. Therefore, the models are useful for neurosurgical training.
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Affiliation(s)
- Ricardo Ysaac García Núñez
- Universidade Federal do Acre – Graduate Program in Animal Health and Production – Rio Branco (AC), Brazil
| | | | - Yuri Karaccas de Carvalho
- Universidade Federal do Acre – Centro de Ciências Biológicas e da Natureza – Rio Branco (AC), Brazil
- Universidade Federal Fluminense – Faculdade de Medicina Veterinária – Departamento de Patologia e Clínica Veterinária – Niterói (RJ), Brazil
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Kumar JI, Jallo GI, Shimony N. Knowledge Review of Spinal Deformity and the Need for Fusion and Fixation following Treatment for Spinal Tumors among the Pediatric Age Group. Pediatr Neurosurg 2023; 58:281-289. [PMID: 37531944 DOI: 10.1159/000531984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 07/05/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Spinal tumors are rare pathology in the pediatric population. The tumors can be classified as extradural, intradural extramedullary, or intramedullary. Any of the spinal tumors can eventually lead to spinal deformity. The progressive spinal deformity can be part of the initial presentation or evolve on long follow-up, even years after the initial intervention and treatment. SUMMARY Management of spinal deformity associated with spinal tumors in children is not well defined. Patients with progressive symptoms and even neurological deficits need correction for their deformity when diagnosed. Patients that do not have pain or related neurological deficits should be evaluated for the severity of their deformity and followed long-term. Special consideration is needed for young patients who need multilevel surgery or have deformity at presentation. KEY MESSAGES When considering the need for instrumentation and fusion, the surgeon should consider the age of the patient, expected future growth of the spine, neurologic status, extent of initial deformity, and the number of vertebral levels involved by tumor. Providers should also consider how surgery may fix or prevent deformity, especially when instrumentation can affect imaging at follow-up.
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Affiliation(s)
- Jay I Kumar
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
| | - George I Jallo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Nir Shimony
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Semmes-Murphey Clinic, Memphis, Tennessee, USA
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Greil ME, Bergquist J, Kashlan ON, Kwon WK, Durfy S, Hofstetter CP. Incidence and management of dural tears in full-endoscopic unilateral laminotomies for bilateral lumbar decompression. Eur Spine J 2023; 32:2889-2895. [PMID: 37264093 DOI: 10.1007/s00586-023-07749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE To report incidence of dural lacerations in lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) and to describe patient outcomes following a novel full-endoscopic bimanual durotomy repair. METHODS Retrospective review of prospectively collected database including 5.5 years of single surgeon experience with LE-ULBD. Patients with no durotomy were compared with patients who experienced intraoperative durotomy, including demographics, ASA score, prior surgery, number of levels treated, procedure time, hospital length of stay (LOS), visual analogue scale, perioperative complications, revision surgeries, use of analgesics, and Oswestry Disability Index (ODI). RESULTS In total, 13/174 patients (7.5%) undergoing LE-ULBD experienced intraoperative durotomy. No significant differences in demographic, clinical or operative variables were identified between the 2 groups. Sustaining a durotomy increased LOS (p = 0.0019); no differences in perioperative complications or rate of revision surgery were identified. There was no difference in minimally clinically important difference for ODI between groups (65.6% for no durotomy versus 55.6% for durotomy, p = 0.54). CONCLUSION In this cohort, sustaining a durotomy increased LOS but, with accompanying intraoperative repair, did not significantly affect rate of complications, revision surgery or functional outcomes. Our method of bimanual endoscopic dural repair provides an effective approach for repair of dural lacerations in interlaminar ULBD cases.
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Affiliation(s)
- Madeline E Greil
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA
| | - Julia Bergquist
- Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA
| | - Osama N Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Woo-Keun Kwon
- Department of Neurosurgery, College of Medicine, Korea University Guro Hospital, Korea University, Seoul, Republic of Korea
| | - Sharon Durfy
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA
| | - Christoph P Hofstetter
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA.
