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Single-door laminoplasty has been widely used in the treatment of multisegment cervical myelopathy, with the clinical advantages of decompression of the spinal cord, relieving preoperative neurological symptoms or signs, and maintaining cervical mobility. However, in clinical work, patients with limited cervical spine activity after single open door laminoplasty are often encountered, and the direct contact with the adjacent vertebral arch can be observed in the postoperative X-ray of the anterior and lateral cervical spine, which is called the adjacent vertebral arch bone impact, which is one of the important causes of the limited cervical spine movement. In recent years, there have been many reports on the prevention of bone impact, although the short-term clinical effect is significant, but long-term clinical efficacy to be further study, and the cause and the pathogenesis of bone impact is no consensus, this paper on the surgery of adjacent vertebral arch impact epidemiology, biomechanics, clinical performance, surgical effect and improvement.
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OBJECTIVE@#To evaluate the short-term curative effects of ARCH titanium plate fixation combined with expansive single open-door laminoplasty (EOLP) in treating cervical spondylotic myelopathy (CSM).@*METHODS@#EOLP with ARCH titanium plate as internal fixation material was applied in 32 patients with CSM from January to December 2016. There were 23 males and 9 females with an average age of 64.5 years ranging from 39 to 82 years. The course of disease ranged from 6 to 24 months with an average of 13.1 months. The clinical efficacy was evaluated by Japanese Orthopaedic Association (JOA) scoring method, which included upper and lower limb motor function, limb sensory function and bladder function. The sagittal diameter of the narrowest segment of vertebral canal was measured by imaging data before operation and 6 months after operation, and the improvement rate was calculated to determine the decompression effect.@*RESULTS@#All the patients were followed up from 6 to 20 months with an average of 12.2 months. Preoperative symptoms of 32 patients were improved to varying degrees, the JOA score increased from 9.78±1.34 before operation to 12.94±1.16 at 6 months after operation, the improvement rate of JOA was(44.09±11.06)% (<0.01). The spinal canal was significantly enlarged, the sagittal diameter of the narrowest vertebral canal was increased from (8.47±0.60) mm preoperatively to (12.51±0.78) mm 6 months postoperatively, the improvement rate was (48.27±11.81)% (<0.01). No loosening, displacement, rupture or "re-closure" of the internal fixator was found during the follow-up.@*CONCLUSIONS@#ARCH titanium plate fixation combined with EOLP in the treatment of CSM can significantly reduce the possibility of "re-closure" and other related postoperative complications and the short-term clinical efficacy is satisfactory.
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Plates , Cervical Vertebrae , Laminoplasty , Retrospective Studies , Spinal Cord Diseases , Titanium , Treatment OutcomeABSTRACT
Objective:To observe the efficacy of laminoplasty with reconstructing of cervical extensor attachment on cervical spondylotic myelopathy (CSM) involving C2 segment. Methods:From March, 2014 to January, 2017, 46 cases with CSM involving C2 accepted surgery in our hospital. They were divided into two groups according to the surgical methods. Control group (n = 21) accepted traditional laminoplasty, while observation group (n = 25) accepted laminoplasty with extensor muscle attachment point reconstruction. They were assessed with Japanese Orthopaedic Association (JOA) spinal scores, cervical range of motion (ROM), cervical curvature, areas of posterior cervical muscles and axial symptoms. Results:There was no significant difference at operative time and intraoperative blood loss (t < 0.863, P > 0.05) between groups. After surgery, the JOA score increased in both groups (F > 24.961, P < 0.001), but there was no significant difference between two groups (t < 0.282, P > 0.05). ROM varied little in both groups (F < 0.931, P > 0.05). The cervical neutral position curvature decreased in the control group (F = 8.241, P < 0.01), but not in the observation group (F = 2.705, P > 0.05). The areas of posterior muscle decreased in control group (t = 2.678, P < 0.05), but not in the observation group (t = 0.854, P > 0.05). The incidence of axial symptoms was less in the observation group than in the control group (Z = -2.192, P < 0.05). Conclusion:Laminoplasty could relieve the spinal compression at C2 segment and promote the recovery of neurological function, and it can do better in cervical curvature and posterior cervical muscle atrophy as combination with reconstruction of extensor muscle attachment, to reduce the axial symptoms.
