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BACKGROUND:Endoscopic treatment of lumbar disc herniation has obvious advantages over traditional open surgery.Endoscopic surgery involves the implantation of a working cannula,which requires only partial bone removal,and there are no studies on the effects of two types of intraoperative foraminoplasty and laminoplasty on the mechanical properties of the local structure of the lumbar spine. OBJECTIVE:To compare the effect of foraminoplasty and laminoplasty on the biomechanical properties of disc and isthmus of the responsible segment. METHODS:The lumbosacral CT images of a healthy male volunteer were taken,and a finite element model M0 of the L3 to sacral vertebrae was established,on which the primary and secondary foraminoplasty models M1 and M2 of the L5/S1 and the laminoplasty model M3 were built.The same load was applied to compare the intervertebral motion range,disc Von Mises stress and equivalent stress characteristics of L5 vertebral isthmus with each model. RESULTS AND CONCLUSION:(1)Compared with M0,M1 and M2 motion range in L5/S1 segment did not change significantly in all directions;M2 overall motion range increased by 8.60%in flexion;M3 increased by 8.23%and 8.26%in L5/S1 right bending and right torsion,and 5.39%and 5.67%in overall motion range in flexion and right bending,with no significant changes in motion range in the rest of working conditions.(2)Compared with M0,M1 showed no significant change in the extremes of Von Mises stress at L5/S1 disc;M2 increased 11.06%,12.50%,18.32%,and 15.48%in flexion,extension,left torsion,and right torsion;M3 increased 12.22%,19.54%,10.05%,and 9.97%in flexion,extension,left torsion,and right torsion,and the rest working conditions and L4/5 disc maximum Von Mises stress did not change significantly.(3)Compared to M0,the maximum Von Mises stress in the left isthmus of L5 of M1 increased by 12.43%in left bending,18.38%,13.29%,13.62%,and 40.00%in the right isthmus in extension,right bending,left torsion,and right torsion.The maximum Von Mises stress in the left isthmus of L5 of M2 increased by 38.87%,42.63%,16.95%,and 19.35%,and that in the right isthmus increased by 12.58%,33.70%,12.92%,and 17.42%in flexion,extension,left bending,and left torsion.The maximum Von Mises stress in the left isthmus of L5 of M3 increased 67.07%,78.14%,32.33%,62.94%,and 89.99%in flexion,extension,left and right bending,and right torsion.(4)The results suggest that foraminoplasty and laminoplasty have a small effect on spinal motion range;there is a mild increase in the extreme values of disc Von Mises stress in the segments operated by interbody laminoplasty and secondary foraminoplasty;there is no significant change in the extreme values of disc Von Mises stress in adjacent segments,and there is a significant increase in the Von Mises stress in the ipsilateral isthmus operated by the interbody laminoplasty model.
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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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Purpose: This study aimed to develop a minimally invasive surgical procedure for laminar lift and posterior cervical laminoplasty via the intermuscular approach using a canine model. Methods: Six Alaskan dogs were used for developing the surgical approach. The bilateral laminae of C3-7 were cut with an ultrasonic osteotome and fixed with bilateral plates to maintain the lamina lifting and reshape a wider spinal canal. The important structures, such as ligaments, supraspinous ligaments, interspinous ligaments, and ligamentum flavum were preserved. The therapeutic effect was evaluated by preoperative and postoperative imaging results and neck mobility. Results: The surgical procedures were all successfully performed in the 6 animals. All the dogs survived well within 1 year of postoperative follow-up. The postoperative neck mobility was as good as the preoperative one. Computed tomography results showed that the anteroposterior diameter of the spinal canal was successfully enlarged and maintained well. Conclusions: The minimally invasive surgical procedure for laminar lift and posterior cervical laminoplasty via the intermuscular approach was feasible in a canine model, which might be applied in clinical practice.
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Animals , Dogs , Minimally Invasive Surgical Procedures/methods , Manipulation, Spinal/veterinary , Laminoplasty/methods , Vertebral Body/surgeryABSTRACT
Background Cervical spondylotic myelopathy is a degenerative disease of the intervertebral disc and the vertebral body of the spine that causes cervical spinal cord injury due to central vertebral canal stenosis. Its prevalence is higher in the elderly. Treatment is usually surgical when the spinal cord is affected either clinically with pyramidal release or radiologically with the altered spinal cord. Objective The goal of the present study is to analyze the myelomalacia and the ossification of the posterior longitudinal ligament as prognostic factors in the postoperative evolution of patients with cervical canal compression who underwent laminoplasty with the open- or French-door techniques. Methods We performed a retrospective analysis of 18 surgical cases of spondylotic cervical myelopathy of the same senior neurosurgeon, using the chi-squared test to analyze prognostic factors for patients' postoperative evolution in the Nurick scale, after open-door or French-door laminoplasty. Findings The comparison between the pre and postoperative showed an improvement of 71.43% in cases that did not have ligament ossification compared with 45.45% of cases that presented posterior longitudinal ligament ossification. Also, there was a better prognosis in patients without myelomalacia, as 71.43% of them improved their condition against only 45.45% of improvement in those with myelomalacia. Conclusion There is a need for further studies with larger samples to expressively prove that the presence of longitudinal ligament ossification and the previous presence of myelomalacia are factors that can lead to worse prognosis in the postoperative evolution of patients with cervical spondylotic myelopathy submitted to laminoplasty.