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Wu PH, Chin BZJ, Lee P, Woon CY, Kim HS, George R, Lin S, Tan YHG. Ambulatory uniportal versus biportal endoscopic unilateral laminotomy with bilateral decompression for lumbar spinal stenosis-cohort study using a prospective registry. Eur Spine J 2023; 32:2726-2735. [PMID: 36862219 DOI: 10.1007/s00586-023-07620-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Endoscopic spine surgery has been established as a practical, minimally invasive technique for decompression in patients with lumbar spinal stenosis. However, there remains a paucity of studies prospective cohort study comparing uniportal lumbar endoscopic unilateral laminotomy with bilateral decompression and unilateral biportal endoscopic unilateral laminotomy with bilateral decompression with open spinal decompression-both viable techniques with satisfactory clinical outcomes in the treatment of lumbar spinal stenosis. OBJECTIVE/AIM To compare the efficacy of UPE and BPE lumbar decompression surgery for patients with lumbar spinal stenosis. METHODS A prospective registry of patients who had undergone spinal decompression for lumbar stenosis via UPE or BPE under a single fellowship trained spine surgeon was studied. Baseline characteristics, initial clinical presentation, and operative details including complications were recorded for all included patients. Clinical outcomes, such as visual analogue scale and Oswestry Disability Index, were recorded at preoperative, immediate postoperative, 2-week, 3-, 6-, and 12-month follow-up periods. RESULTS A total of 62 patients underwent endoscopic decompression surgery for lumbar spinal stenosis (29 UPE, 33 BPE). No significant baseline differences were found between uniportal and biportal decompression, when comparing operative duration (130 vs. 140 min; p = 0.30), intraoperative blood loss (5.4 vs. 6mLs; p = 0.05), and length of hospital stay (23.6 vs. 20.3 h; p = 0.35). Two patients (7%) who underwent uniportal endoscopic decompression required conversion to open surgery due to inadequate decompression. Intraoperative complication rates were significantly higher in the UPE group (13.4% vs. 0%, p < 0.05). VAS score (leg & back) and ODI improved significantly (p < 0.001) in both endoscopic decompression groups across all follow-up time points, with no appreciable statistical differences between both groups. CONCLUSION UPE has the same efficacy as BPE in the treatment of lumbar spinal stenosis. While UPE surgery enjoys added aesthetic benefits of only one wound, BPE had potentially lower risks of intraoperative complication, inadequate decompression, and conversion to open surgery during early period of learning curve.
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Affiliation(s)
- Pang Hung Wu
- Orthopaedic Surgery, Juronghealth Campus, National University Health System, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Orthopaedic Department, JurongHealth Campus, National University Health System, Singapore, Singapore.
| | - Brian Zhao Jie Chin
- Orthopaedic Surgery, Juronghealth Campus, National University Health System, Singapore, Singapore
| | - Peng Lee
- Orthopaedic Surgery, Juronghealth Campus, National University Health System, Singapore, Singapore
| | - Chang Yi Woon
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hyeun Sung Kim
- Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea
| | - Rajeesh George
- Orthopaedic Surgery, Juronghealth Campus, National University Health System, Singapore, Singapore
| | - Shuxun Lin
- Orthopaedic Surgery, Juronghealth Campus, National University Health System, Singapore, Singapore
| | - Yu-Heng Gamaliel Tan
- Orthopaedic Surgery, Juronghealth Campus, National University Health System, Singapore, Singapore
