Severe C8 or T1 Symptoms after Cervical Laminoplasty and Related Factors: Are There Any Differences between C3–C6 Laminoplasty and C3–C7 Laminoplasty?

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.

Hydrocephalus as a Complication of Durotomy during Cervical Laminoplasty: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: We report a case of hydrocephalus as a complication of durotomy during cervical laminoplasty. SUMMARY OF LITERATURE REVIEW: Hydrocephalus is a very rare complication of cervical laminoplasty. MATERIALS AND METHODS: A 72-year-old man had an incidental durotomy during cervical laminoplasty. The dural leak was repaired by secondary surgery. However, the patient continued to complain of headaches and developed confusion and drowsiness. A computed tomographic scan of the brain showed hydrocephalus. After insertion of a lumbar drain, the patient experienced a temporary improvement in the neurologic symptoms. After 6 months, the neurologic symptoms recurred and a ventriculoperitoneal (VP) shunt was placed. RESULTS: After placement of the VP shunt, the neurologic symptoms improved significantly. CONCLUSIONS: If a patient shows deterioration of neurologic symptoms after an incidental durotomy, surgeons should consider the possibility of hydrocephalus.

Analysis of clinical efficacy of unilateral open-door cervical laminoplasty combined with foraminotomy for cervical ossification of posterior longitudinal ligament / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical efficacy of unilateral open-door laminoplasty combined with foraminotomy for cervical ossification of posterior longitudinal ligament(OPLL).</p><p><b>METHODS</b>The clinical data of 45 patients with OPLL underwent surgical treatment between September 2011 and September 2015 were retrospectively analyzed. There were 26 males and 19 females with a mean age of 53.6 years old(ranged from 28 to 71 years). Among them, 24 cases received the surgery of unilateral open-door cervical laminoplasty combined with foraminotomy(combined group), and 21 cases received a single unilateral open-door cervical laminoplasty(single group). Operation time, intraoperative blood loss, complications including C₅ nerve root palsy and axial symptoms were compared between two groups. Pre-and post-operative Japanese Orthopedic Association(JOA) score, improvement rate of neurological function, Neck Disability Index(NDI) score, and cervical Cobb angle were recorded and analyzed between the two groups.</p><p><b>RESULTS</b>All the patients were followed up for 12-24 months, with an average of (14.3±2.8) months for combined groups and (13.7±3.1) months for single group, and no significant difference was found between the two groups(>0.05). There was no significant difference in operation time and intraoperative blood loss between two groups(>0.05). Postoperative JOA scores obtained obvious improvement in all patients(<0.05). However, there was no significant difference between two groups for the improvement rate of neurological function(>0.05). At final follow-up, NDI scores of combined group and single group were 13.6±1.8 and 16.1±2.4 respectively, there was significant difference between two groups(<0.05). The incidence of C₅ nerve root palsy was lower in combined group(4.2%) than that of single group (28.6%). There was no significant difference in incidence rate of axial symptoms between two groups(>0.05). There was no significant difference in cervical Cobb angle between pre-and post-operative conditions, or between two groups(>0.05).</p><p><b>CONCLUSIONS</b>Unilateral open-door cervical laminoplasty combined with foraminotomy is an effective method to treat cervical OPLL, which could provide sufficient decompression of spinal cord and nerve root, prevent the C₅ nerve root palsy.</p>

Efficacy of treating multilevel cervical spondylotic myelopathy with single-door laminoplasty via Y type nano-bone plate / 西安交通大学学报(医学版)

Objective To explore the application value of single-door laminoplasty via Y type nano-bone plate in treating multilevel cervical spondylotic myelopathy (MCSM) and analyze the short-term efficacy.Methods From January 2013 to December 2016,79 cases of MCSM were treated with single-door laminoplasty via Y type nano-bone plate to evaluate the improvement of post-operative neurological function by the Japanese Orthopaedic Association (JOA) evaluation system.We also measured cervical curvature of cervical X-ray and C5 sagittal diameter of the spinal canal before operation and 6 months after operation to understand the maintenance and enlargement of the spinal canal.The improvement degree of spinal cord compression was evaluated by preoperative and postoperative cervical MRI.Osseous healing on the open door side and the door shaft side was observed with the aid of three-dimensional spiral CT.Results Follow-up ranged from 6 to 36 months,with an average of (20.4±7.9)months.Preoperative JOA score was (8.6 ± 1.3) points and JOA score 6 months after operation was (14.3 ± 1.5)points (P ＜ 0.05).JOA improvement rate was (68.6 ± 15.8)％;postoperative follow-up X-ray and threedimensional spiral CT showed that the spinal canal had satisfying enlargement,the door shaft side all had osseous healing,the open door side osseous healing was not obvious,and there was no lamina collapse or reclosing.Sagittal diameter of theC spinal canal was (8.9±l.1)mm before operation and (15.1±l.1)mm 6 months after operation (P＜0.05).The spinal canal enlargement rate was (70.8±22.3)％,cervical curvature was (14.8± 7.0)°preoperatively and (15.1±6.7)°postoperatively with no significant difference (P＞0.05).Conclusion EOLP via Y type nano-bone plate is safe and efficacious in treating MCSM.It not only provides a good immediate fixation,but also provides the possibility for the open door side lateral osseous fusion.

