AS DIFERENTES TÉCNICAS DE LAMINOPLASTIA CERVICAL / DIFFERENT CERVICAL LAMINOPLASTY TECHNIQUES

Introdução: A laminoplastia cervical é uma das técnicas-padrão para o tratamento da mielopatia cervical espondilótica. Foi desenvolvida por ortopedistas japoneses na década de 1970 como alternativa à laminectomia. Ao longo dos anos, vários tipos de laminoplastia foram descritos. A de porta aberta e porta francesa são as mais utilizadas e estudadas na literatura e a partir delas foram descritas variações técnicas, incluindo o uso da endoscopia. Objetivo: Rever as técnicas de laminoplastia descritas na literatura. Métodos: Foi realizada revisão de literatura nas plataformas Pubmed e Scielo em janeiro de 2024. Inicialmente foram selecionados 66 artigos que abordavam algo relacionado aos tipos de técnica de laminoplastia em seu título. Os resumos desses artigos foram lidos e selecionados aqueles que abordavam revisão sobre o tema ou que descreviam um novo tipo de laminoplastia ou variação técnica de porta aberta ou porta francesa. Resultados: Foram considerados para estudo um total de 20 artigos. Conclusões: Após o advento da laminoplastia open-door e de french-door, surgiram algumas variações, como a laminoplastia two-open-door, a laminoplastia open-door alternada e as associadas à laminectomia C3.

Background: Cervical laminoplasty is one of the standard techniques for the treatment of spondylotic cervical myelopathy. It was developed by Japanese orthopedists in the 1970s as an alternative to laminectomy. Over the years, several types of laminoplasty have been described. Open-door and French-door laminoplasty are the most widely used and studied in the literature and based on them, technical variations have been described, including the use of endoscopy. Objective: To review the laminoplasty techniques described in the literature. Methods: A literature review was conducted on the Pubmed and Scielo platforms in January 2024. Initially, 66 articles were selected that addressed something related to types of laminoplasty technique in their title. The abstracts of these articles were read and those that addressed a review on the subject or that described a new type of laminoplasty or technical variation of open-door or French-door were selected. Results: A total of 20 articles were considered for study. Conclusions: After the advent of open-door and french-door laminoplasty, some variations emerged, such as two-open-door laminoplasty, alternating open-door laminoplasty and those associated with C3 laminectomy.

CUSTOMIZED BIOMODEL OF THE CERVICAL SPINE FOR LABORATORY LAMINOPLASTY TRAINING / BIOMODELO PERSONALIZADO DA COLUNA CERVICAL PARA TREINAMENTO DE LAMINOPLASTIA EM LABORATÓRIO

Background: Additive manufacturing has been developed as a promising innovation for many areas, including medicine. There are many ways to use it in spine surgeries and the use of biomodels in the laboratory to study and training of cervical laminoplasty has not yet been reported in the literature. Objective: To evaluate the use of a biomodel of the cervical spine for surgical training of laminoplasty. Method: This is an experimental study. Were printed 10 identical biomodels of the cervical spine based on CT and MRI scans of a patient diagnosed with spondylotic cervical myelopathy. The additive manufacturing method used was fused deposition modeling and the raw material chosen was polyatic acid. The sample was divided into 2 groups: control (n = 5; the biomodels were submitted to CT scanning) and open-door (n = 5; the biomodels were submitted to open-door laminoplasty and postoperative CT). The area and anteroposterior diameter of the vertebral canal were measured on CT scans. Result: The time for printing each piece was 12 h. During the surgical procedure, the support of the biomodels was sufficient to keep them static. The use of drill was feasible; however, continuous irrigation was mandatory to prevents the heating of the plastic material. The raw material used allowed the CT study of the biomodels. It was observed an increase the dimensions of the vertebral canal in 24,80% (0.62 cm2) in the area and 24,88% (3.12 mm) in the anteroposterior diameter. Conclusion: The cervical spine biomodels can be used for laminoplasty training, even using thermosensitive material such as PLA. The use of continuous irrigation is essential during the use of the drill.

