A Comparison of the Surgical Outcomes of Laminoplasty and Laminectomy with Fusion in the Treatment of Multilevel Cervical Spondylotic Myelopathy: A Retrospective Cohort Study.

AIM: To compare the effectiveness of laminoplasty and laminectomy with fusion in the treatment of patients with cervical spondylotic myelopathy (CSM). MATERIAL AND METHODS: This study retrospectively reviewed 52 patients diagnosed with CSM who underwent either laminoplasty (LP group) or laminectomy with fusion (LF group). The preoperative and postoperative clinical outcomes were evaluated using Cobb?s angle of cervical lordosis, visual analogue scale (VAS) and modified Japanese Orthopaedic Association (mJOA) scores, and radiographs showing the antero-posterior diameter and area of the spinal canal. RESULTS: The mean age of the LP group was 60.12 years, while that of the LF group was 63.84 years. The pre- and postoperative mean mJOA scores were 11.46 ± 1.27 and 15.27 ± 0.87, respectively, in the LP group and 10.15 ± 1.89 and 14.92 ± 1.23, respectively, in the LF group. The pre- and postoperative Cobb angles were 16.22 ± 6.36° and 14.45 ± 4.50°, respectively, in the LP group and 14.39 ± 5.34° and 15.10 ± 6.21°, respectively, in the LF group. Recovery rates were 58.26% and 60.76% in the LP and LF groups, respectively. The mJOA scores, antero-posterior diameter and area improved significantly after surgery in both groups, while the Cobb angle increased in the LF group and decreased in the LP group. CONCLUSION: Laminoplasty and laminectomy with fusion improved neurological functions in patients diagnosed with CSM. Laminectomy with fusion should be the preferred choice when treating patients with preoperative axial pain as, despite expanding the spinal canal successfully, laminoplasty can also worsen the pain. However, laminectomy with fusion (except for OPLL) should not be the treatment of choice in a mobile spine as it severely restricts neck movements and impairs the Health-Related Quality of Life (HRQoL) of the patient. In the absence of kyphotic deformity, laminoplasty should be the preffered method for treatment.

Prediction of outcome following laminoplasty of cervical spondylotic myelopathy: Focus on the minimum clinically important difference.

The minimum clinically important difference (MCID) of the Japanese Orthopaedic Association (JOA) score has been reported to be around 2.5 points in cervical myelopathy. This study sought to define significant predictive factors on achieving the MCID following laminoplasty in a large series of patients with cervical spondylotic myelopathy (CSM). A total of 485 consecutive patients with CSM (295 males and 190 females; mean age: 67.0 years; age range: 42-91 years) who underwent laminoplasty were prospectively enrolled. The average postoperative follow-up period was 26.6 months (range: 12-66 months). We calculated the achieved JOA score. The relationships between outcomes and various clinical and imaging predictors including comorbidity and quantitative performance tests were examined. Logistic regression analysis was conducted to identify the predictors correlated with a JOA score of 2.5 points or more. Clinically meaningful gains were exhibited in 299 patients (61.6%) with a JOA score of ≥2.5 points, whereas 186 patients (38.4%) achieved a JOA score of <2.5 points. Univariate logistic regression analysis showed the predictive factors with a shorter duration of CSM symptoms, lower preoperative JOA scores, absence of hypertension, no use of anticoagulant/antiplatelet agents, and nonsmoking status. Multivariate logistic regression analysis determined that the duration of CSM symptoms (odds ratio: 0.771, 95% confidence interval: 0.705-0.844; p < 0.01) was the only significant predictive factor for achieving JOA scores of ≥2.5 points. An important predictor of MCID achievement following laminoplasty was shorter duration of CSM symptoms.

Effect of body mass index on surgical times of lumbar laminoplasty and lower limb arthroplasties.

BACKGROUND: Obesity is an important factor affecting incidence and development of musculoskeletal degenerative changes. In addition, obese patients are considered less favorable surgical candidates for decompression surgery in degenerative lumbar spinal canal stenosis and lower limb arthroplasty. The purpose was to assess disease characteristics of lumbar spinal canal stenosis as well as lower limb osteoarthritis, and to investigate surgical times based on body mass index (BMI) in lumbar decompressive surgery and lower limb arthroplasties. METHODS: A total of 1161 patients with a diagnosis of lumbar canal stenosis (LCS), hip osteoarthritis (HOA) and knee osteoarthritis (KOA) were enrolled. The present investigation was conducted as a retrospective study using routinely collected data. All patients underwent primary decompressive surgery (laminoplasty: LAM) or lower limb arthroplasty (total hip arthroplasty: THA and total knee arthroplasty: TKA). All of the patients were divided into 3 groups based on BMI (kg/m2) (Group A: ≤ 24.9; Group B: 25-29.9; Group C: ≥ 30) within each disease category. To assess disease characteristics, age, gender, and BMI were evaluated for each disease category. Moreover, surgical times for LAM, THA and TKA were also assessed based on BMI classification. RESULTS: A total of 269, 470, and 422 patients were allocated to the HOA category, the KOA category, and the LCS category, respectively. The KOA category included the oldest patients and largest BMI, compared to the HOA and the LCS categories. Regarding gender difference, LCS was more common in males than in females, while opposite phenomenon was observed in the HOA and the KOA categories. The heaviest group (Group C) was significantly younger than Groups A or B in TKA and LAM. Surgical time was significantly longer in patients with overweight or obese patients than in those with normal weight in TKA and LAM, while BMI didn't affect the time in THA. CONCLUSIONS: Disease characteristics of the KOA category and the LCS category were notably affected by BMI, and surgical times in TKA and LAM were significantly longer for overweight or obese patients, whereas THA was less affected by BMI concerning disease characteristics and surgical time.