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<p><b>OBJECTIVE</b>To analyze the effect whether or not retaining muscle ligament complex of C2 attachment on cervical spine kyphotic deformity after single open-door laminoplasty.</p><p><b>METHODS</b>A total 40 patients with cervical spondylotic myelopathy underwent single open-door laminoplasty from February 2011 to June 2014 were retrospectively analyzed. Of them, single open-door for C₃-C₆ was 40 cases (group A), including 28 males and 12 females, with an average age of (68.4±9.3) years old;and single open-door for C₄-C₆ plus C₃ laminectomy decompression (in order to protect the muscle ligament complex of C₂ attachment) was 40 cases (group B), including 26 males and 14 females, with an average age of (66.8±8.4) years old. Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS), Cobb angle of sagittal plane from C₂-C₇, cervical range of motion were used to evaluate effects before operation and at the latest follow-up.</p><p><b>RESULTS</b>All the patients were followed up from 24 to 31 months with an average of(26.5±3.4) months. There was no significant differences in VAS, JOA scores and cervical range of motion before surgery between two groups (>0.05) and all above items were significantly improved at the latest follow-up (<0.05), but there was no significant difference between two groups(>0.05). There was no significant difference in cervical Cobb angle before surgery between two groups(>0.05), and postoperative Cobb angle had obviously improved in two groups(<0.05), but the improvement of group B was better than that of group A.</p><p><b>CONCLUSIONS</b>Starting the laminoplasy on C₄ level and retainning the muscle ligament complex of C₂ attachment can obviouly decrease cervical spine syphotic deformity.</p>
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<p><b>OBJECTIVE</b>To compare the clinical effects between anterior cervical discectomy and fusion(ACDF) combined with anterior cervical corpectomy and fusion(ACCF) and cervical posterior single open-door laminoplasty with mini-titanium plate fixation in treating three-segment cervical spondylotic myelopathy.</p><p><b>METHODS</b>The clinical data of 63 patients (39 males and 24 females) with three-segment cervical spondylotic myelopathy underwent surgical treatment from March 2014 to March 2016 were retrospectively analyzed. Among them, 43 cases were treated by ACDF combined with ACCF(anterior group), and 20 cases were treated by cervical posterior single open-door laminoplasty with mini-titanium plate fixation(posterior group). Operative time, intraoperative blood loss, postoperative complications were compared between two groups. And according to JOA score to evaluate the clinical effect.</p><p><b>RESULTS</b>All the patients were follow-up from 16 to 40 months with an average of 25.8 months. Operative time of anterior group and posterior group were (123.70±6.21) min and(118.70±5.41) min, respectively, there was no significant difference between two groups(>0.05). Intraoperative blood loss of anterior group and posterior group were (85.23±7.51) ml and (107.18±9.41) ml, respectively, there was significant difference between two groups(<0.05). In anterior group, axial symptoms occurred in 6 cases, dysphagia in 1 case, and no C₅ nerve root palsy, hoarseness and choking cough were found, the incidence rate of complication was 16.3%(7/43); and in posterior group, axial symptoms occurred in 5 cases, C5 nerve root palsy in 1 case, and no dysphagia, hoarseness and choking cough were found, the incidence rate of complication was 30.0%(6/20); there was significant defference in incidence rate of complication between two group(<0.05). At 1 week after operation and final follow-up, the JOA scores of anterior group were obviously better than that of posterior group(<0.05).</p><p><b>CONCLUSIONS</b>Above-mintioned two surgical treatment for cervical spondylotic myelopathy can provide instantly stability, the method of ACDF combined with ACCF was obviously better that of the method of cervical posterior single open-door laminoplasty in intraoperative blood loss, the incidence rate of complications, clinical effect.Thus, for the treatment of three-segment cervical spondylotic myelopathy, the method of ACDF combined with ACCF would be firstly chosen.</p>
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Results: The C 2-C 7 Cobb angle at last follow-up was significantly decreased when compared with preoperative value ( t=8.000, P=0.000), but there was no significant difference in C 2-C 7 SVA between pre- and post-operation ( t=-1.842, P=0.074). The preoperative T 1S was (19.69±3.39)°; there were 17 cases in group A and 19 cases in group B with no significant difference in gender and age between 2 groups ( P>0.05). The preoperative C 2-C 7 Cobb angle in group B was significantly lower than that in group A ( t=-2.150, P=0.039), while there was no significant difference in preoperative C 2-C 7 SVA between 2 groups ( t=0.206, P=0.838). At last follow-up, except for the curvature loss after operation in group B was significantly lower than that in group A ( t=-2.723, P=0.010), there was no significant difference in the other indicators between 2 groups ( P>0.05).