Introdução: A manufatura aditiva tem se desenvolvido como inovação promissora para muitas áreas, incluindo a medicina. Existem muitas maneiras de utilizá-la em operações de coluna, e o uso de biomodelos em laboratório para estudo e treinamento de laminoplastia cervical ainda não foi relatado na literatura. Objetivo: Avaliar a utilização de um biomodelo da coluna cervical para treinamento cirúrgico de laminoplastia. Método: Trata-se de estudo experimental. Foram impressos 10 biomodelos idênticos da coluna cervical baseados em exames de tomografia computadorizada e ressonância magnética de um paciente com diagnóstico de mielopatia cervical espondilótica. O método de manufatura aditiva utilizado foi a modelagem por deposição fundida e a matéria-prima escolhida foi o ácido poliático. A amostra foi distribuída em 2 grupos: controle (n = 5; os biomodelos foram submetidos à tomografia computadorizada) e open-door (n = 5; os biomodelos foram submetidos à laminoplastia open-door e tomografia pós-operatória). A área e o diâmetro anteroposterior do canal vertebral foram medidos na tomografia. Resultado: O tempo de impressão de cada peça foi de 12 h. Durante o procedimento, o suporte utilizado para fixar o biomodelo foi suficiente para mantê-los estáticos. O uso de broca mostrou-se viável; porém, a irrigação contínua foi mandatória para evitar o aquecimento do material plástico. A matéria-prima utilizada permitiu o estudo tomográfico dos biomodelos. Observou-se aumento das dimensões do canal vertebral em 24,80% (0,62 cm2) na área e 24,88% (3,12 mm) no diâmetro anteroposterior. Conclusão: Os biomodelos da coluna cervical podem ser utilizados para o treinamento de laminoplastias, mesmo utilizando material termossensível. O uso de irrigação contínua é essencial durante o uso da broca.

Tratamiento de la mielopatía cervical mediante abordaje posterior: laminoplastia vs. laminectomía con fijación posterior. ¿Existen diferencias desde el punto de vista clínico y radiológico? / Treatment of cervical myelopathy by posterior approach: Laminoplasty vs. laminectomy with posterior fixation, are there differences from a clinical and radiological point of view?

Introducción La mielopatía cervical degenerativa representa una entidad patológica producida por la estenosis del canal medular cervical, resultando en una compresión crónica de la médula espinal, variable y progresiva. El abordaje quirúrgico de la columna cervical puede realizarse por vía anterior y/o vía posterior. Respecto al abordaje posterior, existen 2 técnicas fundamentales: laminoplastia y laminectomía con fijación posterior (LFP). En la literatura actual existe controversia acerca de cuál de las 2 técnicas permite obtener mejores resultados postoperatorios. El objetivo es el estudio de las diferencias entre laminoplastia y LFP desde el punto de vista clínico y radiológico. Materiales y métodosSe realiza un estudio de una cohorte histórica de 39 pacientes (12 LFP y 27 laminoplastia) intervenidos en un período de 10 años en el Hospital Universitario La Paz con un seguimiento de 12 meses tras la cirugía. Se analizan y comparan los resultados clínicos mediante la escala de Nurick y la Escala Japanese Orthopaedic Association modificada (mJOA) y los resultados radiológicos mediante el ángulo de Cobb, eje sagital vertical, T1 Slope y el alineamiento (medido mediante Cobb-T1 Sloppe). Resultados Se observan diferencias significativas en la mejoría postoperatoria de la escala Nurick (p=0,008) y mJOA (p=0,018) en el grupo de laminoplastia. En LFP se objetiva una tendencia a una mejoría mayor, pero no se alcanza la significación estadística debido al bajo tamaño muestral de este grupo. No se objetivan diferencias estadísticamente significativas en cuanto a la variables radiológicas. Respecto al total de complicaciones, se observó un número mayor en el grupo de laminoplastia (7 casos) frente a LFP (un caso), pero no se vieron diferencias estadísticamente significativas... (AU)