Short-term Outcomes Following Cervical Laminoplasty and Decompression and Fusion With Instrumentation.

STUDY DESIGN: Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database years 2010 to 2015. OBJECTIVE: Investigate which short-term outcomes differ for cervical laminoplasty and laminectomy and fusion surgeries. SUMMARY OF BACKGROUND DATA: Conflicting reports exist in spine literature regarding short-term outcomes following cervical laminoplasty and posterior laminectomy and fusion. The objective of this study was to compare the 30-day outcomes for these two treatment groups for multilevel cervical pathology. METHODS: Patients who underwent cervical laminoplasty or posterior laminectomy and fusion were identified in National Surgical Quality Improvement Program (NSQIP) based on Current Procedural Terminology (CPT) code: laminoplasty 63,050 and 63,051, posterior cervical laminectomy 63,015 and 63,045, and instrumentation 22,842. Propensity-adjusted multivariate regressions assessed differences in postoperative length of stay, adverse events, discharge disposition, and readmission. RESULTS: Three thousand seven hundred ninety-six patients were included: 2397 (63%) underwent cervical laminectomy and fusion and 1399 (37%) underwent cervical laminoplasty. Both groups were similar in age, sex, body mass index (BMI), American Society of Anesthesiologist Classification (ASA), Charleston Comorbidity Index (CCI), and had similar rates of malnutrition, chronic kidney disease, diabetes, chronic obstructive pulmonary disease, and history for steroid use. Age more than 70 and age less than 50 were not associated with one treatment group over the other (P > 0.05). Compared with laminoplasty patients, laminectomy and fusion patients had increased lengths of stay (LOS) (4.5 vs. 3.7 d, P < 0.01) and increased rates of adverse events (41.7% vs. 35.9%, P < 0.01), discharge to rehab (16.4% vs. 8.6%, P < 0.01), and skilled nursing facilities (12.2% vs. 9.7%, P = 0.02), and readmission (6.2% vs. 4.5%, P = 0.05). Both groups experienced similar rates of death, pulmonary embolus, deep vein thrombosis, deep and superficial surgical site infection, and reoperation (P > 0.05 for all). CONCLUSION: Posterior cervical laminectomy and fusion patients were found to have increased LOS, readmissions, and complications despite having similar pre-op demographics and comorbidities. Patients and surgeons should consider these risks when considering surgical treatment for cervical pathology. LEVEL OF EVIDENCE: 3.

Comparison of laminectomy and fusion vs laminoplasty in the treatment of multilevel cervical spondylotic myelopathy: A meta-analysis.

PURPOSE: The purpose of this study is to evaluate the clinical safety and efficacy between laminectomy and fusion (LF) versus laminoplasty (LP) for the treatment of multi-level cervical spondylotic myelopathy (CSM). METHODS: The authors searched electronic databases using PubMed, MEDLINE, Embase, Cochrane Controlled Trial Register, and Google Scholar for relevant studies that compared the clinical effectiveness of LF and LP for the treatment of patients with multilevel CSM. The following outcome measures were extracted: the Japanese Orthopaedic Association (JOA) scores, cervical curvature index (CCI), visual analog scale (VAS), Nurich grade, reoperation rate, complications, rate of nerve palsies. Newcastle Ottawa Quality Assessment Scale (NOQAS) was used to evaluate the quality of each study. Data analysis was conducted with RevMan 5.3. RESULTS: A total of 14 studies were included in our meta-analysis. No significant difference was observed in terms of postoperative Japanese Orthopaedic Association score (P = .29), visual analog scale neck pain (P = .64), cervical curvature index (P = .24), Nurich grade (P = .16) and reoperation rate (P = .21) between LF and LP groups. Compared with LP group, the total complication rate (OR 2.60, 95% CI 1.85, 3.64, I = 26%, P < .00001) and rate of nerve palsies (OR 3.18, 95% CI 1.66, 6.11, I = 47%, P = .0005) was higher in the LF group. CONCLUSIONS: Our meta-analysis reveals that surgical treatments of multilevel CSM are similar in terms of most clinical outcomes using LF and LP. However, LP was found to be superior than LF in terms of nerve palsy complications. This requires further validation and investigation in larger sample-size prospective and randomized studies.