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Compressive cervical myelopathy (CCM) is a common disease of spinal surgery. Various kinds of reasons such as herniation of cervical disc and ossification of the posterior longitudinal ligament (OPLL) lead to spinal canal stenosis, thereby compressing the spinal cord, and a series of neurological symptoms are caused. Currently, posterior cervical expansive open-door laminoplasty (PCEOLP) is widely used for cervical decompression in patients with CCM involving three or more levels. This operation can expand the spinal canal while preserving the posterior structures of the cervical spine, and non-neurological complications are relatively rare. However, there are characteristic complications to this procedure such as nerve root palsy, axial neck pain, and loss of range of motion (ROM). Various modified techniques of PCEOLP have been developed to reduce postoperative complications. In this review, clinical research progress of PCEOLP in recent years is summarized, mainly focusing on internal fixation of materials and methods, operative approach, cervical decompression level, combined application of different surgical procedures, opening size and application of new technologies.
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Objective To investigate the clinical effect of titanium plate fixation for posterior one-door-open laminoplasty in the treatment of elderly patients with multi segmental cervical spondylotic myelopathy,to analyze the advantages and disadvantages of open cervical spine fixation under fixed mode.Methods Thirty-eight cases with multi segmental cervical spondylotic myelopathy treated in China Meitan General Hospital with titanium plate fixation and posterior cervical laminoplasty from January 2011 to January 2014 were selected as the research object,a retrospective analysis was made on the clinical data of the patients.Group A with 20 cases was fixed with open-door segment C3~C6;18 cases in group B were treated with open door fixation of segmental C3~C7.X-ray,CT,MR were examined in preoperative time,JOA score was performed at 7d and 6 months after surgery.Door opening angle of CT cross section,the anteroposterior diameter(APD)of the spinal canal and shaft fusion were measured.MR spinal cord signal changes and the degree of compression,cervical spine activity, postoperative pain,the initial pain degree,VAS score and remission time differences were evaluated and analyzed.Results The incision healed in group A and B after the operation,the incidence rate of axial symptoms was 30%(6/20)in group A and 38.9%(7/18)in group B,the difference was statistically significant(P= 0.043); postoperative JOA scores were(12.2 ± 2.3)% points and(12.8 ± 1.7)points respectively in group A and B,the improvement rate of nerve function were(49.31 ± 14.5)% and(47.93 ±18.6)%,respectively in group A and B,the change rate of cervical spine were(-2.37±1.88)% and(-2.65 ±1.23)%,respectively in group A and B,the difference was not statistically significant(P>0.05).Initial VAS scores were(3.2±1.3)points and(4.1±1.7)points respectively in group A and B,the pain time were(55.2±28.5)d and(24.9± 19.2)d respectively,and complete remission time were(93.2± 47.3)d and(152.5 ± 59.3)d respectively,the differences between the two groups were statistically significant(P=0.028,P=0.031) .There were no change in opening angle,the anteroposterior diameter of spinal canal and spinal canal expansion rate at 7 days after surgery,but the door had bony fusion,without lamina closure phenomenon,and the seveity of spinal cord compression was improved at 6 months after surgery, compared with the preoperative time.Conclusion To obtain the ideal clinical treatment effect on titanium plate fixation of open-door laminoplasty in the treatment of multilevel cervical myelopathy in the elderly patients,the characteristics of the patient's own disease and selective fixation section should be taken into consideration.
