ABSTRACT
OBJECTIVE@#To investigate the clinical effect of double-door laminoplasty combined with C dome decompression in treatment of cervical spinal stenosis.@*METHODS@#The clinical data of 28 patients with cervical spinal stenosis who underwent double-door laminoplasty combined with C dome decompression from June 2016 to June 2018 were retrospectively analyzed, including 17 males and 11 females, aged 39 to 74 years with an average of (61.0±6.7) years. The clinical effects were evaluated by JOA score, axial symptoms, cervical spine activity, cervical spinal cord compression degree and so on.@*RESULTS@#All patients were followed up for 6 to12 months with an average of 10.2 months. The JOA score in the final follow-up was significantly improved (0.05). After operation, sagittal diameter at the narrowest level of C-C spinal canal was (16.20±1.82) mm, which was significantly higher than (8.38±1.16) mm before operation (<0.05). There were 4 cases with axial symptoms in 24 patients with the incidence rate of 14.29% (4/24).@*CONCLUSION@#Double-door laminoplasty combined with C dome decompression can directly expand the volume of C-C spinal canal, relieve the compression of spinal cord and nerve root, reduce the damage to the posterior cervical ligament complex as much as possible, maintain the stability of cervical spine sequence, reduce the occurrence of axial symptoms, and the operation is relatively simple, without the need of metal internal fixation.
ABSTRACT
BACKGROUND:Some scholars suggest that the nerve root palsy after cervical spinal stenosis treated with decompression and implant internal fixation is related with the cervical stability and cervical lordosis, but there is controversial. OBJECTIVE:To explore the C 5 nerve root palsy and stability after cervical spinal stenosis treated with posterior laminectomy lateral mass fixation and single-door decompression laminoplasty. METHODS:Twenty-nine cervical spinal stenosis patients were selected and treated with posterior decompression and implant internal fixation. Posterior laminectomy lateral mass fixation for the treatment of cervical spinal stenosis:C3-6 lateral mass and C7 pedicel screw internal fixation was performed and caused rough surface on the facet joint;the unstable segment was confirmed according to the preoperative anteraposterior plain film and dynamic radiographs combined with MRI and CT images, and then the corresponding segments were treated with lateral mass internal fixation, single-door decompression laminoplasty and laminoplasty. RESULTS AND CONCLUSION:Al the 29 cervical spinal stenosis patients were fol owed-up for 8 months to 2.3 years. Among them, 14 cases were treated with posterior laminectomy lateral mass fixation, two cases had nerve root palsy in the early stage after implantation, three cases had incomplete paralysis after long-term symptom recurrence and treated with second surgery of scar remove and decompression;15 cases were treated with single-door decompression laminoplasty, and one case had C 5 never root palsy and shoulder abduction dysfunctionafter treatment, no preoperative symptom recurrence. The nerve root palsy wil restored in 6 weeks for shortest and 9 months for longest. As the limitation of the case number, it is not clear whether there were significant differences in the correlation between C 5 nerve root palsy and segmental stability, cervical lordosis, spinal decompression degree and the range for spinal cord shift, as wel as the nerve root palsy degree and the cervical spinal stenosis recurrence caused by forward scar between two treatment methods, so accumulation observation of the cases and clinical experience are needed.
ABSTRACT
There have been paucity of reports on atlas hypoplasia, and as a result this condition is not clearly defined, nor well understood. The authors reported three cases of atlas hypoplasia that were found in adults who presented with myelopathic symptoms. On radiographic examination, it was found that the anterior-posterior diameter of the atlas was remarkably narrower in all three cases in comparison with normal persons. The MRI in all three cases also revealed intramedullary high signal lesions at the levels where severe spinal cord compression was present. This led to our diagnosis of atlas hypoplasia causing myelopathy.
Subject(s)
Adult , Humans , Diagnosis , Magnetic Resonance Imaging , Spinal Cord Compression , Spinal Cord DiseasesABSTRACT
100 patients involving Cervical Spinal Stenosis have been operated on from 10/1995- 9/1999 in the Spinal Surgery Dep. A Centre for Trauma- orthopedics in HCM city. The clinical data was as following: 32 cases involving Cervical Spondylosis; 63 cases involving Cervical Disc Herniation; 5 OPLL and CDH. Mean age: 49, 95 (29-76). Men: 69. Women: 31. 85 surgical interventions for 81 patients using Anterior Decompression and Fusion for one to three stages (4 reoperated cases: 2 epidural hematomas and 2 graf dislocations). 19 cases operated by posterior Approaches: two laminectomy, 17 using the KUROKAWA technique with four technical failure (turned to ITOH in two cases and lamiectomy in two cases). Grafting technique used: argenson 1, Bailey-Badgley 5, Bohlman 11, Bohlman and Kokubun 1, Kokubun 45, Kokubun for 2 different stages 1, Smith-Robinson and Kokubun for two different stages 1. Good fusion was obtained in all of the cases using the Anterior Decompression and Grafting. The recovery rate for whole group was 71% following the Scale of JOA. 71/87 cases accompanied by the neurological deficits recovered from motor weakness. Among them, there were 60,56% complete recovery, 39.44% partial recovery. 52/81 cases with anterior decompression and arthrodesis were followed between 3 to 39 months. 35 of them have been reviewed further 12 months. 11 of 19 cases operated by laminaplasty have been reviewed from 9 to 29 months. 9 of them with follow-up more than 12 months. Surgical treatment is really an effective method for Cervical Spinal stenosis. The skillfull surgical decompression techniques should be practiced.
Subject(s)
Constriction, Pathologic , General SurgeryABSTRACT
During 7/1996 - 11/1998, MEDIC - MRI department had studied 4571 patients included 985 cervical spinal cases (22%), infections (03%), degenerative diseases (51%), cervical spinal stenosis (30%), trauma (35%), tumor (06%), miscellaneous lesion (05%). Cervical spinal stenosis has been usually seen. The main etiologies of cervical spinal stenosis include cervical disc herniation, cervical spondylosis, and ossification of the posterior longitudinal ligament. It causes the severe complications such as radiculopathy and chronic myelopathy (tetraplegia, sensory disorder, and bladder dysfunction). The best knowledge of the lesion of the cervical spinal stenosis could facilitate treatment and save the patient life with hope of good motor recovery. The purpose of this study is to determine whether MRI can be used to define the nature of cervical spinal stenosis.
Subject(s)
Constriction, Pathologic , Magnetic Resonance ImagingABSTRACT
Acase of 14-year-old student is presented with the complaint of recurrent attack of transient quadriparesis during hyperextension of the neck. On 3-dimensional spinal CT and MRI, the authors confirmed intrusion of posterior tubercle of the atlas with increased signal on T1- and T2- weighted image was found. The clinical manifestations were improved without having cervical instability after a posterior laminectomy of the atlas.
Subject(s)
Adolescent , Humans , Laminectomy , Magnetic Resonance Imaging , Neck , QuadriplegiaABSTRACT
Extended hemilaminectomy was performed in the treatment of compression of the cervical spinal cord produced by ossification of the posterior longitudinal ligament, multilevel degeneration and protrusion of the intervertebral discs and simple spinal canal stenosis. The results showed that with this operation the cross sectional area of the spinal canal was enlarged by 50% of the original, and the sagittal diameter lengthened 2,5mm postoperatively, so the compression of the. spinal cord was relieved. Since the function of the spinal process, the supra-and interspinal ligaments and the structure of one side of the lamina were preserved, mechanical stability of the cervical spine was maintained.