Importance of the preoperative cross-sectional area of the semispinalis cervicis as a risk factor for loss of lordosis after laminoplasty in patients with cervical spondylotic myelopathy.

PURPOSE: To investigate the effect of the preoperative cross-sectional area (CSA) of the semispinalis cervicis on postoperative loss of cervical lordosis (LCL) after laminoplasty. METHODS: A total of 144 patients who met the inclusion criteria between January 1999 and December 2015 were enrolled. Radiographic assessments were performed to evaluate the T1 slope, C2-7 sagittal vertical axis (SVA), cephalad vertebral level undergoing laminoplasty (CVLL), preoperative C2-7 Cobb angle, and preoperative CSA of the semispinalis cervicis. RESULTS: The T1 slope and the summation of the CSAs (SCSA) at each level of the semispinalis cervicis correlated with LCL, whereas the C2-7 SVA, CVLL, and preoperative C2-7 Cobb angle did not. Multiple regression analysis demonstrated that a high T1 slope and a low SCSA of the semispinalis cervicis were associated with LCL after laminoplasty in patients with cervical spondylotic myelopathy (CSM). The CSA of the semispinalis cervicis at the C6 level had the greatest association with LCL, which suddenly decreased with a LCL of 10°. The best cutoff point of the CSA of the semispinalis cervicis at the C6 level, which predicts LCL > 10°, was 154.5 mm2 (sensitivity 74.3%; specificity 71.6%; area under the curve 0.828; 95% confidence interval 0.761-0.895). CONCLUSION: Preoperative SCSA of the semispinalis cervicis was a risk factor for LCL after laminoplasty. Spine surgeons should evaluate semispinalis cervicis muscularity at the C6 level when planning laminoplasty for patients with CSM. These slides can be retrieved under Electronic Supplementary Material.

Comparable clinical and radiological outcomes between skipped-level and all-level plating for open-door laminoplasty.

PURPOSE: To compare the clinical and radiological outcomes between skipped-level and all-level plating for cervical laminoplasty. METHODS: Patients with cervical spondylotic myelopathy (CSM) treated by open-door laminoplasty with minimum 2-year postoperative follow-up were included. All patients had opening from C3-6 or C3-7 and were divided into skipped-level or all-level plating groups. Japanese Orthopaedic Association (JOA) scores and canal measurements were obtained preoperatively, immediate (within 1 week) postoperatively, and at 2, 6 weeks, 3, 6 and 12 months postoperatively. Paired t test was used for comparative analysis. Receiver operating characteristic analysis was used to determine the canal expansion cutoff for spring-back closure. RESULTS: A total of 74 subjects were included with mean age of 66.1 ± 11.3 years at surgery. Of these, 32 underwent skipped-level plating and 42 underwent all-level plating. No significant differences were noted between the two groups at baseline and follow-up. Spring-back closure was observed in up to 50% of the non-plated levels within 3 months postoperatively. The cutoff for developing spring-back closure was 7 mm canal expansion for C3-6. No differences were observed in JOA scores and recovery rates between the two groups. None of the patients with spring-back required reoperation. CONCLUSIONS: There were no significant differences between skipped-level and all-level plating in terms of JOA or recovery rate, and canal diameter differences. This has tremendous impact on saving costs in CSM management as up to two plates per patient undergoing a standard C3-6 laminoplasty may be omitted instead of four plates to every level to achieve similar clinical and radiological outcomes. LEVEL OF EVIDENCE: III. These slides can be retrieved under Electronic Supplementary Material.

Anterior cervical corpectomy and fusion versus posterior laminoplasty for the treatment of oppressive myelopathy owing to cervical ossification of posterior longitudinal ligament: a meta-analysis.