Introdução A mielopatia espondilótica cervical é uma doença degenerativa do disco intervertebral e do corpo da coluna vertebral que causa lesão da medula espinhal cervical devido à estenose do canal vertebral central. Sua prevalência é maior em idosos. O tratamento geralmente é cirúrgico quando a medula espinhal é afetada clinicamente com a liberação piramidal ou radiologicamente com a medula espinhal alterada. Objetivo Este estudo tem como objetivo analisar a mielomalácia e a ossificação do ligamento longitudinal posterior como fatores prognósticos na evolução pós-operatória de pacientes com compressão do canal cervical submetidos à laminoplastia pelas técnicas de porta aberta ou porta francesa. Métodos Foi realizada uma análise retrospectiva de 18 casos cirúrgicos de mielopatia espondilótica cervical do mesmo neurocirurgião sênior, utilizando o teste do quiquadrado para analisar os fatores prognósticos da evolução pós-operatória dos pacientes na escala de Nurick, após laminoplastia aberta ou francesa. Resultados A comparação entre o pré e pós-operatório mostrou uma melhora de 71,43% nos casos que não apresentavam ossificação ligamentar em comparação com 45,45% nos casos que apresentavam ossificação do ligamento longitudinal posterior. Além disso, houve um melhor prognóstico em pacientes sem mielomalácia, pois 71,43% deles melhoraram sua condição contra apenas 45,45% de melhora naqueles com mielomalácia. Conclusão Há necessidade de mais estudos com amostras maiores para comprovar expressivamente que a presença de ossificação ligamentar longitudinal e a presença prévia de mielomalácia são fatores de pior prognóstico na evolução pós-operatória de pacientes com mielopatia espondilótica cervical submetidos à laminoplastia.
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Objective:To explore the clinical efficacy of open-door laminoplasty in treatment of cervical spinal hyperextension injury accompanied with or without spinal cord-canal mismatch.Methods:A retrospective case-control study was performed to analyze the clinical data of 42 patients with cervical spine hyperextension in Shanghai Ninth People’s Hospital，Shanghai Jiaotong University School of Medicine from January 2016 to June 2019. There were 31 males and 11 females at age range of 40-78 years［（59.7 ± 9.9）years］. All patients underwent open-door laminoplasty.Preoperative Japanese Orthopaedic Association score（JOA）was（10.2 ± 3.8）points，and American Spinal Injury Association（ASIA）spinal cord injury score was（260.4 ± 47.5）points. Those with spinal cord occupation rate（SCOR）equal to or more than 70% were classified as spinal cord-canal mismatched group（n=21），and those with SCOR less than 70% were classified as spinal cord-canal matched group（n=21）. ASIA total score，ASIA upper and lower limb motor scores，ASIA sensory score，JOA score，surgical improvement rates and complications were compared between the two groups before operation，at postoperative one week and at the latest follow-up.Results:All patients were followed up for 12-26 months［（19.1 ± 2.3）months］. Both groups had significantly improved ASIA total score at postoperative one week and at the latest follow-up，compared with that before operation（ P < 0.05）. The two groups showed no significant difference in ASIA total score at postoperative one week（ P > 0.05）. ASIA total score in unmatched group was（307.6 ± 9.9）points at the latest follow-up，significantly lower than that in matched group［（315.4 ± 8.7）points］（ P < 0.01）. ASIA upper limb motor score in mismatched group was（29.1 ± 7.0）points and（36.6 ± 6.5）points at postoperative one week and at the latest follow-up，significantly lower than that in matched group［（42.0 ± 5.7）points，（47.4 ± 2.5）points］（ P < 0.01），while there was no significant difference in ASIA lower limb motor score and sensory score between the two groups（ P > 0.05）. Both groups showed significantly improved JOA score at postoperative one week and at the latest follow-up，compared with that before operation（ P < 0.05）. JOA score in mismatched group was（11.5 ± 3.0）points and（12.5 ± 3.0）points at postoperative one week and at the latest follow-up，significantly lower than that in matched group［（13.5 ± 2.4）points，（15.0 ± 2.0）points］（ P < 0.01）. Postoperative improvement rate in matched group was 95%（20/21），and was 85%（18/21）in mismatched group（ P < 0.05）. Cervical axial pain occurred in 3 patients in each group and C 5 nerve root palsy in 2 patients in matched group，all of which were relieved after conservative treatment. No implant loosening or breakage occurred during follow-up. Conclusions:Open-door laminoplasty can improve part of the nerve function of patients with cervical hyperextension injury. However，the overall improvement degree of nerve function especially recovery of upper limb motor function in patients with spinal cord-canal mismatch is inferior to those in spinal cord-canal matched patients.
