Analysis of clinical effects of absorbable hemostatic fluid gelatin and absorbable gelatin sponge on the hemostasis during operation of unilateral open-door cervical expansive laminoplasty / 中国骨伤

<p><b>OBJECTIVE</b>To compare the hemostatic effect between absorbable hemostatic fluid gelatin (HFG) and absorbable gelatin sponge(GS) during operation of unilateral open-door cervical expansive laminoplasty.</p><p><b>METHODS</b>The clinical data of 83 patients underwent unilateral open-door cervical expansive laminoplasty from February 2014 to May 2016 were retrospectively analyzed. According to the used hemostatic materials, patients were divided into two groups. In HFG group, there were 30 males and 11 females, ranging in age from 29 to 81 years, with an average of(55.6±11.6)years; 14 cases were simple cervical spinal stenosis, 9 were cervical spinal stenosis and ossification of posterior longitudinal ligament, and 18 were cervical spinal stenosis complicated with multiple cervical disc herniation. And in GS group, there were 32 males and 10 females, ranging in age from 36 to 78 years, with an average of (55.4±11.1) years; 12 cases were simple cervical spinal stenosis, 10 were cervical spinal stenosis complicated with ossification of posterior longitudinal ligament, and 20 were cervical spinal stenosis complicated with multiple cervical disc herniation. There was no significant difference in the age, gender, and disease categories of patients between two groups (>0.05). The operative time, intraoperative bleeding, postoperative drainage, and postoperative complications were compared between two groups.</p><p><b>RESULTS</b>The average operative time, intraoperative bleeding, and postoperative drainage in HFG group were(137.2±30.0) min, (156.1±74.6) ml, and (212.1±67.6) ml, respectively; and in GS group were (154.8±33.5) min, (242.9±120.7) ml, and(303.3±115.5) ml, respectively. There were significantly differences in above items between two groups(<0.05). No acute heamatoma or related complications was found postoperatively.</p><p><b>CONCLUSIONS</b>Compared with GS, HFG can obviously decrease operative time, intraoperative bleeding, and postoperative drainage. It is a safe and effective hemostatic material for the operation of unilateral open-door cervical expansive laminoplasty.</p>

Influence on postoperative axial symptom by unilateral laminoplasty combined with different fixations / 医疗卫生装备

Objective To observe the influence of preoperatively physical curvature abnormality and different fixation systems on postoperative axial symptom (PAS) and union rate of hinge groove after unilateral expansive laminoplasty for the patient with cervical spondylotic myelopathy (CSM).Methods The study reviewed 106 CSM patients who underwent unilateral laminoplasty supplemented by lateral mass or pedicle screw/rod fixation with a minimum of 36 months of follow-up.According to being complicated with physical curvature abnormality or not,the incidence,initial onset,severity,duration of PAS and union rate of hinge groove at postoperative 6 months were respectively compared to analyze the influences of two internal methods on the features of PAS.Results For 50 cases without physical curvature abnormality,fusion rates of hinge groove in pedicle placement group was higher than that in lateral mass fixation group,the P value reached statistical difference (t=142.2,P=0.032).Duration of PAS in pedicle group was shorter than that in lateral mass group,the difference reached statistic significance (t=147.2,P=0.019).For 56 cases of with physical curvature abnormality,incidence of PAS in pedicle group presented was lower than that in lateral mass group,the difference achieved statistic significance (x2=3.89,P=-0.042).Conclusion Whether concomitant with physical curvature abnormality or not,pedicle fixation would be beneficial to promoting bony fusion of hinge groove,shortening duration of PAS and reducing incidence of PAS in contrast to lateral mass fixation to some extent after unilateral laminoplasty for treating CSM patients.

Efficacy of Cervical Expansive Laminoplasty for Quadriplegic Patients Without Cervical Bony Injury

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the efficacy of cervical expansive laminoplasty for patients with quadriplegia due to traumatic cervical spinal cord injury (SCI) without skeletal injury. SUMMARY OF LITERATURE REVIEW: There are a few studies on the surgical results for acute cervical SCI without bony injury. MATERIALS AND METHODS: From 2003 to 2010, among the patients who visited emergency room with post-traumatic quadriplegia, 12 patients who had underwent cervical expansive laminoplasty for acute cervical SCI without body injury and cord compression on MR images were included in this study. We evaluate the pre-operative swelling on MRI, the change of neurologic symptoms at pre-, post operative state, respiration state, complication and survival period. RESULTS: The average of motor index scores at the time of admission to the emergency room was 23 (4–30), and the average was changed to 29(4–43) during the follow-up period. No significant neurological improvement was observed in 11 cases except 1 case. The average time for operation after the injury was 26 hours(9–72). 4 patients showed paradoxical respiration when they first visited emergency room and the symptom continued after the operation and during follow-up periods. Another 4 patients showed paradoxical respiration after the operation. In all 8 cases who showed paradoxical respiration, tracheostomy and occasional ventilation were needed. In the follow-up period, 6 patients died due to respiratory failure within 1 year after the surgery. All these patients presented severe spinal cord edema on preoperative MRI with paradoxical respiration. CONCLUSIONS: Efficacy of expansive laminoplasty for quadriplegic patients due to acute cervical SCI without bony injury may be limited. In many patients, no significant neurological recovery was observed but it was clearly identified that prognosis was related to the grades of spinal cord edema and paradoxical respiration.