PURPOSE: The purpose of this research is to compare the clinical efficacy, postoperative complication and surgical trauma between anterior cervical corpectomy and fusion versus posterior laminoplasty for the treatment of oppressive myelopathy owing to cervical ossification of the posterior longitudinal ligament (OPLL). STUDY DESIGN: Systematic review and meta-analysis. METHODS: An comprehensive search of literature was implemented in three electronic databases (Embase, Pubmed, and the Cochrane library). Randomized or non-randomized controlled studies published since January 1990 to July 2017 that compared anterior cervical corpectomy and fusion (ACCF) versus posterior laminoplasty (LAMP) for the treatment of cervical oppressive myelopathy owing to OPLL were acquired. Exclusion criteria were non-human studies, non-controlled studies, combined anterior and posterior operative approach, the other anterior or posterior approaches involving cervical discectomy and fusion and laminectomy with (or without) instrumented fusion, revision surgeries, and cervical myelopathy caused by cervical spondylotic myelopathy. The quality of the included articles was evaluated according to GRADE. The main outcome measures included: preoperative and postoperative Japanese Orthopedic Association (JOA) score; neuro-functional recovery rate; complication rate; reoperation rate; preoperative and postoperative C2-C7 Cobb angle; operation time and intraoperative blood loss; and subgroup analysis was performed according to the mean preoperative canal occupying ratio (Subgroup A:the mean preoperative canal occupying ratio < 60%, and Subgroup B:the mean preoperative canal occupying ratio ≥ 60%). RESULTS: A total of 10 studies containing 735 patients were included in this meta-analysis. And all of the selected studies were non-randomized controlled trials with relatively low quality as assessed by GRADE. The results revealed that there was no obvious statistical difference in preoperative JOA score between the ACCF and LAMP groups in both subgroups. Also, in subgroup A (the mean preoperative canal occupying ratio < 60%), no obvious statistical difference was observed in the postoperative JOA score and neurofunctional recovery rate between the ACCF and LAMP groups. But, in subgroup B (the mean preoperative canal occupying ratio ≥ 60%), the ACCF group illustrated obviously higher postoperative JOA score and neurofunctional recovery rate than the LAMP group (P < 0.01, WMD 1.89 [1.50, 2.28] and P < 0.01, WMD 24.40 [20.10, 28.70], respectively). Moreover, the incidence of both complication and reoperation was markedly higher in the ACCF group compared with LAMP group (P < 0.05, OR 1.76 [1.05, 2.97] and P < 0.05, OR 4.63 [1.86, 11.52], respectively). In addition, the preoperative cervical C2-C7 Cobb angle was obviously larger in the LAMP group compared with ACCF group (P < 0.05, WMD - 5.77 [- 9.70, - 1.84]). But no statistically obvious difference was detected in the postoperative cervical C2-C7 Cobb angle between the two groups. Furthermore, the ACCF group showed significantly more operation time as well as blood loss compared with LAMP group (P < 0.01, WMD 111.43 [40.32,182.54], and P < 0.01, WMD 111.32 [61.22, 161.42], respectively). CONCLUSION: In summary, when the preoperative canal occupying ratio < 60%, no palpable difference was tested in postoperative JOA score and neurofunctional recovery rate. But, when the preoperative canal occupying ratio ≥ 60% ACCF was associated with better postoperative JOA score and the recovery rate of neurological function compared with LAMP. Synchronously, ACCF in the cure for cervical myelopathy owing to OPLL led to more surgical trauma and more incidence of complication and reoperation. On the other hand, LAMP had gone a diminished postoperative C2-C7 Cobb angle, that might be a cause of relatively higher incidence of postoperative late neurofunctional deterioration. In brief, when the preoperative canal occupying ratio < 60%, LAMP seems to be effective and safe. However, when the preoperative canal occupying ratio ≥ 60%, we prefer to choose ACCF while complications could be controlled by careful manipulation and advanced surgical techniques. No matter which option you choose, benefits and risks ought to be balanced.

Outcomes of cervical laminoplasty-Population-level analysis of a national longitudinal database.

OBJECTIVE: Cervical laminoplasty is an important alternative to laminectomy in decompressing of the cervical spine. Further evidence to assess the utility of laminoplasty is required. We examine outcomes of cervical laminoplasty via a population level analysis in the United States. METHODS: We performed a population-level analysis using the national MarketScan longitudinal database to analyze outcomes and costs of cervical laminoplasty between 2007 and 2014. Outcomes included postoperative complications, revision rates, and functional outcomes. RESULTS: Using a national administrative database, we identified 2613 patients (65.6% male, mean 58.5 years) who underwent cervical laminoplasty. Mean length of stay was 3.1 ±â€¯2.8 days and mean follow-up was 795.5 ±â€¯670.6 days. The overall complication rate was 22.5% (N = 587), 30-day readmission rate was 7.5% (N = 195), and mortality rate was 0.08% (N = 2, elderly patients only). The complication rate was significantly increased in elderly patients (age >65 years) compared to non-elderly patients (OR 0.751, p < .01). The use of intraoperative neuromonitoring (IONM) during the cervical laminoplasty procedure did not significantly impact outcomes. The overall re-operation rate after the initial procedure was 10.9%. Total costs of cervical laminoplasty were mainly driven by hospital charges with physician-related payments comprising a small amount. CONCLUSIONS: Our national analysis of cervical laminoplasty found the procedure to be clinically effective with low complication rates and postoperative symptomatic improvement.

Surgical outcomes of laminoplasty for cervical spondylotic myelopathy in very elderly patients (older than 80 years): Time from symptom onset to surgery and changes in spinal cord signal intensity on MRI.