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Objective To study the effect of hemilaminectomy, total laminectomyand recapping laminoplasty on stability of the cervical spine. Methods Fourteen fresh adult sheep cervical spine specimens were divided into two groups, with 7 cases in each group. Each specimen was applied with a pure moment load of 3.0 N·m under flexion/extension, left/right lateral bending, and left/right axial rotation. The range of motion (ROM) and neutral zone (NZ) of specimens were measured. In the first group, the ROMs and NZs of the specimens were measured and compared under the intact state, C5 hemilaminectomy state and C4-6 hemilaminectomy state respectively. In the second group, the ROMs and NZs of specimens under the intact state, C4-6 total laminectomy state and C4-6 recapping laminoplasty state were measured and compared. Results There were no significant differences in ROMs and NZs between C5 hemilaminectomy state and C4-6 hemilaminectomy state compared with the intact state (P<0.05). Compared with the intact state, ROMs of the specimens were significantly increased during flexion and extension under C4-6 laminectomy state and C4-6 recapping laminoplasty state (P<0.05). In addition, compared with the C4-6 laminectomy state, ROMs of the specimen were significantly decreased only during extension unde C4-6 recapping laminoplasty state (P<0.05), while no significant differences were found in ROMs between total laminectomy and laminoplasty under other loads. Conclusions With hemilaminectomy, ROMs and NZs of the cervical spine did not increase significantly, and stability of the cervical spine was not affected. With C4-6 total laminectomy, ROMs and NZs during flexion and extension increased significantly, and stability of the cervical spine was affected. Recapping laminoplasty did not significantly improve stability of the cervical spine with total laminectomy.
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BACKGROUND: Herniated cervical intervertebral disc volume measurement is an important parameter for quantitative evaluation of cervical disc degeneration, but it faces a lot of problems such as different measurement standards and the undefined measurement error range. OBJECTIVE: To investigate the accuracy of PACS software in measuring cervical disc volume, provide reliable measurement methods and accurate data support for clinical observation and research on cervical disc volume change and degeneration. METHODS: The error rate was obtained by repeated measurements of the normal saline with a known volume of 5.0 mL by means of PACS software. With reference to this error rate, volume changes of cervical disc herniation before and after cervical microendoscopic laminoplasty were “monitored” and analyzed in 30 cases. This study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University (approval No. 2019-KY-274) on September 26, 2019. RESULTS AND CONCLUSION: (1) For the measurement of normal saline with known volume, it was found that the error rate of measurement by PACS software was ±5%, suggesting that the measurement of cervical disc volume by PACS software is a simple and accurate method. (2) After cervical microendoscopic laminoplasty, there were 70 patients with reduced cervical disc volume reduction absorption rate of 5%-100%, and the absorption ratio was 76.1% (70/92). The volume increased by 11, but the increase was not more than 5% in the patients with cervical disc herniation after treatment. (3) The spontaneous disappearance or reduction of the herniated cervical disc after cervical microendoscopic laminoplasty was as early as 7 days, and the longest was 76 months. (4) The effects were excellent in 11 cases, good in 15 cases, and fair in 4 cases. The excellent and good rate was 86.7%.
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BACKGROUND: Axial symptoms often occur in patients after posterior cervical single-door vertebroplasty. Some studies have proposed a modified surgical method to remove C3 lamina and retain cervical semisacinous muscle on C2 spinous to reduce the occurrence of axial symptoms after surgery. OBJECTIVE: To compare the clinical effects, cervical motion range and curvature of C3 laminectomy and mini-titanium plate fixation after single-door vertebroplasty. METHODS: Totally 43 patients with cervical spondylosis were selected from the General Hospital of Southern Theater Command of PLA from June 2012 to June 2017, including 25 males and 18 females. Among them, 27 patients underwent C3-6 or C3-7 single-door mini-titanium fixation vertebroplasty as fixation group and 16 patients underwent C4-6 or C4-7 single-door mini-titanium fixation vertebroplasty through posterior approach after C3 laminectomy as resection group. Preoperatively, 6 months postoperatively and at final follow-up, JOA score, cervical motion range, and C2-7 Cobb angle were compared between the two groups. This study was approved by the Ethics Committee of General Hospital of Southern Theater Command of PLA. RESULTS AND CONCLUSION: (1) All 43 patients successfully underwent the operation without vascular or spinal cord injury. (2) JOA score was higher in the two groups at postoperative 6 months and final follow-up than that preoperatively (P 0.05). (3) Motion range in the two groups was smaller at postoperative 6 months and final follow-up than that preoperatively (P < 0.05). Motion range was smaller in the fixation group than in the resection group at postoperative 6 months and final follow-up (P < 0.05). (4) C2-1 Cobb angle in the two groups was smaller at postoperative 6 months and final follow-up than that preoperatively (P < 0.05). C2-7 Cobb angle was smaller in the fixation group than in the resection group at postoperative 6 months and final follow-up (P < 0.05). (5) There was no hypersensitivity, rejection or immune response in the two groups. (6) Results indicate that C3 laminectomy and mini-titanium plate fixation have the same effect on improving neurological function, but the removal of C3 lamina can more effectively prevent the reduction of postoperative cervical motion range and curvature.