Posterior laminoplasty combined with foraminotomy in treatment of mixed cervical spondylosis / 局解手术学杂志

Objective To study the clinical efficacy and safety of posterior laminoplasty combined with foraminotomy in the treatment of mixed cervical spondylosis.Methods A total of 70 patients with mixed type cervical spondylosis from January 2012 to January 2014 in our hospital were randomly divided into observation group and control group.Patients in observation group received posterior laminoplasty com-bined with foraminotomy,and patients in control group received anterior cervical discectomy and fusion surgery.The operation time,intraoper-ative blood lossing,postoperative JOA scores and NDI scores between two groups were compared.The cervical curvature and range of motion were measured by X-ray.Results There was no significant difference in postoperative JOA scores,cervical curvature and range of motion be-tween two groups(P >0.05).The operative time and intraoperative blood loss of observation group was less than those of control group,the difference was no significance.The NDI scores of carrying and drive in observation group were higher than those in control group,while the NDI scores of other items between two groups had no significant difference(P >0.05).The incidence of complications in observation group was 10.81% (4 /37),the control group was 24.42% (8 /33),the difference between two groups was statistically significant,(χ2 =3.428, P <0.05).Conclusion The posterior laminoplasty combined with foraminotomy have good clinical effect for mixed type cervical spondylosis with advantages of a shorter operation time,simple operation,less intraoperative bleeding,lower incidence of complications,which is a kind of safe and effective surgical method.

Preliminary Experiences of the Combined Midline-Splitting French Door Laminoplasty with Polyether Ether Ketone (PEEK) Plate for Cervical Spondylosis and OPLL

OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of cervical midline-splitting French-door laminoplasty with a polyether ether ketone (PEEK) plate. The authors retrospectively analyzed the results of patients with cervical laminoplasty miniplate (MAXPACER(R)) without bone grafts in multilevel cervical stenosis. METHODS: Fifteen patients (13 males and 2 females, mean age 50.0 years (range 35-72)) with multilevel cervical stenosis (ossification of the posterior longitudinal ligament and cervical spondylotic myelopathy) underwent a combined surgery of midline-splitting French-door laminoplasty with or without mini plate. All 15 patients were followed for at least 12 months (mean follow-up 13.3 months) after surgery, and a retrospective review of the clinical, radiological and surgical data was conducted. RESULTS: The radiographic results showed a significant increase over the postoperative period in anterior-posterior diameter (9.4+/-2.2 cm to 16.2+/-1.1 cm), open angles in cervical lamina (46.5+/-16.0degrees to 77.2+/-13.1degrees), and sectional volume of cervical central canal (100.5+/-0.7 cm2 to 146.5+/-4.9 cm2) (p<0.001). The sagittal alignment of the cervical spine was well preserved (31.7+/-10.0degrees to 31.2+/-7.6degrees, p=0.877) during the follow-up period. The clinical results were successful, and there were no significant intraoperative complications except for screw displacement in two cases. The mini plate constructs did not fail during the 12 month follow-up period, and the decompression was maintained. CONCLUSION: Despite the small cohort and short follow-up duration, the present study demonstrated that combined cervical expansive laminoplasty using the mini plate is an effective treatment for multilevel cervical stenosis.