OBJECTIVE: We aimed to assess the surgical outcomes of laminoplasty for cervical spondylotic myelopathy (CSM) in very elderly patients (older than 80 years), focusing specifically on the time from symptom onset to surgery and on the loss in spinal cord signal intensity on magnetic resonance imaging (MRI). PATIENTS AND METHODS: We retrospectively reviewed 100 consecutive patients (61 males and 39 females) with CSM who underwent laminoplasty between 2006 and 2014. The patients were stratified based on the age at the time of surgery, with Group A consisting of 26 patients aged 80 years or older and Group B consisting of 74 patients younger than 80 years. The severity of myelopathy was assessed in terms of the Japanese Orthopaedic Association (JOA) score. Signal intensity loss on MRI was graded from I to III based on the size of the area with intensity changes (Grade I, one disk; Grade II, larger than one disk) and presence of intramedullary hypointensity on T1-weighted sagittal scans (Grade III). Surgical outcome, morbidities, and changes in spinal cord signal intensity on MRI were analyzed. RESULTS: The time from symptom onset to surgery was 6.2±5.2 and 16.5±18.8months in Groups A and B, respectively, with significantly shorter duration of symptoms in Group A (p<0.001). Compared to Group B, Group A had lower mean JOA score preoperatively (8.8±1.9 vs. 10.1±1.7) and postoperatively (12.1±1.7 vs. 13.5±1.6), as well as lower mean JOA score recovery rate (40.7±12.5% vs. 51.0±15.4%) (p<0.05 for all). However, there was no difference between the groups regarding achieved JOA score (Group A, 3.3±1.0; Group B, 3.4±1.0). Preoperatively, intramedullary signal intensity change was observed in 84.6% of patients in Group A (22/26; 3, 13, and 6 patients with Grade I, II, and III, respectively), and in (82.4%) of patients in Group B (61/74; 18, 38, and 5 patients with Grade I, II, and , respectively), with significantly higher incidence of Grade III pattern in Group A than in Group B. CONCLUSION: Compared to younger patients, very elderly patients had a shorter time from symptom onset to surgery but lower preoperative JOA score, indicating that the condition of very elderly patients is likely to deteriorate and become severe rapidly after the onset of myelopathy. However, it is very important to know these pathologies and optimize the timing of surgery, as laminoplasty for CSM can be beneficial even in very elderly patients.

Predictors of cervical lordosis loss after laminoplasty in patients with cervical spondylotic myelopathy.

PURPOSE: To determine whether radiological, clinical, and demographic findings in patients with cervical spondylotic myelopathy (CSM) were independently associated with loss of cervical lordosis (LCL) after laminoplasty. METHODS: The prospective study included 41 consecutive patients who underwent laminoplasty for CSM. The difference in C2-7 Cobb angle between the postoperative and preoperative films was used to evaluate change in cervical alignment. Age, sex, body mass index (BMI), smoking history, preoperative C2-7 Cobb angle, T1 slope, C2-7 range of motion (C2-7 ROM), C2-7 sagittal vertical axis (C2-7 SVA), and cephalad vertebral level undergoing laminoplasty (CVLL) were assessed. Data were analyzed using Pearson and Spearman correlation test, and univariate and stepwise multivariate linear regression. RESULTS: T1 slope, C2-7 SVA, and CVLL significantly correlated with LCL (P < 0.001), whereas age, BMI, and preoperative C2-7 Cobb angle did not. In multiple linear regression analysis, higher T1 slope (B = 0.351, P = 0.037), greater C2-7 SVA (B = 0.393, P < 0.001), and starting laminoplasty at C4 level (B = - 7.038, P < 0.001) were significantly associated with higher postoperative LCL. CONCLUSIONS: Cervical alignment was compromised after laminoplasty in patients with CSM, and the degree of LCL was associated with preoperative T1 slope, C2-7 SVA, and CVLL.

Double-door cervical laminoplasty with suture anchors: evaluation of the clinical performance of the constructs.

PURPOSE: We aimed to investigate the clinical performance of the constructs of double-door cervical laminoplasty with suture anchors by examining bony fusion at the hinges and lamina closure. METHODS: We retrospectively analysed computed tomography (CT) scans obtained preoperatively, immediately after the operation, and at follow-up of patients who underwent cervical laminoplasty using suture anchors. Hinge fracture, bony healing at the hinges, suture anchor failure, and the lamina angle (LA) were evaluated using CT. Lamina closure was defined as an LA <55° at follow-up. RESULTS: A total of 226 laminae and hinges from 37 patients were evaluated. CT scans immediately after the operation revealed that 13 laminae (5.8 %) were fractured, one of which collapsed into the spinal canal. Bony fusion at an average of 12.7 months after the operation was noted at 222 hinges (98.2 %), which was not affected by hinge fracture. One dislodged suture anchor was identified. The mean LAs were 34.4 ± 4.2° preoperatively, 87.4 ± 12.3° immediately after the operation, and 82.5 ± 12.9° at follow-up. At follow-up, four cases of lamina closure were identified (1.8 %), and the closure rate was significantly higher at C3 than at the other levels, although it was not affected by age, sex, causative disease, cervical alignment, suture anchor use, and hinge fracture. CONCLUSIONS: The constructs of double-door cervical laminoplasty with suture anchors are stable with a high rate of fusion at the hinges. However, if the procedure is performed at C3, special modifications should be made to avoid lamina closure.