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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.
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Introducción: Evaluar los resultados clínico en pacientes portadores de mielopatía cervical espondilótica intervenidos quirúrgicamente en nuestro servicio mediante laminoplastia open door. Materiales y métodos: Realizamos un análisis retrospectivo de los pacientes intervenidos por mielopatía cervical espondilótica mediante laminoplastia entre 2010 y 2017. De los 102 pacientes intervenidos perdimos 18 casos o los datos fueron insuficientes. De los 84 casos 58 son masculinos. La media de edad fue de 63 años de los cuales se valoró: asociación de polo lumbar, tiempo entre sintomatología y cirugía, balance sagital, mielomalacia y resultados clínicos mediante la escala de Nurick y el JOA modificado. Resultados: El área más frecuente de laminoplastia fue de C3-C6 (83%). El promedio del JOA preoperatorio fue de 12,1 y postoperatorio a los 6 meses de 14,8, obteniendo una tasa de recuperación mediante el método del Hirabayasi de 81%. El Nurick preoperatorio promedio fue de 2 y a los 6 meses de 1.1. Cuarenta y dos pacientes (50%) presentaban en la RMN hiperintensidad de señal medular en T2. La tasa de recuperación del JOA y Nurick fue significativamente mayor en pacientes intervenidos a menos de 12 meses de inicio de sintomatología. Notamos una alta incidencia de sufrimiento bipolar (48%). No hubo complicaciones mayores, 2 presentaron paresia transitoria de C5, 1 paciente presento seroma que requirió drenaje superficial y 4 presentaron dolor axial leve que no tenían previo a la cirugía. Conclusiones: En nuestra experiencia la laminoplastia open door es una técnica con muy buenos resultados clínicos y con baja incidencia de complicaciones para el tratamiento de la mielopatia cervical espondilótica. Notamos una asociación significativa entre la tasa de recuperación del JOA y el periodo entre sintomatología y cirugía. Por otro lado, no encontramos asociación significativa entre el resultado clínico y el número de espacios liberados así como la presencia de alteraciones de señal medular.
Background: To evaluate the clinical results in patients with cervical spondylotic myelopathy operated surgically in our service by means of "open door" laminoplasty. Methods: We performed a retrospective analysis of patients who underwent cervical spondylotic myelopathy by laminoplasty between 2010 and 2017. Of the 102 patients operated on, we lost 18 cases or the data were insufficient. Of the 84 cases, 56 male patients with an average age of 63 years were evaluated: association of the lumbar pole, time between symptomatology and surgery, sagittal balance, myelomalacia and clinical results using the Nurick scale and the modified JOA. Results: The most frequent area of laminoplasty was C3-C6 (70%). The preoperative JOA average was 10.6 and postoperative at 3 months of 14.5, obtaining a recovery rate using the Hirabayashi method of 61%. The preoperative Nurick averaged 3.08 and at 3 months of 1.2. 42 patients presented with MRI hyperintense signaling in T2. The recovery rate of JOA and Nurick was significantly higher in patients operated on less than 6 months after symptom onset. We note a high incidence of bipolar suffering (30%). There were no major complications, 2 presented transient paresis of C5, 1 patient presented seroma that required superficial drainage and 4 presented mild axial pain that they did not have prior to surgery. Conclusions: In our experience, open-door laminoplasty is a technique with very good clinical results and a low incidence of complications for the treatment of cervical spondylotic myelopathy. We note a significant association between the rate of recovery of the JOA and the period between symptoms and surgery. On the other hand, we did not find a significant association between the clinical result and the number of spaces released as well as the presence of marrow signal alterations.
Introdução: Avaliar os resultados clínicos em pacientes com mielopatia espondilótica cervical operada cirurgicamente em nosso serviço por laminoplastia aberta. Materiais e métodos: Foi realizada uma análise retrospectiva de pacientes operados por mielopatia espondilótica cervical por laminoplastia entre 2010 e 2017. Dos 102 pacientes operados, perdemos 18 casos ou os dados foram insuficientes. Dos 84 casos, 58 são do sexo masculino. A média de idade foi de 63 anos, sendo avaliada: associação do pólo lombar, tempo entre sintomatologia e cirurgia, equilíbrio sagital, mielomalácia e resultados clínicos utilizando a escala de Nurick e o JOA modificado. Resultados: A área de laminoplastia mais frequente foi a C3-C6 (83%). O JOA médio pré-operatório foi de 12,1 e no pós-operatório aos 6 meses de 14,8, obtendo-se uma taxa de recuperação pelo método de Hirabayasi de 81%. O Nurick médio pré-operatório foi 2 e em 6 meses de 1.1. Quarenta e dois pacientes (50%) apresentavam sinalização hiperintensa da ressonância magnética em T2. A taxa de recuperação de JOA e Nurick foi significativamente maior em pacientes operados em menos de 12 meses após o início dos sintomas. Notamos uma alta incidência de sofrimento bipolar (48%). Não houve complicações maiores, 2 apresentaram paresia transitória de C5, 1 paciente apresentou seroma que necessitou de drenagem superficial e 4 apresentaram dor axial leve que não tiveram antes da cirurgia. Conclusões: Em nossa experiência, a laminoplastia por portas abertas é uma técnica com resultados clínicos muito bons e baixa incidência de complicações para o tratamento da mielopatia espondilótica cervical. Notamos uma associação significativa entre a taxa de recuperação do JOA e o período entre sintomas e cirurgia. Por outro lado, não encontramos associação significativa entre o resultado clínico e o número de espaços liberados, bem como a presença de alterações no sinal medular.