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Guo L, Li J, Zhang F, Sun Y, Zhang W. Posterior endoscopic decompression combined with anterior cervical discectomy and fusion versus posterior laminectomy and fusion for multilevel cervical spondylotic myelopathy: a retrospective case-control study. BMC Musculoskelet Disord 2023; 24:578. [PMID: 37454072 DOI: 10.1186/s12891-023-06713-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE To compare the clinical efficacy of surgical treatment for multilevel cervical spondylotic myelopathy (MCSM) between the hybrid procedure, posterior endoscopic decompression (PED) combined with anterior cervical discectomy fusion (ACDF), and posterior cervical laminectomy and fusion (PCLF). METHODS A retrospective analysis was performed on 38 patients who received surgical treatment for MCSM from January 2018 to December 2021, including 19 cases in hybrid procedure group (13 males and 6 females), followed up for 10 to 22 (12.8 ± 10.3) months, and 19 cases in PCLF group (15 males and 4 females), followed up for 10 to 21 (11.7 ± 8.9) months. Perioperative information, including operation time, intraoperative blood loss, length of hospitalization, and complications, were compared between two groups. Visual analogue scale (VAS) of pain, neck disability index (NDI) and Japanese Orthopaedic Association (JOA) score were recorded to evaluate clinical efficacy. Cervical lordosis was calculated by radiographic examination. RESULTS Intraoperative blood loss, length of hospital stay were less in hybrid group than PCLF group, while operation time is longer in hybrid group, with a statistically significant difference (p < 0.05). Increased lordosis was better in hybrid group. There was no significant difference in preoperative VAS, JOA and NDI at pre-operation and final follow-up between two groups. But at post-operation and final follow-up, VAS was less in hybrid group than PCLF group (p < 0.05). There were 2 cases of neurostimulation symptoms in hybrid group, 2 cases of C5 nerve root palsy, 2 cases of subcutaneous fat necrosis and 1 case of dural tear in PCLF group, and all patients relieved with symptomatic treatment. CONCLUSION The hybrid procedure of PED combined with ACDF showed satisfied clinical outcome, with less intraoperative blood loss, shorter length of hospitalization and lower post-operative neck pain than PCLF. It is an effective surgical treatment for MCSM.
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Affiliation(s)
- Lei Guo
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei, China
| | - Jiaqi Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei, China
| | - Fei Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei, China
| | - Yapeng Sun
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei, China
| | - Wei Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei, China.
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舒 涛, 吴 帝, 沈 茂. [Research progress of different minimally invasive spinal decompression in lumbar spinal stenosis]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:895-900. [PMID: 37460188 PMCID: PMC10352501 DOI: 10.7507/1002-1892.202303110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/01/2023] [Indexed: 07/20/2023]
Abstract
Objective To review the application and progress of different minimally invasive spinal decompression in the treatment of lumbar spinal stenosis (LSS). Methods The domestic and foreign literature on the application of different minimally invasive spinal decompression in the treatment of LSS was extensively reviewed, and the advantages, disadvantages, and complications of different surgical methods were summarized. Results At present, minimally invasive spinal decompression mainly includes microscopic bilateral decompression, microendoscopic decompression, percutaneous endoscopic lumbar decompression, unilateral biportal endoscopy, and so on. Compared with traditional open surgery, different minimally invasive spinal decompression techniques can reduce the operation time, intraoperative blood loss, and postoperative pain of patients, thereby reducing hospital stay and saving treatment costs. Conclusion The indications of different minimally invasive spinal decompression are different, but there are certain advantages and disadvantages. When patients have clear surgical indications, individualized treatment plans should be formulated according to the symptoms and signs of patients, combined with imaging manifestations.