A prospective randomized trial comparing anterior cervical discectomy and fusion versus plate-only open-door laminoplasty for the treatment of spinal stenosis in degenerative diseases.

OBJECTIVE: For three or more involved cervical levels, there is a debate over which approach yields the best outcomes for the treatment of multilevel cervical degenerative disease. Our objective is to compare the radiological and clinical outcomes of two treatments for multilevel cervical degenerative disease: anterior cervical discectomy and fusion (ACDF) versus plate-only open-door laminoplasty (laminoplasty). METHODS: Patients were randomized on a 1:1 randomization schedule with 17 patients in the ACDF group and 17 patients in the laminoplasty group. Clinical outcomes were assessed by a visual analog scale (VAS), Japanese Orthopedic Association (JOA) scores, operative time, blood loss, rates of complications, drainage volume, discharge days after surgery, and complications. The cervical spine curvature index (CI) and range of motion (ROM) were assessed with radiographs. RESULTS: The mean VAS score, the mean JOA score, and the rate of complications did not differ significantly between groups. The laminoplasty group had greater blood loss, a longer operative time, more drainage volume, and a longer hospital stay than the ACDF group. There were no significant differences in the CI and ROM between the two groups at baseline and at each follow-up time point. ROM in both groups decreased significantly after surgery. CONCLUSIONS: Both ACDF and laminoplasty are effective and safe treatments for multilevel cervical degenerative disease. ACDF causes fewer traumas than laminoplasty.

Comparison between Radiological and Clinical Outcomes of Laminoplasties with Titanium Miniplates for Cervical Myelopathy.

BACKGROUND: Laminoplasty is a surgical procedure frequently performed for cervical myelopathy. We investigated correlations between changes in the anteroposterior diameter (APD) of the spinal canal, spinal canal area (SCA), and laminar angle (LA) and clinical outcomes of laminoplasty. METHODS: Of the 204 cervical myelopathy patients who underwent laminoplasty from July 2010 to May 2015, 49 patients who were evaluated with pre- and postoperative computed tomography of the cervical vertebrae were included. The average age of the patients was 60.4 years (range, 31 to 82 years), and the average duration of follow-up was 31.6 months (range, 9 to 68 months). Changes in the APD and SCA were measured at the middle of the vertebral body. Changes in LA were measured where both pedicles were clearly visible. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) score and visual analog scale score for pain preoperatively (1 day before surgery) and postoperatively (last outpatient visit) and examining postoperative complications. RESULTS: The APD showed an average of 54.7% increase from 11.5 to 17.8 mm. The SCA showed an average of 57.7% increase from 225.9 to 356.3 mm2. The LA increased from 34.2° preoperatively to 71.9° postoperatively. The JOA score increased from an average of 9.1 preoperatively to 13.4 postoperatively. Three patients were found to have hinge fractures during surgery. Postoperative complications, including two cases of C5 palsy, were recorded. The correlation coefficient between the LA change and JOA score improvement was -0.449 (p < 0.05). Patients with a < 33° (25%) increase in the LA showed the most significant clinical improvement. CONCLUSIONS: Patients with a < 33° (25%) change in the LA after laminoplasty with a titanium miniplate showed the most significant clinical improvement. Thus, LA changes can be useful in predicting the clinical outcome of laminoplasty.

Safety and efficacy of cervical laminoplasty using a piezosurgery device compared with a high-speed drill.

BACKGROUND: Piezosurgery is a relatively new osteotomy technique using microvibrations of scalpels at ultrasonic frequencies to perform safe and effective osteotomies without damage to adjacent soft tissue, which is widely used in spinal, oral, and maxillofacial surgery. We hypothesized that such a device could also be useful in cervical laminoplasty. The purpose of this study was to compare the safety and efficacy of a piezosurgery device with those of a highspeed drill in cervical laminoplasty. METHODS: A prospectively randomized clinical study was designed. Forty-two consecutive patients were enrolled in the study. All patients underwent modified expansive open-door laminoplasty and were randomly divided into 2 groups according to the instrument for transection of the lamina, using high-speed drill (drill group) or piezosurgery device (piezosurgery group). The operation time, intraoperative blood loss, and postoperative drainage were recorded. Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) as clinical assessments were quantified. RESULTS: No significant difference was observed in the operation time between the 2 groups. In the piezosurgery group, there were less loss of the intraoperative blood and postoperative drainage compared with the drill group. However, clinical results (VAS and JOA scores) showed no significant difference between both groups during the all follow-up periods. CONCLUSION: The piezosurgery is a useful instrument and at least as safe and efficacious as the conventional high-speed drill in cervical laminoplasty.