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Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Spinal Cord Compression/surgery , Cervical Vertebrae/pathology , Laminoplasty/adverse effects , Laminoplasty/methods , Magnetic Resonance Imaging , Retrospective Studies , Follow-Up Studies , Evaluation StudyABSTRACT
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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Objective: To investigate the feasibility and effectiveness of modified replanting posterior ligament complex (PLC) applying piezoelectric osteotomy in the treatment of primary benign tumors in thoracic spinal canal. Methods: The clinical data of 38 patients with primary benign tumors in thoracic spinal canal between March 2014 and March 2016 were retrospectively analyzed. There were 16 males and 22 females, aged from 21 to 72 years (mean, 47.1 years). The disease duration ranged from 6 to 57 months (mean, 32.6 months). Pathological examination showed 24 cases of schwannoma, 6 cases of meningioma, 4 cases of ependymoma, 2 cases of lipoma, and 2 cases of dermoid cyst. The lesions located in 18 cases of single segment, 15 cases of double segments, and 5 cases of three segments. The length of the tumors ranged from 0.7 to 6.5 cm. There were boundaries between the tumors and the spinal cord, cauda equina, and nerve roots. The preoperative Japanese Orthopaedic Association (JOA) score was 12.2±2.3 and the thoracic Cobb angle was (11.7±2.7)°. Modified PLC replantation and microsurgical resection were performed with piezoelectric osteotomy. Continuity of uniside supraspinal and interspinous ligaments were preserved during the operation. The PLC was exposed laterally. After removing the tumors under the microscope, the pedicled PLC was replanted in situ and fixed with bilateral micro-reconstruction titanium plate. X-ray film, CT, and MRI examinations were performed to observe spinal stability, spinal canal plasty, and tumor resection after operation. The effectiveness was evaluated by JOA score. Results: The operation time was 56-142 minutes (mean, 77.1 minutes). The intraoperative blood loss was 110-370 mL (mean, 217.2 mL). The tumors were removed completely and the incisions healed well. Three cases complicated with cerebrospinal fluid leakage, and there was no complications such as spinal cord injury and infection. All the 38 patients were followed up 24-28 months (mean, 27.2 months). There was no internal fixation loosening, malposition, or other related complications. At last follow-up, X-ray films showed no sign of kyphosis and instability. CT showed no displacement of vertebral lamina and reduction of secondary spinal canal volume, and vertebral lamina healed well. MRI showed no recurrence of tumors. At last follow-up, the thoracic Cobb angle was (12.3±4.1)°, showing no significant difference when compared with preoperative value ( t=0.753, P=0.456). JOA score increased to 23.7±3.8, showing significant difference when compared with preoperative value ( t=15.960, P=0.000). Among them, 14 cases were excellent, 18 were good, 6 were fair, and the excellent and good rate was 84.2%. Conclusion: Modified replanting PLC applying piezoelectric osteotomy and micro-reconstruction with titanium plate for the primary benign tumors in thoracic spinal canal can reconstruct the anatomy of the spinal canal, enable patients to recover daily activities quickly. It is an effective and safe treatment.