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Affiliation(s)
- 涛 舒
- 贵州医科大学临床医学院(贵阳 550004)Guizhou Medical University, School of Clinical Medicine, Guiyang Guizhou, 550004, P. R. China
| | - 帝求 吴
- 贵州医科大学临床医学院(贵阳 550004)Guizhou Medical University, School of Clinical Medicine, Guiyang Guizhou, 550004, P. R. China
| | - 茂 沈
- 贵州医科大学临床医学院(贵阳 550004)Guizhou Medical University, School of Clinical Medicine, Guiyang Guizhou, 550004, P. R. China
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Doi K, Mizuno J, Ohara Y, Tani S. Comparison of the Degree of Expanded Spinal Canal Area between the Hinge-Side Area and the Open-Side Area in Cervical Open-Door Laminoplasty. Neurol India 2023; 71:689-692. [PMID: 37635499 DOI: 10.4103/0028-3886.383874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background There have been reports on the significant canal cross-sectional area (CSA) expansion difference between pre- and post-operation, but no comparison of CSA expansion between the hinge-side area (Area H) and the open-side area (Area O) has been reported. This study aimed to measure the spinal CSA expansion between Area H and Area O retrospectively after open-door laminoplasty using new titanium spacers and evaluated this common decompression procedure's effectiveness. Materials and Methods This study included 27 patients diagnosed with cervical spondylotic radiculopathy or myelopathy, ossification of the posterior longitudinal ligament, and developmental canal stenosis from February 2021 to October 2022. The CSA difference between pre- and post-cervical laminoplasty (C4-C6 levels) was measured with cervical transverse computed tomography scan images. The CSA difference in Area H and Area O between pre- and post-laminoplasty was similarly calculated. Results The spinal canal areas of each segment after open-door laminoplasty were significantly enlarged (P < 0.05). Area O was also significantly enlarged compared to that of Area H (P < 0.05). Conclusion Area O was more enlarged than Area H, and both sides were statistically enlarged after open-door laminoplasty.
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Affiliation(s)
- Kazuma Doi
- Center for Minimally Invasive Spinal Surgery, Shin Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Junichi Mizuno
- Center for Minimally Invasive Spinal Surgery, Shin Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Yukoh Ohara
- Center for Minimally Invasive Spinal Surgery, Shin Yurigaoka General Hospital, Kawasaki, Kanagawa; Department of Neurosurgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Satoshi Tani
- Center for Minimally Invasive Spinal Surgery, Shin Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
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Hajhouji F, Benyaich Z, Laghmari M, Ghannane H, Ait Benali S. Spontaneous spinal epidural hematoma in a toddler presenting with torticollis: case report and literature review. Childs Nerv Syst 2023; 39:1935-1939. [PMID: 36738321 DOI: 10.1007/s00381-023-05870-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Spontaneous spinal epidural hematoma (SSEH) is a rare entity, especially in toddlers and infants. The nonspecificity of its presenting symptoms in children may be a source of delayed diagnosis. CASE DESCRIPTION We report the case of a 20-month-old young boy without medical history who presented with irreducible torticollis, worsened a few days later by severe tetraplegia and respiratory distress. Spinal magnetic resonance imaging (MRI) showed a posterior epidural hematoma, extending from C3 to T1 and compressing the spinal cord. An urgent decompressive surgery via an extensive laminectomy and evacuation of the clot was performed. The patient demonstrated a partial neurological recovery on follow-up. CONCLUSION SSEH is a rare and serious condition that may compromise the functional and vital prognosis of the patient, hence the importance of prompt diagnosis and urgent treatment.
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Affiliation(s)
- Farouk Hajhouji
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Zakariae Benyaich
- Department of Neurosurgery, CHU Souss Massa, Agadir, Morocco.
- Faculty of Medicine and Pharmacy of Agadir, Ibn Zohr University, Agadir, Morocco.
| | - Mehdi Laghmari
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
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Kim Y, Koutsouras GW, Bourdages G, Beutler T. Insidious onset of spontaneous spinal epidural hematoma in immune thrombocytopenic purpura: a case-based review. Childs Nerv Syst 2023; 39:1903-1909. [PMID: 37126139 DOI: 10.1007/s00381-023-05963-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/16/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Spontaneous spinal epidural hematoma (SSEH) can result from various etiologies with a variable degree of neurological deficits. Here, we describe a rare case of SEH secondary to immune thrombocytopenic purpura (ITP) in a child and review the literature of SSEH caused by ITP. CASE REPORT A 9-year-old female who presented with rapid neurological decline, including bowel and bladder incontinence and paraparesis. A SSEH was observed extending from C2 to T6, causing a mass effect on the spinal cord. Her platelet count was only 7000/µL. Multidisciplinary care was established with neurosurgery, pediatric hematology, and pediatric surgery. The patient was managed emergently with splenectomy and surgical evacuation, with multilevel laminectomy and laminoplasty for evacuation of the hematoma. After a short course of rehabilitation, the patient regained all neurological function. CONCLUSION We report the first case of cervicothoracic SSEH secondary to ITP in a child managed with emergent splenectomy and surgical evacuation with multilevel lamoplasty. We also described the methods of timely diagnosis, urgent management, and overall prognosis of patients with this condition.