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<p><b>OBJECTIVE</b>To evolve the formula of relationship between opening angle of laminoplasty and the increased value of cross-sectional area, and to predict the opening angle according to the opening size of lanminoplasty.</p><p><b>METHODS</b>From January 2013 to December 2015, 26 patients underwent single open-door laminoplasty in C₃-C₇. Among them, 10 patients with ossification of posterior longitudinal ligament, there were 6 males and 4 females, aged from 39 to 58 years old with an average of 49.2 years; and 16 patients with cervical spondylotic myelopathy, there were 10 males and 6 females, aged from 40 to 58 years old with an average of 50.2 years. Through the changes of spinal canal shape between preoperation and postoperation to set up the regular geometric model, and to deduce the formula of the relationship between the opening angle of laminoplasty and the increased value of cross-sectional area, and predict the formula of opening angle. According to the preoperative and postoperative CT scan, the needed parameters were measured, and were substituted in the above formula to get the change of cross-sectional area before and after operation, predicting the opening angle of laminoplasty. The differences between the change of cross-sectional area before and after operation, predictive the opening angle of laminoplasty and practical measured data were analyzed by statistical methods, thus to verify the feasibility of formula in practical application.</p><p><b>RESULTS</b>All imaging data of 26 patients were obtained. There were significant differences in changes of cross-sectional areas in every patients (laminoplasty in C₃ to C₇) before and after operation in the same segment(<0.01). The increasing extent in cross-sectional areas was gradually diminished following the opening angle increasing. There was no significant difference between the opening angle attained by formula and the data measured by software in the same segment(>0.05).</p><p><b>CONCLUSIONS</b>Increment of cross-sectional areas following C₃-C₇ laminoplasty can be accurately attained and the opening angle can also be predicted by a certain formula, which can help surgeons to attain the accurate opening angle and reduce the postoperative complications.</p>
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<p><b>OBJECTIVE</b>To compare the short term curative effect of posterior open door laminoplasty between continuous placement of shaping plate and intermittent placement in treating multilevel cervical spondylotic myelopathy.</p><p><b>METHODS</b>From January 2012 to March 2015, 43 patients with multi segment cervical spondylotic cervical were treated with posterior open door laminoplasty, 21 patients with continuous placement of shaping plate(continuous group), 22 patients with intermittent placement of shaping plate(intermittent group). Operative time, intraoperative blood loss, JOA score, VAS score, postoperative spinal sagittal diameter and cervical curvature, postoperative cervical activity, complications, hospitalization expenses etc. were observed.</p><p><b>RESULTS</b>The patients of two groups were followed up with an average of (23.2±8.1) months and (23.3±8.0) months in continuous group and intermittent group, respectively. There was no significant difference in operative time, intraoperative blood loss, hospitalization time between two groups(>0.05). JOA and VAS scores of all patients at final follow up were obviously improved than preoperative(<0.05). Postoperative spinal sagittal diameter at 3 days and final follow up were obviously improved(<0.05), and there was no significant difference between postoperative at 3 days and final follow up(>0.05). Cervical activity of all patients at final follow up was decreased than preoperative(<0.05), but there was no significant difference between two groups(>0.05). There was no significant difference in postoperative complication and there was significant difference in hospitalization expenses between two groups.</p><p><b>CONCLUSIONS</b>Posterior open door laminoplasty with continuous or intermittent placement of shaping plate have similar clinical effects in ameliorating nerve function for the treatment of multilevel cervical spondylotic myelopahty. However, the hospitalization expenses of intermittent group is obviously reduced, and the medical resources can be saved.</p>
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PURPOSE: To introduce a new simple technique using suture anchors and ceramic spacers to stabilize the elevated laminae in open-door cervical laminoplasty. Although ceramic spacers were placed in the opened laminae and fixed with nylon threads in this series, it was occasionally difficult to fix the nylon threads to the lateral mass. MATERIALS AND METHODS: Study 1: A preliminary study was conducted using a suture anchor system. Sixteen consecutive patients who underwent surgery for cervical myelopathy were prospectively examined. Study 2: The second study was performed prospectively to evaluate the feasibility of this new technique based on the result of the preliminary study. Clinical outcomes were examined in 45 consecutive patients [cervical spondylotic myelopathy (CSM)] and 43 consecutive patients (OPLL). The Japanese Orthopedic Association scoring system (JOA score), axial neck pain, and radiological findings were analyzed. RESULTS: 1) In one case, re-operation was necessary due to dislodgement of the ceramic spacer following rupture of the thread. 2) In all patients, postoperative CT scans showed that the anchors were securely inserted into the bone. In the CSM group, the average JOA score improved from 9.5 points preoperatively to 13.3 at follow-up (recovery 51%). In the OPLL group, the average JOA score improved from 10.1 (5-14) points preoperatively to 14.4 (11-16) at follow-up (recovery 62%). There were no serious complications. CONCLUSION: The use of the suture anchor system made it unnecessary to create a hole in the lateral mass and enabled reliable and faster fixation of the HA spacers in open-door laminoplasty.
