RESUMO
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.
RESUMO
<p><b>BACKGROUND</b>Surgical treatment of thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) is technically demanding, and the results tend to be unfavorable. Various operative approaches and treatment strategies have been attempted, and posterior decompression with transforaminal thoracic interbody fusion (PTTIF) may be the optimal method with which the anterior-posterior compression was removed in one step. It is comparatively less traumatic with fewer serious complications.</p><p><b>METHODS</b>Sixteen patients with thoracic myelopathy due to concurrent OLF and OPLL at the same level underwent PTTIF. We investigated clinical outcomes and neurological improvements. Magnetic resonance imaging (MRI) was performed on all patients preoperatively and postoperatively, and intramedullary signal changes were evaluated.</p><p><b>RESULTS</b>The mean operating time was 275 minutes, and the mean operative bleeding amount was 1031 ml. Cerebrospinal fluid leakage occurred in three patients and healed well after repair. Neurological symptom deterioration occurred in one patient, but the patient recovered to nearly the preoperative level after methylprednisolone treatment. The follow-up period ranged from 28 to 47 months. The mean score on the Japanese Orthopedic Association scale improved from 4.3±1.2 preoperatively to 7.3±1.7 at 3 months postoperatively to 8.5±1.5 at the final follow-up (P < 0.01), with a recovery rate of (63.6±20.0)%. Postoperative images showed a significant improvement in local kyphosis (P < 0.01). Eleven patients (68.8%) showed increased signal intensity (ISI) on preoperative T2-weighted MRI. At the final follow-up, the intramedullary ISI totally recovered in five patients. Neurological improvement was worse in patients with persistent ISI than in the other patients (P < 0.05).</p><p><b>CONCLUSIONS</b>PTTIF is an effective therapeutic option for combined OPLL and OLF and provides satisfactory neurological recovery and stabilized thoracic fusion through a single posterior approach. Intramedullary signal changes do not always indicate a poor prognosis; only irreversible ISI is correlated with a poor clinical result.</p>