Introduction Cervical degenerative myelopathy is a variable and progressive degenerative disease caused by chronic compression of the spinal cord. Surgical approaches for the cervical spine can be performed anteriorly and/or posteriorly. Regarding the posterior approach, there are 2 fundamental techniques: laminoplasty and laminectomy with posterior fixation (LPF). There is still controversy concerning the technique in terms of outcome and complications. The aim of the present work is to analyze from the clinical and radiological point of view these 2 techniques: laminoplasty and LPF. Materials and methods A historical cohort of 39 patients was reviewed (12 LFP and 27 laminoplasty) including patients operated in a 10 years period at the Hospital Universitario La Paz with a follow-up of 12 months after surgery was carried out. The clinical results were analyzed and compared using the Nurick scale and the modified Japanese Orthopaedic Association Scale (mJOA) and the radiological results using the Cobb angle, Sagittal Vertical Axis, T1 Slope and alignment (measured by Cobb-T1 Sloppe). Results Significant differences were observed in the postoperative improvement of the Nurick scale (P=.008) and mJOA (P=.018) in the laminoplasty group. In LFP there is a tendency to a greater improvement, but statistical significance is not reached due to the low sample size of this group. No statistically significant differences were observed in the radiological variables. Regarding the total number of complications, a higher number was observed in the laminoplasty group (7 cases) versus LFP (one case), but no statistically significant differences were observed. (AU)

Treatment of cervical myelopathy by posterior approach: Laminoplasty vs. laminectomy with posterior fixation, are there differences from a clinical and radiological point of view?

INTRODUCTION: Cervical degenerative myelopathy is a variable and progressive degenerative disease caused by chronic compression of the spinal cord. Surgical approaches for the cervical spine can be performed anteriorly and/or posteriorly. Regarding the posterior approach, there are 2 fundamental techniques: laminoplasty and laminectomy with posterior fixation (LPF). There is still controversy concerning the technique in terms of outcome and complications. The aim of the present work is to analyze from the clinical and radiological point of view these 2 techniques: laminoplasty and LPF. MATERIALS AND METHODS: A historical cohort of 39 patients was reviewed (12 LFP and 27 laminoplasty) including patients operated in a 10 years period at the Hospital Universitario La Paz with a follow-up of 12 months after surgery was carried out. The clinical results were analyzed and compared using the Nurick scale and the modified Japanese Orthopaedic Association Scale (mJOA) and the radiological results using the Cobb angle, Sagittal Vertical Axis, T1 Slope and alignment (measured by Cobb-T1 Sloppe). RESULTS: Significant differences were observed in the postoperative improvement of the Nurick scale (p = 0.008) and mJOA (p = 0.018) in the laminoplasty group. In LFP there is a tendency to a greater improvement, but statistical significance is not reached due to the low sample size of this group. No statistically significant differences were observed in the radiological variables. Regarding the total number of complications, a higher number was observed in the laminoplasty group (7 cases) versus LFP (one case), but no statistically significant differences were observed. CONCLUSIONS: Laminoplasty and LFP are both safe and effective procedures in the treatment of cervical degenerative myelopathy. The findings of our study demonstrate statistically significant clinical improvement based on the Nurick and mJOA scales with laminoplasty. No significant differences in terms of complications or radiological variables were observed between the 2 techniques.

Laminoplastia cervical con foraminotomía unilateral C4-C5: nota técnica y serie de casos / Cervical laminoplasty with unilateral C4-5 foraminotomy: Technical note and case series

Objetivo La laminoplastia «open door» es una técnica ampliamente utilizada para el tratamiento de la mielopatía cervical multinivel. A pesar de presentar resultados funcionales y radiológicos satisfactorios a largo plazo, la parálisis de C5 postoperatoria continúa siendo una complicación severa e invalidante con una incidencia variable en la literatura. El objetivo del presente trabajo es describir e ilustrar la técnica quirúrgica paso a paso con el agregado de la foraminotomía unilateral C4-5, y evaluar los resultados obtenidos hasta el momento, haciendo especial énfasis en la parálisis de C5. Material y métodos Estudio retrospectivo de 20 pacientes intervenidos por mielopatía cervical mediante la técnica de laminoplastia cervical «extendida» con foraminotomía unilateral, para la cual se detallan los pasos. Resultados Entre enero de 2013 y abril de 2019 se trataron 20 pacientes con «laminoplastia cervical extendida». Un solo paciente agregó déficit de C5 postoperatorio (5%). El porcentaje de recuperación del Japanese Orthopaedic Association score (JOA modificado) postoperatorio fue del 54,5%, siendo similar a lo observado en otras series. Conclusión Se desarrolló e ilustró la técnica de laminoplastia cervical «extendida» con foraminotomía unilateral de C4-5 para la prevención de la parálisis de C5. Se analizaron los resultados, y se obtuvo una incidencia de parálisis de C5 coincidente con el menor porcentaje reportado en la literatura. Sería de utilidad un estudio prospectivo y aleatorizado para valorar el rol de la foraminotomía preventiva C4-5 unilateral (AU)