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Adult , Aged , Female , Humans , Male , Middle Aged , Ceramics , Cervical Vertebrae/diagnostic imaging , Feasibility Studies , Follow-Up Studies , Laminoplasty/methods , Postoperative Period , Prospective Studies , Spinal Cord Diseases/surgery , Suture Anchors , Sutures , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
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.
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Humans , Asian People , Longitudinal Ligaments , Orthopedics , Spinal Canal , Spinal Cord Diseases , Tomography, X-Ray ComputedABSTRACT
Objective To study the effect of posterior unilateral open-door laminoplasty which anchor the different segments of patients on neurological function improvement rate,cervical range of motion,axial symptoms and complications.Methods From June 2009 to April 2013,86 patients with cervical spondylotic myelopathy received posterior unilateral open-door laminoplasty by anchoring were selected.The open segments were C3-7.They were divided into two groups according to the anchor segments.Group A of 48 patients,anchor segments was C3-7,using 5 anchoring nails.Group B of 38 patients,anchor segments was C3,5,7,using 3 anchoring nails.The improvement rate of nerve function,ranges of neck motion,incidence of axial symptoms and postoperative complications were compared between two groups.Results The improvement rate of nerve function,loss of ranges of neck motion and incidence of axial symptoms between group A and group B had no significant difference[(56.4 ± 18.3)％ vs.(56.8 ± 19.6)％,(9.27 ± 5.42)° vs.(9.06 ± 4.89)°,22.9％ (11/48) vs.23.7％ (9/38)] (P ＞ 0.05).Two groups of patients with postoperativefollow-up were not found door re-clousure phenomenon.Conclusions In the anchor posterior unilateral open-door laminoplasty,they have same improvement rate of neural function on anchoring 3 segments and anchoring 5 segments.The postoperative complications are not increased,but the cost of internal fixation is decreased,operation become more economical.
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Objective To compare the bony fusion in different degrees of vertebral plate hinge fracture after single open-door cervical expansive laminoplasty with centerpiece mini-plate fixation.Methods The clinical data of 79 patients received the unilateral simple open-door cervical expansive laminoplasty with centerpiece mini-plate fixation from January 2010 to December 2012 were retrospectively analyzed.The vertebral plate hinge fracture was divided into incomplete fracture and complete fracture according to thepostoperative CT scan.The complete fracture was divided into four types:type Ⅰ in which there was no displacement;type Ⅱ in which there was mild to moderate displacement;type Ⅲ in which there was complete displacement or separated; type Ⅳ in which there was hinge' s collapse into cervical canal.The hinge fracture healing was observed and the difference of different types of fracture healing rate was compared.Results Follow-up of 12-45 (21.2 ± 5.6) months.CT scan found 395 segments 1 week after the operation,vertebral plate hinge complete fracture accounted for 58.2％ (230/395).And type Ⅰ accounted for 66.1％ (152/230),type Ⅱ accounted for 25.7％(59/230),type Ⅲ accounted for 6.5％(15/230) and type Ⅳ accounted for 1.7％ (4/230).The fusion rate of incomplete fracture at 6 months after the operation was higher than that complete fracture [97.6％(161/165) vs.80.9％(186/230)],there was significant difference (P＜ 0.05).The fracture rate in different types of complete fracture at 3,6 months after the operation had significant difference (P ＜ 0.05).Type Ⅲ fracture had the lowest healing rate.Conclusion Type Ⅰ fracture is the major type for vertebral plate hinge complete fracture,complete fracture get a relatively bad bony fusion and type Ⅲ fracture has the lowest healing rate.