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Objective: To explore the practicability and safety of ultrasonic bone curette in the laminoplasty of spinal canal after resection of intraspinal tumors. Methods: The clinical data of 17 patients with thoracolumbar intraspinal tumors treated with ultrasonic bone curette after resection of intraspinal tumors between December 2015 and April 2017 were retrospectively analyzed. All patients were male, aged 42-73 years with an average of 57.4 years. The disease duration was 2-47 months with an average of 21.1 months. Among them, there were 4 cases of thoracic intrathoracic tumors (T 10 in 1, T 12 in 3) and 13 cases of lumbar intrathoracic tumors (L 1 in 5, L 2 in 4, L 3 in 2, and L 4 in 2). Postoperative pathological diagnosis showed that 8 cases were schwannoma, 4 cases were meningioma, 2 cases were neurofibroma, 2 cases were dermoid cyst, and 1 case was ependymoma. Spinal nerve function was evaluated preoperatively according to Frankel classification criteria, with 2 cases of grade B, 7 cases of grade C, and 8 cases of grade D. During the operation, the time of single segmental vertebral canal posterior wall incision, the overall operation time, intraoperative blood loss, intraoperative dural injury, and cerebrospinal fluid leakage, spinal cord and nerve root injury were recorded. At 3-6 months after operation, the tumor and bone healing were observed according to MRI and CT three-dimensional reconstruction, and the spinal nerve function was evaluated by Frankel classification. Results: The time of ultrasonic osteotomy for the posterior wall of a single segmental vertebral canal was 3.4-5.7 minutes, with an average of 4.1 minutes. The overall operation time was 135-182 minutes, with an average of 157.3 minutes. The intraoperative blood loss was 300-500 mL, with an average of 342.6 mL. There was no accidental dural injury, and cerebrospinal fluid leakage, nerve root injury, or spinal cord injury. The incision healed by first intention after operation. All the 17 patients were followed up 9-18 months, with an average of 12.7 months. MRI examination showed no tumor recurrence, and CT three-dimensional reconstruction showed good bone healing in all patients. During the follow-up, there was no loosening or rupture of the internal fixator and there was no re-compression of the spinal cord. At last follow-up, according to Frankel classification, there were 1 case as grade B, 5 cases as grade C, 7 cases as grade D, and 4 cases as grade E. Conclusion: The application of ultrasonic bone curette in laminoplasty of spinal canal after resection of intraspinal tumors can preserve the integrity of the bone ligament structure of posterior column, maintain the volume of vertebral canal, and has high safety, practicability, and good postoperative effectiveness.
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OBJECTIVE@#To investigate the effect of bone cement dispersion and distribution on the clinical effect and the degree of pain reduction of percutaneous vertebroplasty(PVP) in the treatment of osteoporosis spinal fracture.@*METHODS@#A retrospective analysis was made of 130 cases of osteoporotic spinal fractures admitted from August 2016 to April 2018, of which 114 cases were followed up completely. The VAS score, Oswestry disability index(ODI), kyphosis angle(Cobb angle), anterior column height and complications were analyzed.@*RESULTS@#Finally, 114 cases were included. The grade of bone cement dispersion was 42 cases (36.8%) in grade 1, including 14 males and 28 females, with an average age of (73.43 ±7.91) years. There were 36 cases of grade 2(31.6%), including 10 males and 26 females with an average age of (71.22 ±8.06) years, and 36 cases with grade 3 (31.6%), including 9 males and 27 females, with an average age of (74.81 ±6.91) years. There were no significant differences in preoperative general data among the three groups (>0.05). The VAS, ODI score of grade 1, grade 2 and grade 3 of bone cement dispersion and distribution were significantly lower than those of preoperative follow-up(0.05). In terms of bone cement leakage, 15 cases(41.7%) were in grade 2 of diffusion distribution, 23 cases(63.9%) in grade 3 more than 8 cases(19%) in grade 1 of diffusion distribution, exhibiting a significant difference among the three groups (<0.05). The diffusive distribution in grade 2(7, 19.4%) and grade 3(8, 22.2%) less than that in grade 1(18, 42.9%)(<0.05). Bone cement dispersion and distribution with grade 2 and 3 level could effectively improve the kyphosis deformity and reduce the loss of anterior column height in the injured vertebrae compared with that with grade 1, showing a statistical difference among the three groups(<0.05).@*CONCLUSIONS@#Bone cement dispersion and distribution with any grades in PVP are effective in relieving pain, and bone cement dispersion and distribution with grade 2 could not only relieve the pain of patients, but also correct the kyphosis angle of the injured vertebrae. The height of the anterior column of the injured vertebrae and the risk of cement leakage and non-operative vertebral body fracture is relatively low.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Cements , Fractures, Compression , Osteoporotic Fractures , General Surgery , Retrospective Studies , Spinal Fractures , Treatment Outcome , VertebroplastyABSTRACT
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.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Plates , Cervical Vertebrae , Laminoplasty , Retrospective Studies , Spinal Cord Diseases , Titanium , Treatment OutcomeABSTRACT
STUDY DESIGN: Retrospective study. PURPOSE: We experienced the situation wherein some patients had new-onset pain or dysesthesia around the ring and little fingers (C8 symptom) or ulnar aspect of the forearm (T1 symptom) after cervical laminoplasty (LP). We investigated the incidence and the cause of new C8 or T1 symptoms and the clinical outcomes after C3–C6 LP or C3–C7 LP. OVERVIEW OF LITERATURE: There were some reports regarding complications after cervical LP. However, there was no report regarding C8 or T1 symptoms after cervical LP. METHODS: Among the 33 patients enrolled in this study, 11 and 22 patients were treated with C3–C6 LP and C3–C7 LP, respectively. We prospectively evaluated C8 or T1 symptoms daily postoperatively for 1 week. The distance of the posterior spinal cord shifting and posterior subarachnoid space from C2 to T1 was measured by T2-weighted midsagittal magnetic resonance imaging (MRI). We evaluated pre- and postoperative axial neck pain, Japanese Orthopaedic Association (JOA) score, and JOA score improvement rate. RESULTS: C8 or T1 symptoms occurred in five and three patients with C3–C6 LP (45.5%) and C3–C7 LP (13.6%), respectively. The distance of the posterior subarachnoid space in C3–C6 LP at C7 was significantly shorter than that in C3–C7 LP at T1 on MRI 24 hours postoperatively (p=0.0448). Postoperative axial neck pain, pre- and postoperative JOA scores, and JOA score improvement rate were not significantly different. CONCLUSIONS: The incidence of C8 or T1 symptoms in C3–C6 LP was higher than that in C3–C7 LP. C8 or T1 symptoms would be caused by the posterior fila radicularia and spinal cord impingement on the intact lower end of the lamina.