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Affiliation(s)
- YeonSoo Kim
- Department of Neurosurgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - George W Koutsouras
- Department of Neurosurgery, SUNY Upstate University Hospital, Syracuse, NY, USA.
| | - George Bourdages
- Department of Neurosurgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Timothy Beutler
- Department of Neurosurgery, SUNY Upstate University Hospital, Syracuse, NY, USA
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Vedantam A, Harinathan B, Warraich A, Budde MD, Yoganandan N. Differences in spinal cord biomechanics after laminectomy, laminoplasty, and laminectomy with fusion for degenerative cervical myelopathy. J Neurosurg Spine 2023; 39:28-39. [PMID: 37029671 DOI: 10.3171/2023.3.spine2340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/13/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE Spinal cord stress/strain during neck motion contributes to spinal cord dysfunction in degenerative cervical myelopathy (DCM), yet the effect of surgery on spinal cord biomechanics is unknown. It is expected that motion-preserving and fusion surgeries for DCM will have distinct effects on spinal cord biomechanics. The aim of this study was to compare changes in spinal cord biomechanics after laminectomy with fusion, laminectomy, and laminoplasty using a patient-specific finite element model (FEM) for DCM. METHODS A patient-specific FEM of the cervical spine and spinal cord was created using MRI from a subject with mild DCM. Multilevel laminectomy with fusion, laminectomy, and laminoplasty were simulated for DCM using the patient-specific FEM. Spinal cord von Mises stress and maximum principal strain during neck flexion-extension, lateral bending, and axial rotation were recorded. Segmental range of motion, intradiscal pressure, and capsular ligament strain were also measured. FEM outputs were calculated as a change with respect to the preoperative values and compared between the three models. RESULTS Across the surgical levels, spinal cord stress increased after laminectomy for neck flexion (+50%), neck extension (+37.8%), and axial rotation (+23%). Similarly, spinal cord strain increased in neck extension (+118.4%) and axial rotation (+75.1%) after laminectomy. Laminoplasty was associated with greater spinal cord stress in neck flexion (+57.4%) and increased strain in lateral bending (+56.7%) and axial rotation (+20.9%). Compared with laminectomy and laminoplasty, spinal cord biomechanics for laminectomy with fusion revealed significantly reduced median extension stress (13.7 kPa vs 9.7 kPa, p = 0.03), lateral bending strain (0.01 vs 0.007, p = 0.007), axial rotation stress (3.7 kPa vs 2.1 kPa, p = 0.04), and axial rotation strain (0.017 vs 0.009, p = 0.04). CONCLUSIONS Spinal cord strain decreased in neck flexion in all three models, yet spinal cord stress increased with neck flexion for laminectomy and laminoplasty. Changes in spinal cord biomechanics for laminoplasty parallel those for laminectomy with fusion except during neck flexion, lateral bending, and axial rotation. Compared with motion-preserving approaches such as laminectomy and laminoplasty, laminectomy with fusion was associated with the lowest spinal cord stress and strain in flexion-extension, lateral bending, and axial rotation of the neck.
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Affiliation(s)
- Aditya Vedantam
- 1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Balaji Harinathan
- 1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- 2School of Mechanical Engineering, Vellore Institute of Technology, Chennai, India; and
| | | | - Matthew D Budde
- 1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Narayan Yoganandan
- 1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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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. Comput Methods Programs Biomed 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] [What about the content of this article? (0)] [Affiliation(s)] [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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