Combined use of posterior unilateral open-door laminoplasty and leverage fixation for treatment of multi-segmental cervical spondylotic myelopathy / 军事医学

Objective To evaluate the clinical efficiency of posterior unilateral open-door laminoplasty and leverage titanium plate internal fixation in the treatment of cervical spondylotic myelopathy ( CSM ) with multi-segmental spinal stenosis.Methods Between Mar 2011 and May 2015, 25 patients with multi-segmental CSM with multi-segmental spinal stenosis were treated by posterior unilateral open-door laminoplasty and leverage fixation .There were 16 males and 9 females, whose mean age was 60.6 ±9.9 years during the surgery.The change of clinical symptoms and signs was recorded during follow-up,and they all received X-ray and MRI.In all the patients, the preoperative and postoperative neurological function, the cervical curvature,cervical vertebra tube volume and axial symptoms were measured , recorded and analyzed. There was statistically significant difference (P<0.05) in the mean Japanese Orthopaedic Association (JOA) score, and Visual Analogue Scale ( VAS) .Results All the 25 patients were followed up for more than 6 months ( 6-24 months ) .No symptoms of C5 nerve root were found in our series .According to the JOA score and VSA score ,the neurological functions of each patient were significantly improved .The preoperative JOA score was 10.16 ±1.35 and the improvement rate 61.24%. There was statistically significant difference between the preoperative VSA score and the postoperative one (6.68 ±1.12 vs 2.32 ±0.84) ( P<0.05).The preoperative and postoperative meansurement of the spinal vertebrai canal diameter was (9.22 ±2.01) and (15.64 ±2.08) mm, respectively,so there was statistically significant difference (P <0.05), indicating that the cavical spinal canal was increased after operation .Conclusion Leverage titanium plate internal fixation can effectively help maintain the expanded vertebral canal after unilateral open -door laminoplasty ,reduce the incidence of postoperative axial symptoms , and maintain the cervical physical curvature .

Clinical outcome of expansive unilateral open-door laminoplasty in cervical myelopathy with OsteoMed M3 plate and screws / 国际外科学杂志

Objective To retrospectively describe the technique and review the surgical results of OsteoMed M3 titanium plate and screws used to secure the posterior elements in the open position after expansive unilateral opendoor laminoplasty.Methods Twenty-six patients with multilevel cervical disc herniation and canal stenosis were treated with an expansive unilateral open-door laminoplasty with OsteoMed M3 plate and screws.The follow-up period was over 1 year.The improvement of spinal function after surgeries under JOA was evaluated to analyse the effects and releated factors.Results All of 26 cases' follow-up period was over 1 year.The mean JOA score increased significantly from 9.40 ± 1.658 ( range,5 to 13 ) points before surgery to 13.80 ± 1.958 ( range,7 to 16) points at final follow- up ( t =- 21.137,P =0.000 ).Mean recovery rate was 57.9％.Postoperative radiography,magnetic resonance imaging and computed tomography scan demonstrated significantly increased sagittal diameter and canal expansion.Two cases without relief of nurological symptoms underwent an additional anterior multilevel corpectomy.One case with ossification of the posterior longitudinal ligament had not good enough neurologic improvement after surgery.No neurologic deterioration owing to hinge reclosure or major surgery-related complications were observed.It would reduce the recovery for those with old age,long history,worse symptoms,cervical kyphosis and abnormal signal in MR imaging.It was good for patients to do early active cervical exercises after surgery.Conclusion Unilateral open- door laminoplasty with OsteoMed M3 titanium plate and screws fixation effectively maintains expansion of the spinal canal and resists closure while preserving alignment and stability.This modified technique is easy to perform with a low complication,is and economic,and is good for clinical application.

Double-door expansive laminoplasty using allogenic bone spacers / 中国矫形外科杂志

[Objective]To study the application of allogenic bone spacer in double-door expansive laminoplasty.[Method]From Apr.2003 to Jun.2004,22 patients underwent double-door expansive laminoplasty using allogenic bone spacers in authors department.All patients were followed up for 16～30 months,with an average time of 18.4 months.JOA scoring system was used to evaluate the neurological status.ROM of cervical spine and bone fusion was determined on X-ray and CT at follow-ups.[Result]At final follow-up,JOA scores improved from(8.3?2.6)points before surgery to(13.3?3.1)points.ROM of cervical spine was reduced from(41.3?10.8)? to(23.4?8.7)?.No postoperative instability happened after operation.Bone fusion between allograft and spinous processes was completed in 69.6%,partial in 23.2% and failed in 7.1% of the operated levels.No breakage and displacement of allograft spacers were found.[Conclusion]Double-door expansive laminoplasty using allogenic bone spacers is safe and effective for cervical spondylotic myelopathy.