Objective The open-door laminoplasty technique is widely used in the treatment of multilevel cervical myelopathy. Despite the satisfactory functional and radiological results of this technique, postoperative C5 palsy is still a severe and disabling complication with a variable incidence in the literature. The objective of this article is to describe and demonstrate the surgical technique step by step with the addition of unilateral C4-5 foraminotomy and to evaluate the results obtained to date, with special emphasis on C5 palsy. Material and methods Retrospective study of 20 patients operated on for cervical myelopathy using the “extended” laminoplasty technique, which is described step by step. Results Between January 2013 and April 2019, 20 patients were operated on using the extended laminoplasty technique. Only one patient (5%) presented postoperative C5 palsy. The postoperative recovery rate of the modified JOA (Japanese Orthopaedic Association) score was 54.5%, similar to that observed in other series. Conclusion The extended cervical laminoplasty technique with unilateral C4-5 foraminotomy was developed and demonstrated for the prevention of C5 palsy. The results were analysed and an incidence of C5 palsy coinciding with the lowest percentage reported in the literature was obtained. A prospective randomised study would be useful to assess the role of preventive unilateral C4-5 foraminotomy (AU)

Cervical laminoplasty with unilateral C4-5 foraminotomy: Technical note and case series.

OBJECTIVE: The open-door laminoplasty technique is widely used in the treatment of multilevel cervical myelopathy. Despite the satisfactory functional and radiological results of this technique, postoperative C5 palsy is still a severe and disabling complication with a variable incidence in the literature. The objective of this article is to describe and demonstrate the surgical technique step by step with the addition of unilateral C4-5 foraminotomy and to evaluate the results obtained to date, with special emphasis on C5 palsy. MATERIAL AND METHODS: Retrospective study of 20 patients operated on for cervical myelopathy using the "extended" laminoplasty technique, which is described step by step. RESULTS: Between January 2013 and April 2019, 20 patients were operated on using the extended laminoplasty technique. Only one patient (5%) presented postoperative C5 palsy. The postoperative recovery rate of the modified JOA (Japanese Orthopaedic Association) score was 54.5%, similar to that observed in other series. CONCLUSION: The extended cervical laminoplasty technique with unilateral C4-5 foraminotomy was developed and demonstrated for the prevention of C5 palsy. The results were analysed and an incidence of C5 palsy coinciding with the lowest percentage reported in the literature was obtained. A prospective randomised study would be useful to assess the role of preventive unilateral C4-5 foraminotomy.

Cervical laminoplasty with unilateral C4-5 foraminotomy: Technical note and case series. / Laminoplastia cervical con foraminotomía unilateral C4-C5: nota técnica y serie de casos.

OBJECTIVE: The open-door laminoplasty technique is widely used in the treatment of multilevel cervical myelopathy. Despite the satisfactory functional and radiological results of this technique, postoperative C5 palsy is still a severe and disabling complication with a variable incidence in the literature. The objective of this article is to describe and demonstrate the surgical technique step by step with the addition of unilateral C4-5 foraminotomy and to evaluate the results obtained to date, with special emphasis on C5 palsy. MATERIAL AND METHODS: Retrospective study of 20 patients operated on for cervical myelopathy using the "extended" laminoplasty technique, which is described step by step. RESULTS: Between January 2013 and April 2019, 20 patients were operated on using the extended laminoplasty technique. Only one patient (5%) presented postoperative C5 palsy. The postoperative recovery rate of the modified JOA (Japanese Orthopaedic Association) score was 54.5%, similar to that observed in other series. CONCLUSION: The extended cervical laminoplasty technique with unilateral C4-5 foraminotomy was developed and demonstrated for the prevention of C5 palsy. The results were analysed and an incidence of C5 palsy coinciding with the lowest percentage reported in the literature was obtained. A prospective randomised study would be useful to assess the role of preventive unilateral C4-5 foraminotomy.