Cervical corpectomies: results of a survey and review of the literature on diagnosis, indications, and surgical technique.

OBJECTIVES: Cervical corpectomy is an uncommon procedure and there are only limited data on the procedure's indications, surgical approaches, and complications. The diagnosis, indications, surgical planning, and complications of cervical corpectomy were therefore surveyed to clarify the treatment strategies used by spinal surgeons in central Europe, with special attention to preoperative planning and decision-making for additional dorsal approaches in multilevel cases. MATERIALS AND METHODS: An online survey with 18 questions on the preoperative, intraoperative, and postoperative management of cervical corpectomies was conducted. The relevant specialist societies in Germany and Austria provided 1137 contacts for surgeons, and the responses were compared with recent literature reports. RESULTS: In all, 302 surgeons (27 %) completed the survey, with wide variability in the treatment options offered. Most (51 %) perform fewer than five anterior cervical corpectomy and fusion (ACCF) procedures per year; 35 % do 5-20 per year. Anterior cervical discectomy and fusion (ACDF) was preferred by 41 % of the participants to laminoplasty/laminectomy (19 %/16 %) and ACCF (12 %). Most indications for ACCF involved degenerative (27 %), traumatic (17 %), and neoplastic (20 %) conditions. Intraoperative and postoperative complications were mainly associated with hardware failure. One-third of the surgeons tend to use an additional dorsal approach to increase the corpectomy construct's stability for either two-level or three-level corpectomies. CONCLUSIONS: There is no current consensus in central Europe on the treatment of complex cervical disease and cervical corpectomy. The procedure is still rare, and the need for additional dorsal fixation is unclear. Further studies are needed in order to establish evidence-based standards for patient care.

Is Mini-Plate Fixation Superior to Suture Suspensory Fixation in Cervical Laminoplasty? A Meta-Analysis.

BACKGROUND: Owing to the small sample sizes in individual studies reported to date, whether or not mini-plate fixation is better than suture suspensory fixation in unilateral open-door laminoplasty is unclear. Thus, we conducted a meta-analysis to evaluate which fixation method is superior in cervical laminoplasty for patients with multilevel cervical spondylotic myelopathy (MCSM). METHODS: Several electronic databases were selected to search the related studies. The main endpoints included operation time, blood loss, preoperative Japanese Orthopedic Association (JOA) score, postoperative JOA score, JOA recovery rate, postoperative anteroposterior diameter, open angle, and the incidence of axial symptoms or C5 palsy after surgery. The results are presented as mean difference (MD) for continuous outcomes and odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes. RESULTS: Six studies, including a total of 436 patients, were included in this review. The postoperative JOA score was higher in patients receiving suture suspensory fixation (group B) than in those receiving mini-plate fixation (group A) (MD, 0.51; 95% CI, 0.07-0.96; P = 0.002), as was the incidence of C5 palsy (OR, 0.37; 95% CI, 0.15-0.92; P = 0.03). In 5 of the 6 studies, including 282 patients, the incidence of axial symptoms was lower in group A (OR, 0.37; 95% CI, 0.21-0.67; P = 0.0009). There were no significant differences (P > 0.05) between groups A and B in terms of operation time, blood loss, JOA recovery rate, postoperative anteroposterior diameter, or open angle after surgery. CONCLUSIONS: Although suture suspensory fixation was associated with better postoperative JOA scores, mini-plate fixation was superior in reducing the incidence of surgical complications. To avoid severe surgical complications, mini-plate fixation is a good choice for laminoplasty for patients with MCSM. Valid evidence depends on more high-quality, randomized controlled trials in the future.

Clinical Outcomes of Spinal Surgery for Patients Undergoing Hemodialysis.

This study investigated the surgical outcomes of spinal surgery for degenerative disorder in patients undergoing hemodialysis. Forty patients maintained on hemodialysis who underwent spinal surgery were reviewed. Of the 17 cases of cervical surgery, anterior fusion was performed in 3 patients, laminoplasty in 12, and posterior fusion in 2. Of the 29 cases of lumber surgery, decompression surgery was performed in 14 patients, spinal fusion in 14, and balloon kyphoplasty in 1. The authors focused on cases of destructive spondyloarthropathy (DSA) and retrospectively compared the non-DSA and DSA groups by examining multiple clinical parameters. Intra- or postoperative severe complications occurred in 4 (10%) patients, and 1 (2.5%) patient died due to cardiac failure. The reoperation rate was 27.6% in patients undergoing lumbar surgery and 5.9% in patients undergoing cervical surgery. Five (35.7%) of 14 patients treated with decompression alone subsequently underwent fusion surgery as a revision intervention. Furthermore, 3 (21.4%) of 14 patients undergoing lumbar surgery treated with a primary spinal fusion subsequently underwent an extended fusion surgery. Although there was no significant difference in the recovery rate of the Japanese Orthopaedic Association scores between the non-DSA and DSA groups, severe complications after spinal surgery tended to occur in the DSA group. Although good neurological recovery can be expected in patients undergoing hemodialysis, attention should be paid to the potential for postoperative complications. Severe complications tended to occur in patients with DSA or in those undergoing hemodialysis for more than 15 years. [Orthopedics.2016; 39(5):e863-e868.].