Improved Z-open door expensive laminoplasty for cervical ossification of the posterior longitudinal ligament / 中国矫形外科杂志

[Objective]To investigate the effects of the expansive Z-open-door laminoplasty for the ossification of posterior longitudinal ligaments(OPLL).[Methods]Thirty-six cases of OPLL were operated by the expansive Z-open-door laminoplasty.According to JOA score(17 Points) the proximate effects of all patients were analyzed.[Results]All cases were followed-up for average 18.6 months.JOA improved from 8.3 preoperatively to 13.8 postoperatively.Improved rate averaged 58.6%.Image show:3 of 31cases of anterior protruding type were changed to straight type,5 cases of straight type still kept initial type.None of all cases changed into posterior protruding type after operation.The flexion and extention range of the neck were less 1/3 and the axis-ward pain happened commonly.[Conclusion]Improved expensive Z-open door laminoplasty for DPLL can decompression clearly.It has advantages of adeguate canal expansion,preventing re-dosing the door,and being safe and reliable.

Evaluation of Factors on Clinical Results Following Expansive Laminoplasty for Cervical Myelopathy / 대한정형외과학회잡지

PURPOSE: To evaluate the results of expansive laminoplasty and to investigate the validity of various factors as prognostic indicators. MATERIALS AND METHODS: We studied retrospectively 37 patients between August 1993 and August 1998. The severity of the pre- and postoperative myelopathy was determined with the Japanese Orthopaedic Association (JOA) score. The recovery ratio was calculated. We divided the patients into two groups with good and fair outcomes, and then assessed for prognostic factors such as preop JOA scores, ages, sex, trauma, duration, Pavlov ratios, compression ratios and signal change in cord on T2W MRI. RESULTS: In 19 patients the percentage recovery of JOA score was higher than 50%, while in 18 patients it was lower than 50%. There were no significant differences in regards to history of trauma, sex, and duration, there was a tendency of good results when there were no changes in the signal in cord on T2W MRI. There were significant differences in the preoperative JOA scores, Pavlov ratios and compression ratios. CONCLUSION: The preoperative JOA score, Pavlov ratio, compression ratio and high signal intensity on T2W MRI can be used to predict prognosis.

Surgical Treatment for Ossification of the Posterior Longitudinal Ligament of the Cervical Spine

Ossification of the posterior longitudinal ligament(OPLL) is a degenerative disease of the spine, usually found in the cervical vertebrae. The etiology and pathogenesis have not been clarified, and its natural course is still unknown. The choice of operative approach, anterior vs. posterior, is still controversial. During the past 13 years, we have operated on 116 patients with myelopathy associated with cevical OPLL; 34 cases(29.3%) were of the continuous type, 30(25.9%) were segemental, 37(31.9%) were mixed, and 15(12.9%) were other type respectively. Forty-six patients underwent anterior cervical decompression by corpectomy, disectomy, and removal of the OPLL, and in these patients, segmental and other types of OPLL were more common and were found in 73% of these cases. On the other hand, 70 patients underwent posterior cervical decompression by cervical laminectomy or expansive laminoplasty; among them, the continuous and mixed type were more common and accounted for 84% of these cases. Surgical outcome was better in patients in whom the duration of pre-operative symptoms was shorter(p<0 .05). Age at surgery, trauma history and surgical approach did not, however, significantly affect the outcome. In conclusion, anterior cervical decompression was seen to give the best results, but was limited to patients with segmental or other types of OPLL, single or two levels of OPLL, and OPLL with herniated cervical disc. The posterior approach, on the other hand, was palliative, and gave better results in patients with continuous or mixed type of OPLL, OPLL of more than level three, and generally compromised patients.

The Experiences of Modified Bilateral Open Expansive Laminoplasty in Secondary Developmental Spinal Stenosis

The surgical intervention for secondary developmental cervical spinal stenosis that results in myelopathy and radiculopathy has been modified by technical improvement to obtain more reliable enlargement of the cervical spinal canal. The authours have experienced good results with the modified open door expansive laminoplasty, so we report this article. The patients were treated by surgical intervention during the period from October 1989 to February 1991. The results obtained were as follows : 1) The average age was 54.7 years, and the sex distribution ratio of female to male was 2 : 8. 2) In clinical symptoms and symptoms of both myelopathy and radiculopathy. 3) In morphological analysis of lesions, all patients except one case had lesions over 3 levels, The lesions were spondylosis, spondylosis combined with soft disc herniation, spondylosis combined with OPLL, spondylosis combined with OPLL and soft disc herniation, OPLL and OYL in the order of frequency. 4) The operation method was as follows : after the patient was positioned in modified Concorde position, open door lamina was anchored to faced joint capsule and surrounding tissue with nylon sutures. And then the raw epidural space was covered with Lyodura by the modified Hirabayashi method. By this method, reclosure of widened spinal canal was prevented. 5) The outcomes were evaluated by JOA score difference between preoperation and post operation times. The outcome of recovery rate was 100% in five cases. Therewere no aggravated or unimproved cases. The results were excellent 8 cases, good 1 case, unchanged 0 case, poor 0 case and expired 1 case.