Double-door laminoplasty combined with C dome decompression for the treatment of cervical spinal stenosis / 中国骨伤

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.

Risk Factor Analysis for C5 Palsy after Double-Door Laminoplasty for Cervical Spondylotic Myelopathy

STUDY DESIGN: A retrospective comparative study. PURPOSE: To clarify the risk factors related to the development of postoperative C5 palsy through radiological studies after cervical double-door laminoplasty (DDL). OVERVIEW OF LITERATURE: Although postoperative C5 palsy is generally considered to be the result of damage to the nerve root or segmental spinal cord, the associated pathology remains controversial. METHODS: A consecutive case series of 47 patients with cervical spondylotic myelopathy treated by DDL at our institution between April 2008 and April 2015 were reviewed. Postoperative C5 palsy occurred in 5 of 47 cases after DDL. We investigated 9 radiologic factors that have been reported to be risk factors for C5 palsy in various studies, and statistically examined these between the two groups of palsy and the non-palsy patients. RESULTS: We found a significant difference between patients with and without postoperative C5 palsy with regards to the posterior shift of spinal cord at C4/5 (p=0.008). The logistic regression analyses revealed posterior shift of the spinal cord at C4/5 (odds ratio, 12.066; p=0.029; 95% confidence interval, 1.295–112.378). For the other radiologic factors, there were no statistically significant differences between the two groups. CONCLUSIONS: In the present study, we showed a significant difference in the posterior shift of the spinal cord at C4/5 between the palsy and the non-palsy groups, indicating that the "tethering phenomenon" was likely a greater risk factor for postoperative C5 palsy.

Box-Shape Cervical Expansive Laminoplasty: Clinical and Radiological Outcomes

OBJECTIVE: Box-shape cervical expansive laminoplasty is a procedure that utilizes a Miniplate(R) or Maxpacer(R) to achieve maximal canal expansion. This method is expected to show much larger canal expansion and good clinical outcome. So we investigated the clinical and radiological outcome of Box-shape cervical expansive laminoplasty. METHODS: Between June 2008 and July 2013, we performed cervical expansive laminoplasty in 87 and 48 patients using the Box-shape cervical expansive laminoplasty, respectively. We analyzed the clinical results of these operations using the Japanese Orthopedic Association (JOA) scoring system and by assessing the position of intralaminar screws with postoperative computed tomography (CT) at POD-6 months. RESULTS: A total of 48 patients with ossification of the posterior longitudinal ligament (OPLL) (36 pts), cervical spondylotic myelopathy (CSM) (12 pts) were enrolled. Overall JOA scores improved from 11.49 to 14.22 at POD-6 months (OPLL: 11.32 -->14.3; CSM: 12-->14). Postoperative CT scans were performed in 39 patients at 177 levels for a total of 354 screws. The malpositioning rate of intralaminar screws was 3.4% and hardware-related neurologic complications did not occur. CONCLUSION: Box-shape cervical expansive laminoplasty creates maximal spinal canal expansion and leads to improved cervical myelopathy. The use of intralaminar screws to fix the remodeled lamina-facet does not represent a significant difficulty.

Cervical Expansive Laminoplasty with 90degrees Box-Shape Double Door Method

OBJECTIVE: The aim of this study is to introduce the surgical method with miniplate and compared the expansion rate of the spinal canal area with other kinds of lamina spacers. METHODS: Between June. 2008 and May 2011, we performed expansive cervical laminoplasty on 61 patients. We analyzed the results of these operations, examining type of lamina spacer used, spinal canal areas between pre- and postoperative CT scans, and operative methods. RESULTS: 39 patients were analyzed retrospectively. Miniplates were used in 21 patients with 103 levels. Hydroxyapatite (HA) was used in 6 patients with 29 levels, and Centerpiece(R) was used in 12 patients with 54 levels. The expansion area was calculated using Photoshop CS3(R). The expansion rate of the miniplates was 76.5%, that of HA was 49.8%, and that obtained with Centerpiece was 50.6%. The excellent 90degrees box-shaped widening of the laminae achieved through the surgery can be checked easily by AP X-ray. All miniplates are positioned horizontally and parallel, and the lamina is seen as a pedicle of thoracic or lumbar spine due to its 90degrees erect position. Neurologic improvement and clinical outcomes will be discussed. No complications were reported with miniplates. CONCLUSION: Box-shaped laminoplasty with miniplates is the widest spinal canal expansion method among the three types of implants examined.

Multi-Spiral CT 3D reconstruction technique to assist the procedure of multilevel degenerative stenosis with traumatic instability in lower cervical spine / 中国矫形外科杂志

[Objective]To study the method of multi-spiral CT(MSCT) 3D reconstruction technique assisting cervical pedicle screw fixation(PSF) and double-door laminoplasty in the treatment of multilevel degenerative stenosis with traumatic instability(MDSTI) of lower cervical spine.[Method]From September 2006 to August 2007,PSF combined with double-door laminoplasty were performed in 9 patients with MDSTI of lower cervical spine.MSCT 3D reconstruction techniques,including volume rendering(VR) and multi-planar reconstruction(MPR),were used to assist preoperative diagnosis,plan and measurement to guide procedure.Postoperative MPR was used again:through coronal format,the degree of screws perforation was measured precisely and the different positions of pedicle screws were divided into three grades according to Richter's method;through axial format,the increase in sagittal diameter and canal area of every laminoplasty level were measured precisely.A comparison between pre- and postoperative ASIA scores was used to present neural function recovery.[Result]Nine patients with MDSTI of lower cervical spine underwent PSF and total 44 screws.According to the classification of Richter,grade 1 were 72.7%(32/44),grade 2 were 27.3%(12/44).No screw perforation occurred(grade 3) and no screws revision resulted from misplacement.No iatrogenic damage occurred.Double-door laminoplasty was performed in total 42 volumes.The postoperative cervical spinal canal sagittal diameter and traverse area were significantly improved(P