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Objective To evaluate the short-term results of ARCH plate in cerical expansive open-door laminoplasty(ELAP)for OPLL.Methods From June 2010 to September 2011,a total of 12 cases with OPLL underwent open-door ELAP by ARCH plate fixation and were followed up in our hospital.8 cases were males and 4 cases were female.The average age was 60.5 years.The neurological effect was evaluated by use Japanese Orthopedic Association(JOA)scoring criteria for cervical myelopathy.The ana-tomical effect was analyzed by compare roentgenogram and CT before and after surgery.Results The JOA scores were improved for 39% after the operation,while the saggital diameters of the cervical spinal canaldural after operation was enlarged for 82%(P<0.05).X-ray films and CT scan after operation that there was no occurrence of re-close of door,there was no occurrence of anchor loosing.Conclusion For OPLL,ELAP using ARCH plate fixation bring less occurrence of re-close of door,slight postoperative neck AS,and satisfactory clinical outcomes.
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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.
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Humans , Durapatite , Retrospective Studies , Spinal Canal , SpineABSTRACT
OBJECTIVE: The purposes of this study are to evaluate the efficacy of en bloc open-door laminoplasty and to investigate the validity of various factors as prognotic indicators in patients with multisegmental spondylotic myelopathy and ossification of posterior longitudinal ligament(OPLL). METHODS: The authors reviewed 43 cases in whom laminoplasty were performed for cervical myelopathy between January 2000 and December 2002. Clinical symptoms and results were evaluated using the Japanese Orthopaedic Association(JOA) scale. The recovery rate was calculated and then assessed for prognostic factors such as preoperative JOA scores, ages, history of previous trauma, duration of symptoms and signal change in cord on T2-weighted magnetic resonance image. RESULTS: In cervical stenosis, canal widening of antero-posterior diameter and dimension after laminoplasty is 4.16mm, 87.43mm2 and in OPLL is 6.20mm, 117.61mm2. In all cases there wasn't neurologic deterioration, mild postoperative complications developed in seven cases. Four patient had a limitation of range of neck motion and the other one showed kyphotic change and another two showed C5 radiculopathy. The recovery rate of JOA score in cervical stenosis and OPLL was 62% and 68% respectively. Duration of symptoms, the severity(preoperative JOA score), and signal change in cord on T2-weighted magnetic resonance image had close relationship to the clinical outcomes. CONCLUSION: Unilateral en bloc laminoplasty is simultaneous expansile and decompressive method. And preoperative JOA score, symptom duration and high signal intensity on T2-weighted magnetic resonance image can be used to predict prognosis.
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Humans , Asian People , Constriction, Pathologic , Neck , Postoperative Complications , Prognosis , Radiculopathy , Spinal Cord DiseasesABSTRACT
OBJECTIVE: The purpose of this study is to introduce a simple yet effective technique to secure the posterior elements in the open position after expansive open-door laminoplasty and to evaluate factors contributing to surgical results after laminoplasty. METHODS: Twenty two myelopathic or radiculopathic patients with multilevel cervical canal stenosis or ossification of the posterior longitudinal ligament were treated with an expansive open-door laminoplasty. Thirteen patients were cervical spinal stenosis and the other 9 patients were diagnosed as the ossification of the posterior longitudinal ligament. The posterior elements were stabilized in the open position with titanium miniplates without spacers. Morphometric analysis was performed on preoperative and postoperative plain radiographs to obtain spinal canal dimensions and to monitor construct integrity. RESULTS: The mean preoperative sagittal canal diameter was 10.3+/-2.2mm. These dimensions increased to 17.4+/-2.8mm after surgery. Most patients improved from the myelopathy or the radiculopathy and the mean recovery rate was 52.4+/-17.1%. The titanium miniplate constructs did not fail during the follow-up period (mean, 38.5 months) and the decompression was maintained. Serious complications such as instability and kyphosis did not develop in any cases. There were no significant factors that predict surgical outcome. CONCLUSION: Expansive open-door laminoplasty using titanium miniplates can be easily performed and is effective technique for decompression and maintenance of the spinal canal diameter.