Mielopatía cervical espondilótica; resultados clínicos post laminoplastia / Spondylotic cervical myelopathy; clinical results after laminoplasty / Mielopatia cervical espondilótica; resultados clínicos após laminoplastia

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.

Laminoplasty and corpectomy in the treatment of cervical spondylotic myelopathy / Laminoplastia e corporectomia no tratamento da mielopatia espondicológica cervical / Laminoplastia y corpectomía en el tratamiento de la mielopatía espondilótica cervical

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.

Quality of life in symptomatic cervical myelopathy after open-door laminoplasty / Qualidade de vida na mielopatia cervical sintomática após uma laminoplastia open-door / Calidad de vida en mielopatía cervical sintomática después de una laminoplastia de puertas abiertas

OBJECTIVE: To analyze the results obtained by open-door laminoplasty using the Newbridge(r)/Blackstone plate, in cases of myelopathy associated with cervical lordosis. METHODS: From December 2010 to October 2012, eight patients between the ages of 49 and 68 underwent open-door laminoplasty with the use of the Newbridge(r) fixation system for maintenance and stabilization of the cervical laminoplasty. Minimum follow-up was four months. For the evaluation of quality of life the questionnaire SF-36 was applied at the following times: preoperative, one month and three months after surgery associated with the subjective assessment of the patient regarding satisfaction with the procedure and with the Nurick neurological scale applied prior to surgery and three months later. RESULTS: According to the SF-36, there was significant improvement in the domains functional ability, general health perceptions and emotional aspects over time; regarding physical limitations and social aspects there was no improvement in the first postoperative month, only in the third month. There were no statistically significant changes observed during the period covered by this study related to pain, vitality and mental health. According to Nurick scale, there was evidence of improvement in symptoms of cervical myelopathy. Based on the subjective evaluation of the patients, surprisingly, all patients were satisfied with the surgical procedure and the results. CONCLUSION: The open-door laminoplasty technique with rigid fixation to maintain the opening is useful in improving the symptoms of cervical myelopathy associated with lordosis, leading to improved quality of life and with a high degree of patient satisfaction and fewer complications.

OBJETIVO: Analisar os resultados obtidos pela laminoplastia open-door com o uso da placa Newbridge(r)/Blackstone, em casos de mielopatia com lordose cervical associada. MÉTODOS: Entre dezembro de 2010 e outubro de 2012, oito pacientes entre as idades de 49 e 68 foram submetidos a laminoplastia open-door com o uso do sistema de fixação Newbridge(r)para manutenção e estabilização da laminoplastia cervical. O seguimento mínimo foi de quatro meses. Para a avaliação da qualidade de vida, o questionário SF-36 foi aplicado nos seguintes tempos: pré-operatório, um e três meses após a cirurgia, associado à avaliação subjetiva do paciente quanto à satisfação com o procedimento e à escala neurológica de Nurick aplicadas antes da cirurgia e três meses depois. RESULTADOS: De acordo com o SF-36, houve melhora significativa nos domínios capacidade funcional, estado geral de saúde e aspectos emocionais ao longo do tempo; com relação às limitações físicas e aos aspectos sociais, não houve melhora no primeiro mês pós-operatório, apenas no terceiro mês. Não foram observadas alterações estatisticamente significantes, durante o período abrangido por este estudo de dor, vitalidade e saúde mental. De acordo com a escala de Nurick, houve evidências de melhoria nos sintomas da mielopatia cervical. Com base na avaliação subjetiva dos pacientes, surpreendentemente, todos os pacientes ficaram satisfeitos com o procedimento cirúrgico e com os resultados. CONCLUSÃO: A técnica de laminoplastia open-door com fixação rígida para manter a abertura é útil para melhorar os sintomas de mielopatia cervical com lordose associada, levando à melhora da qualidade de vida, com alto grau de satisfação dos pacientes e poucas complicações.