Multivariate Analysis of Factors Associated With Axial Symptoms in Unilateral Expansive Open-Door Cervical Laminoplasty With Miniplate Fixation.

Retrospective case-control study.Unilateral expansive open-door cervical laminoplasty with miniplate fixation is an efficient and increasing popular surgery for multilevel cervical spondylotic myelopathy. Axial symptoms are the most frequent complaints after cervical laminoplasty. But the mechanisms have not been fully clarified yet.The objective of this study is to compare the clinical and radiologic data between patients with or without axial symptoms and to investigate the factors associated with axial symptoms by multivariate analysis in cervical laminoplasty with miniplate fixation.A total of 129 patients who underwent cervical laminoplasty with miniplate fixation were comprised from August 2009 to March 2014. Patients were grouped according to whether they suffered from postoperative axial symptoms (PA) or not (NA). The clinical data including gender, age, duration of symptoms, diagnosis type, medical comorbidity, operative level, blood loss, operative time, pre- and post-Japanese Orthopedic Association (JOA) score, JOA recovery rates, and other complications were recorded. The radiologic data including cervical canal diameter, C2-7 Cobb angle, cervical range of motion (ROM), cross-sectional area, open angle, hinge union, and facet joint destroyed would be measured according to X-ray plain and CT scan images. The univariate analysis and multivariate logistic regression analysis were performed.There were 39 patients in PA group and 90 patients in NA group. Both groups gained significant JOA improvement postoperatively (P < 0.05). The preoperative neck pain (P = 0.048), negative change of cervical ROM (P = 0.018), and facet joints destroyed (P = 0.022) were significant different between the 2 groups. There were no significant differences for other clinical and radiography parameters between the groups (P > 0.05). The multivariate analysis showed that the negative change of cervical ROM (OR = 1.062, P = 0.047) and facet joints destroyed (OR = 0.661, P = 0.024) were related to axial symptoms.The change of cervical ROM and facet joints destroyed by miniscrews might be associated with axial symptoms after cervical laminoplasty with miniplate fixation. Cervical spine surgeons should carefully operate to decrease the injury of posterior musculature structure and protect the facet joints.

Predictors of morbidity and mortality among patients with cervical spondylotic myelopathy treated surgically.

PURPOSE: The aim of this study is to report and quantify the associated factors for morbidity and mortality following surgical management of cervical spondylotic myelopathy (CSM). METHODS: The Nationwide Inpatient Sample (NIS) database was use to retrospectively review all patients over 25 years of age with a diagnosis of CSM who underwent anterior and/or posterior cervical fusion or laminoplasty between 2001 and 2010. The main outcome measures were total procedure-related complications and mortality. Multivariate regression analysis was used to identify demographic, comorbidity, and surgical parameters associated with increased morbidity and mortality risk [reported as: OR (95% CI)]. RESULTS: A total of 54,348 patients underwent surgical intervention for CSM with an overall morbidity rate of 9.83% and mortality rate of 0.43%. Comorbidities found to be associated with an increased complication rate included: pulmonary circulation disorders [6.92 (5.91-8.12)], pathologic weight loss [3.42 (3.00-3.90)], and electrolyte imbalance [2.82 (2.65-3.01)]. Comorbidities found to be associated with an increased mortality rate included: congestive heart failure [4.59 (3.62-5.82)], pulmonary circulation disorders [11.29 (8.24-15.47)], and pathologic weight loss [5.43 (4.07-7.26)]. Alternatively, hypertension [0.56 (0.46-0.67)] and obesity [0.36 (0.22-0.61)] were found to confer a decreased risk of mortality. Increased morbidity and mortality rates were also identified for fusions of 4-8 levels [morbidity: 1.55 (1.48-1.62), mortality: 1.80 (1.48-2.18)] and for age >65 years [morbidity: 1.65 (1.57-1.72), mortality: 2.74 (2.25-3.34)]. An increased morbidity rate was found for posterior-only [1.55 (1.47-1.63)] and combined anterior and posterior fusions [3.20 (2.98-3.43)], and an increased mortality rate was identified for posterior-only fusions [1.87 (1.40-2.49)]. Although revision fusions were associated with an increased morbidity rate [1.81 (1.64-2.00)], they were associated with a decreased rate of mortality [0.24 (0.10-0.59)]. CONCLUSION: The NIS database was used to provide national estimates of morbidity and mortality following surgical management of CSM in the United States. Several comorbidities, as well as demographic and surgical parameters, were identified as associated factors.