Comparison of Clinical Results according to the Complications after or during Open Door Laminoplasty Surgery for Cervical Myelopathy / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to compare and analyze the clinical results according to the complications occurring after laminoplasty for cervical myelopathy patients. MATERIALS AND METHODS: Among patients diagnosed as cervical myelopathy, 152 cases in which patients underwent cervical laminoplasty from March 2006 to March 2011 from Chungnam National University Hospital and had follow-up for at least two years were selected for the study, and the mean follow-up period was 39.7 months. The cases were divided into two groups; cases that underwent plate fixation for hinge fracture during cervical laminoplasty or showed postoperative spontaneous interlamina fusion were included in group A and cases that did not show such complications were included in group B. Clinical results were measured using visual analogue scale (VAS) score and Neck Disability Index (NDI) preoperatively, postoperatively, and on the final follow-up. RESULTS: Among 152 cases, 31 cases were included in group A and 121 cases in group B. Group A consisted of 11 cases of fixation due to intraoperative hinge fracture and 20 cases of postoperative spontaneous interlamina fusion. Mean preoperative VAS score was 7.52 in group A and 7.26 in group B, and mean postoperative VAS score was 2.87 in group A and 3.03 in group B. Mean NDI improved from 74.32% preoperatively to 43.84% postoperatively in group A and 75.74% preoperatively to 45.36% postoperatively in group B. In both groups, on postoperative follow-up, no significant difference of VAS score and NDI was found and both showed improvement compared to before surgery. CONCLUSION: The clinical results of cases that underwent plate fixation for hinge fracture that occurred during cervical laminoplasty and postoperative spontaneous interlamina fusion showed no significant difference compared to cases that did not show any complications.

Axial Neck Pain after Cervical Laminoplasty

OBJECTIVE: It has been demonstrated that cervical laminoplasty is an effective and safe method of treating multi-level cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. However, recent reports have suggested that axial neck pain is frequently encountered after cervical laminoplasty. The aim of the present study was to determine clinical significance of the C7 spinous process on axial neck pain after cervical laminoplasty. METHODS: A total of 31 consecutive patients that underwent cervical laminoplasty between March 2002 and December 2008 were reviewed. The authors evaluated and compared axial neck pain and lordotic angle in patients that underwent C7 spinous process preserving surgery (group 1, n = 16) and in patients in which the C7 spinous process was sacrificed (group 2, n = 15). RESULTS: Severe or moderate early axial pain occurred in 56.2% of patients in group 1 and in 86.6% in group 2. Severe or moderate late axial pain occurred in 12.5% in group 1 and in 73.3% in group 2. Eighty-Six percent of patients in group 2 and 43% in group 1 experienced aggravation of their axial neck pain during the early postoperative period. Aggravation of axial neck pain during early postoperative period was less common in group 1 but not statistically significant (p = 0.073). Sixty-six percent of patients in group 2 and 12% in group 1 had aggravated axial neck pain at late postoperative period and aggravation of late axial neck pain was significantly less common in group 1 (p = 0.002). CONCLUSION: The present study demonstrates that C7 spinous process preserving laminoplasty decreases the incidence of aggravated axial neck pain after cervical laminoplasty.

New Cervical Laminoplasty Polyethererketone Cage: Two Case Reports

Cervical laminoplasty is a widely used technique to enlarge the spinal canal for spinal cord decompression. The two common methods are an open door laminoplasty and a midline splitting laminoplasty. Several devices and materials have been used as a spacer for maintaining or stabilizing the lamina in the open or split position, however, some are difficult to implant. Moreover, they are not designed to restore the natural dynamics of the cervical spine, and can cause discomfort to the patient. There is a need to develop a device and material that will be effective in maintaining and stabilizing the position of the lamina after laminoplasty, being able to be implanted easily and safely to restore the natural dynamics of the cervical spine, as well as getting the bony union to the host bone. We report two cervical laminoplasty patients who were treated using a new laminoplasty polyetheretherketone cage.

Results of selective expansive open-door laminoplasty for the treatment of cervical spondylotic myelopathy / 中国矫形外科杂志

[Objective] To evaluate the efficacy and short-term results of selective expansive open-door laminoplasty(ELAP).[Method] From June 2005-June 2006,a total of 102 pataents with cervical spondylotic myelopathy(CSM)were enrolled in this study.Forty-four patients underwent ELAP.Fifty-eight patients undergoing conventional C3~7 ELAP served as controls.The clinical results and radiological examinations of both groups were evaluated at 12 month after surgery.[Result]There was no significant difference in recovery rate of Japanese Orthopaedic Association(JOA)scores.The incidence of axial symptoms in the selective ELAP group was significantly lower than those in the C3~7 ELAP group(P