Subject(s)
Humans , Asian People , Fingers , Forearm , Incidence , Laminoplasty , Magnetic Resonance Imaging , Neck Pain , Paresthesia , Prospective Studies , Retrospective Studies , Spinal Cord , Subarachnoid SpaceABSTRACT
Objective@#To observe the clinical effect of hyperbaric oxygen therapy on cervical spondylotic myelopathy (CSM) in the peri-operative period, and to explore its neural mechanism.@*Methods@#Eighty patients who underwent surgical decompression for CSM were randomly divided into a hyperbaric oxygen group (n=40) and a control group (n=40). Both groups received cervical laminoplasty and systematic rehabilitation treatment after the surgery, while the hyperbaric oxygen group was additionally provided with hyperbaric oxygen therapy in the peri-operative period. The patients′ neurological status was evaluated using Japanese Orthopaedic Association (JOA) scores. Both groups received conventional MRI and diffusion tensor imaging (DTI) before and 6 months after the surgery.@*Results@#After the surgery, both groups gained significant improvement in their average JOA score, with the improvement of the hyperbaric oxygen group significantly greater than in the control group. Pearson correlation analysis showed that the average pre-operative JOA score was significantly correlated with the anisotropic fraction (FA) and the apparent dispersion coefficient (ADC) of the compressed spinal cord. Six months after the surgery such correlation still persisted. During the six months, significant increase was observed in the average FA and significant decrease in the average ADC in both groups, with the average FA of the hyperbaric oxygen group (0.726±0.087) significantly higher at the end of the 6 months than that in the control group. The average ADC (1.148±0.079)×10-3 mm2/s) was significantly lower.@*Conclusions@#DTI′s quantitative indicators can objectively show changes in the microstructure and pathological state of spinal cords. Exposure to hyperbaric oxygen may relieve ischemia and hypoxia of the spinal cord, promoting the repair of injured neurons and accelerating the regeneration of nerve fibers.
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ABSTRACT Introduction: Cervical Spondylotic myelopathy (CSM) is a disabling manifestation of extended cervical stenosis characterized by pronounced neurological dysfunction. Decompressive interventions contribute to significant regression of symptoms and, in some cases, complete recovery can be achieved. Objective: To explore the potential of laminoplasty in patients with extended cervical spondylotic stenoses complicated by myelopathy, and to develop approaches for surgical intervention in these patients. Methods: Fifty-six patients were included in the study. Laminoplasty was performed in 34 patients. Corpectomy was performed in 22 patients who made up the comparison group. The frequency and initial severity of concomitant non-neurological disorders in both groups were comparable. Results: Indications for laminoplasty were determined. They include: symptoms of spondylotic myelopathy, three or more levels of compression, preservation of lordosis, absence of signs of segmental instability, inability to perform anterior decompression, and age over 55 years. The presence of signs of segmental instability, kyphotic deformation, and history of mental disorders may be considered as contraindications for this surgery. Conclusions: Due to a number of advantages, laminoplasty is the treatment of choice for extended cervical spondylotic stenosis. Adequate selection of patients based on the evaluation of clinical symptoms, extension of stenosis, neurological signs and neuroimaging features enable excellent results to be achieved. Level of Evidence: II. Type of Study: Prospective comparative study.
