Laminoplasty versus conservative treatment for acute cervical spinal cord injury caused by ossification of the posterior longitudinal ligament after minor trauma.

BACKGROUND CONTEXT: No reports to date have accurately evaluated the management for acute spinal cord injury (SCI) caused by ossification of the posterior longitudinal ligament (OPLL) after minor trauma. PURPOSE: To assess whether outcomes of laminoplasty is better than conservative treatment. STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: Thirty-one patients underwent surgery (L group) and 29 patients underwent conservative treatment (C group). OUTCOME MEASURES: Disability, muscle strength, sensation, and general health status. METHODS: Patients were managed according to routine clinical practice and the results between groups were compared. Clinical and radiographic outcomes were assessed at admission, discharge, 6 months and at the final visit. Causes for trauma, duration of hospital stay, and complication were also evaluated. RESULTS: Causes for trauma included falling, traffic accidents and sports. Mixed and segmental types were the most frequent cause of OPLL resulting into SCI. Duration of hospital stay and complications were less in the L group. Motor and sensory scores increased in the L group at discharge (p<.05) and at 6 months (p<.05), and maintained thereafter (p>.05); scores improved significantly in the C group at 6 months (p<.05), with a slight deterioration with time (p>.05); scores in the L group were higher than in the C group at each time point after surgery (p<.05). Bodily pain and mental health in SF-36 improved at discharge in the L group (p<.05); all scores improved at 6 months in both the groups (p<.05), with better improvements in the L group (p<.05). The canal diameter increased and occupation ratio decreased in the L group (p<.05), and maintained thereafter (p<.05); a slight increase of occupation ratio was observed in the C group (p>.05). Lordotic angle and range of motion were maintained in both the groups, with no significance between groups (p>.05). High-signal intensity decreased at 6 months (p<.05) in the L group; no significant change was found in the C group during the follow-up (p>.05); Significant difference was detected between the groups at 6 months and at the final visit (p<.05). CONCLUSIONS: Most of the OPLL patients displayed as incomplete SCI after minor trauma. Although spontaneous improvement of SCI without surgery is often observed, laminoplasty has more satisfactory outcomes, prevents late compression of cord, and reduces perioperative complications, although with no significant benefit in cervical alignment and range of motion.

Use of an integrated anterior cervical plate and cage device (PCB) in cervical anterior fusion.

The aim of this study is to evaluate an integrated cage and plate device (the plate cage Benezech, PCB) filled with autogenous bone in anterior cervical discectomy and fusion. The fused segment height, lordosis, and fusion were assessed by postoperative radiographic examination at different intervals. Patients were evaluated using Odom's criteria and the Short Form (SF)-36 Health Survey questionnaire. The mean follow-up duration was 4.1 years. Fusion was achieved in 90.0%, 96.0% and 100% of patients at 3 months, 6 months and at final visit, respectively. The fused segment height and lordosis were restored and maintained. Cage subsidence (3mm) occurred at one level and settling was observed at three levels. An excellent-to-good result was achieved in 81.8% of patients. The data from the SF-36 questionnaire revealed significant postoperative improvement (p<0.01) except for social function and mental health. This study suggests that patients instrumented with PCB can obtain good radiographic and clinical results and that PCB is a safe and effective device in cervical anterior fusion.

Surgery for thoracic myelopathy caused by ossification of the ligamentum flavum.

Between January 1996 and December 2003, our department treated 16 patients (10 men and 6 women; average age 57.5 years) by performing a laminectomy for thoracic myelopathy caused by ossification of the ligamentum flavum (OLF). We followed up all patients for 36 to 86 months (mean follow-up time, 57.3 months). The mean (+/-standard deviation) Japanese Orthopaedic Association score increased from 5.0+/-1.4 points before the operation to 7.7+/-1.9 points at the last follow-up (p<0.01). The average values for pre-operative and post-operative kyphosis of the involved vertebrae were 5.8 degrees +/-4.1 degrees and 8.8 degrees +/-6.0 degrees , respectively; the mean increase in kyphosis was only 3.0 degrees +/-2.4 degrees . An intraoperative dural tear was the main complication and none of the patients developed severe neurological complications. We conclude that laminectomy was both effective and safe in the treatment of thoracic OLF, but it must be performed with great care because of frequent dural adhesions to the OLF. The increase in kyphosis after the laminectomy was minimal when most of the facet joints were left intact and when the patient followed a back extensor exercise program post-operatively.

Efficacy of surgery and type of fusion in patients with degenerative lumbar spinal stenosis.

Degenerative lumbar spinal stenosis (DLSS) can be treated by several surgical procedures. However, the choice of procedure and use of instrumentation remain controversial. In this retrospective study of 81 patients with DLSS, 43 patients received decompression and posterolateral fusion without instrumentation, and the surgery for 38 patients was supplemented with posterior transpedicular screw fixation. Both surgeon-based (Fischgrund criteria) and patient-based (Medical Outcome Trust Short-Form 36 [SF-36] questionnaire) standards were used to assess the clinical outcomes. An excellent to good result was achieved in 71.6% of patients and there was no significant difference 6.2 years later between groups with or without instrumentation (Z=0.0358, p>0.05). SF-36 data revealed significant postoperative improvement (p<0.01), and there was no significant difference between the two groups (t=1.67, p>0.05). Successful fusion occurred in 87% of patients with instrumentation versus 67% of the patients without instrumentation (chi(2)=4.23, p<0.05). Thus, surgical treatment of DLSS generally results in satisfactory outcomes. Transpedicular screw fixation may not improve clinical outcomes and the use of posterior instrumentation should be adopted cautiously.