Progress on the impact of adjacent vertebral arch after single open door laminoplasty / 中国骨伤

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.

Short-term curative effects of ARCH titanium plate fixation combined with expansive single open-door laminoplasty in treating cervical spondylotic myelopathy / 中国骨伤

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.

Effect of Laminoplasty with Reconstructing of Cervical Extensor Attachment on Cervical Spondylotic Myelopathy Involving C2 Segment / 中国康复理论与实践

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.

Comparison of clinical effects between anterior cervical discectomy combined with corpectomy and cervical posterior single open-door laminoplasty in treating three-segment cervical spondylotic myelopathy / 中国骨伤

<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>

Effect of the proximal level on post-laminoplasty loss of lordosis / 中国骨伤

<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>

Relationship between the prediction of the opening angle and the increased value of cross-sectional area in single open-door laminoplasty / 中国骨伤

<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>

Comparison of short term curative effects of open door laminoplasty with different plate density for the treatment of multi segment cervical spondylotic myelopathy / 中国骨伤

<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>