OBJETIVO: Analizar los resultados obtenidos por laminoplastia de puertas abiertas utilizando la placa Newbridge(r)/Blackstone, en casos de mielopatía con lordosis cervical asociada. MÉTODOS: Entre diciembre de 2010 y octubre de 2012, ocho pacientes con edades de 49 a 68 años se sometieron a laminoplastia de puertas abiertas mediante el sistema de fijación Newbridge(r) para el mantenimiento y la estabilización de la laminoplastia cervical. El seguimiento mínimo fue de cuatro meses. Para la evaluación de la calidad de vida, el cuestionario SF-36 se aplicó en los siguientes tiempos: preoperatorio, un mes y tres meses después de la cirugía, asociado con la evaluación subjetiva del paciente con respecto a la satisfacción con el procedimiento y la escala neurológica Nurick aplicada antes de la cirugía y tres meses más tarde. RESULTADOS: De acuerdo con el SF-36, hubo una mejora significativa en las áreas de función física, salud general y los aspectos emocionales a través del tiempo; con respecto a las limitaciones físicas y aspectos sociales, no hubo mejoría en el primer mes postoperatorio, sólo en el tercer mes. Estadísticamente no se observaron cambios significativos durante el período cubierto por este estudio en las áreas de dolor, vitalidad y salud mental. De acuerdo con la escala Nurick, hubo evidencia de mejoría en los síntomas de mielopatía cervical. Con base en la evaluación subjetiva de los pacientes, de forma sorprendente, todos los pacientes se mostraron satisfechos con el procedimiento quirúrgico y los resultados. CONCLUSIÓN: La técnica de laminoplastia de puertas abiertas con fijación rígida para mantener la apertura es útil en la mejora de los síntomas de la mielopatía cervical asociado con lordosis, dando lugar a una mejor calidad de vida con un alto grado de satisfacción del paciente y menos complicaciones.

A new expansive two-open-doors laminoplasty for multilevel cervical spondylotic myelopathy: technical report and follow-up results / Nova tecnica de laminoplastia expansiva para tratamento de mielopatia espondilotica cervical: descricao tecnica e resultados de follow-up

The laminoplasty technique was devised by Hirabayashi in 1978 for patients diagnosed with multilevel cervical spondylotic myelopathy. Objective: To describe an easy modification of Hirabayashi’s method and present the clinical and radiological results from a five-year follow-up study. Method and Results: Eighty patients had 5 levels of decompression (C3-C7), 3 patients had 6 levels of decompression (C2-T1) and 3 patients had 4 levels of decompression (C3-C6). Foraminotomies were performed in 23 cases (27%). Following Nurick`s scale, 76 patients (88%) improved, 9 (11%) had the same Nurick grade, and one patient worsened and was advised to undergo another surgical procedure. No deaths were observed. The mean surgery time was 122 min. Radiographic evaluation showed an increase in the mean sagittal diameter from 11.2 mm at pretreatment to 17.3 mm post surgery. There was no significant difference between pretreatment and post-surgery C2-C7 angles. Conclusions: This two-open-doors laminoplasty technique is safe, easy and effective and can be used as an alternative treatment for cases of multilevel cervical spondylotic myelopathy without instability. .

A laminoplastia é técnica clássica descrita por Hirabayashi em 1978 para descompressão do canal cervical sem utilizar prótese. A principal indicação é o tratamento da mielopatia espondilotica cervical sem instabilidade. Objetivo: Descrever modificação simples da técnica de laminoplastia clássica de Hirabayashi com resultados clínicos e radiográficos em 5 anos de acompanhamento. Resultados e Método: Foram acompanhados 86 pacientes. Em 80, foi feita descompressão por laminoplastia em 5 níveis (C3-C7); em 3, descompressão em 6 níveis (C2-T1); em 3, descompressao em 4 níveis (C3-C6). Em 23 casos (27%), foi realizada foraminotomia associada a descompressão medular. O acompanhamento dos pacientes foi feito utilizando a escala de Nurick. Em 76 pacientes (88%) houve melhora do grau de Nurick. Não houve mortalidade associada à técnica. O tempo médio do procedimento cirúrgico foi de 122 minutos. Em relação à avaliação radiográfica, houve aumento do diâmetro sagital médio do canal cervical de 11,2mm para 17,3mm. Não houve diferença estatística do ângulo C2-C7 nas avaliações antes e após o procedimento cirúrgico. Conclusão: A nova técnica de laminoplastia descrita no presente estudo foi segura, de fácil execução, efetiva, não utiliza protese e não há instabilidade do canal cervical. .