RESUMO Introdução: A mielopatia espondilótica cervical (MSC) é uma manifestação incapacitante de estenose cervical extensa, caracterizada por disfunção neurológica pronunciada. As intervenções descompressivas contribuem para a regressão significativa dos sintomas e, em alguns casos, a recuperação completa pode ser alcançada. Objetivo: Explorar o potencial da laminoplastia em pacientes com estenoses espondilóticas cervicais extensas complicadas por mielopatia e desenvolver abordagens para intervenção cirúrgica nesses pacientes. Métodos: 56 pacientes foram incluídos no estudo. A laminoplastia foi realizada em 34 pacientes. A corpectomia foi realizada em 22 pacientes, que compuseram o grupo de comparação. A frequência e a gravidade inicial dos distúrbios não neurológicos concomitantes em ambos os grupos foram comparáveis. Resultados: As indicações para laminoplastia foram determinadas. Eles incluem: sintomas de mielopatia espondilótica, três ou mais níveis de compressão, preservação da lordose, ausência de sinais de instabilidade segmentar, incapacidade de realizar descompressão anterior e idade superior a 55 anos. A presença de sinais de instabilidade segmentar, deformação cifótica e história de transtornos mentais podem ser considerados como contraindicações para essa cirurgia. Conclusões: Devido a uma série de vantagens, a laminoplastia é o tratamento de escolha para estenose espondilótica cervical estendida. A seleção adequada dos pacientes, com base na avaliação dos sintomas clínicos, extensão da estenose, sinais neurológicos e características de neuroimagem, possibilitam alcançar excelentes resultados. Nível de Evidência: II. Tipo de Estudo: Estudo Comparativo prospectivo.
RESUMEN Introducción: La mielopatía espondilótica cervical (MSC) es una manifestación incapacitante de estenosis cervical extendida caracterizada por una fuerte disfunción neurológica. Las intervenciones de descompresión contribuyen a la regresión significativa de los síntomas y, en algunos casos, se puede lograr una recuperación completa. Objetivo: Explorar el potencial de la laminoplastia en pacientes con estenosis espondilótica cervical extendida complicada por mielopatía y desarrollar enfoques para la intervención quirúrgica en estos pacientes. Métodos: Cincuenta y seis pacientes fueron incluidos en el estudio. Laminoplastia se realizó en 34 pacientes. Corpectomía se realizó en 22 pacientes que componen el grupo de comparación. La frecuencia y la gravedad inicial de los trastornos no neurológicos concomitantes en ambos grupos fueron comparables. Resultados: Se determinaron las indicaciones para laminoplastia. Estas incluyen: síntomas de mielopatía espondilótica, tres o más niveles de compresión, preservación de la lordosis, ausencia de signos de inestabilidad segmentaria, incapacidad para realizar descompresión anterior y edad mayor de 55 años. La presencia de signos de inestabilidad segmentaria, deformación cifótica y antecedentes de trastornos mentales puede considerarse una contraindicación para esta cirugía. Conclusiones: Debido a una serie de ventajas, la laminoplastia es el tratamiento de elección para la estenosis espondilótica cervical extendida. La adecuada selección de pacientes basada en la evaluación de los síntomas clínicos, la extensión de la estenosis, los signos neurológicos y las características de neuroimágenes hacen posible obtener excelentes resultados. Nivel de Evidencia: II Tipo de Estudio: Estudio comparativo prospectivo.
Subject(s)
Humans , Laminoplasty , Spinal Cord Diseases , Spinal Stenosis , SpondylosisABSTRACT
<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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<p><b>OBJECTIVE</b>To explore the reason of postoperative axial pain (PAP) complication caused by unilaterally open-door cervical laminoplasty with Centerpiece mini-plate fixations for the treatment of multilevel cervical spondylotic myelopathy(CSM).</p><p><b>METHODS</b>The clinical data of 79 patients with CSM who underwent unilaterally open-door cervical laminoplasty from January 2010 to December 2013 were retrospectively analyzed. There were 45 males and 34 females, aged from 48 to 75 years old with an average of (58.7±4.4) years, complicated with ossified posterior longitudinal ligament(OPLL) of 42 cases. Courses of disease were from 2.1 to 3.9 years with an average of (3.0±0.4) years. Decompression segment occurred in C₃-C₆ of 31 cases, C₃-C₇ of 9 cases, C₄-C₇ of 39 cases. The condition of PAP was record. Cervical curvature index, cervical lordosis angle, the rate of cervical instability, the motion of flexion and extension between PAP group and non-PAP group were compared preoperatively. Multivariate non-linear regression analysis was used to verify relationship between aforementioned parameters and incidence of PAP. JOA score of preoperative, postoperative 6 months and initial onset of PAP, the improvement rate of JOA score and Odom criteria at final follow-up were used to evaluate curative efficacy.</p><p><b>RESULTS</b>All the patients were followed up from 26 to 44 months with an average of (36±9) months. Among them, 12 patients occurred PAP who receive the conservative treatment. The rate of preoperative cervical instablility of PAP group were higher than that of non-PAP group(<0.05). Preoperative cervical instability was the only independent risk factor in predicting occurrence of PAP. There were no significant differences in cervical curvature, cervical lordosis index, the motion of flexion and extension between PAP and non-PAP group before operation. There were no significant differences in the improvement of nerve function and clinical effect between PAP and non-PAP group after operation(>0.05).</p><p><b>CONCLUSIONS</b>Preoperative cervical instability is prone to inducing the respectively intervertebral motion disorder and imbalance of stress redistribution, which results in PAP after cervical unilateral laminoplasty. Correct treatment of preoperative cervical instability is a key factor to prevent the occurrence of PAP after cervical laminoplasty, which would not affect long-term nerve functional recovery pronouncedly.</p>