Abstract
ObjectivesTo explore the factors associated with the increased spinal cord area in single-door cervical laminoplasty (SDCL) with miniplate fixation.MethodsA retrospective study enrolled 83 patients underwent SDCL with miniplate fixation and the patient characteristics such as age, gender, tobacco use, alcohol use, diabetes mellitus, hypertension, diagnosis, operative level, etc., were obtained. The opening angle, door shaft position and spinal canal area of the patients were measured after surgery. The sagittal canal diameter (SCD), the C2–7 Cobb angle, the cervical curvature index (CCI), the range of motion (ROM) and the spinal canal area were measured before and after operation. The increased cervical spinal cord area was also measured before and after surgery, and the correlation between the above indicators and the increased cervical spinal cord area was studied through Pearson’s correlation analysis and multivariate logistic regression analysis.ResultsThere were 34 patients in small spinal cord area increment group (SAI group), 29 patients in middle spinal cord area increment group (MAI group) and 20 patients in large spinal cord area increment group (LAI group). The preoperative diagnosis(P = 0.001), door shaft position (P = 0.008), preoperative spinal canal area (P = 0.004) and postoperative spinal canal area (P = 0.015) were significant different among the 3 groups. The multivariate analysis showed that the preoperative diagnosis (OR = 2.076, P = 0.035), door shaft position (OR = 3.425, P = 0.020) and preoperative spinal canal area (OR = 10.217, P = 0.009) were related to increased spinal cord area.ConclusionsThe preoperative diagnosis, door shaft position and preoperative spinal canal area might be associated with increased spinal cord area after cervical laminoplasty with miniplate fixation. Preoperative symptoms are mostly caused by compression of the spinal cord, so spinal cord area enlargement can bring a better recovery in patients alongside long-term. Spine surgeons should pay more attention to the accuracy of the preoperative diagnosis, the preoperative measurement of spinal canal area and the door shaft position during the operation.
Highlights
Single-door cervical laminoplasty (SDCL) has been widely used for patients with ossification of the posterior longitudinal ligament (OPLL), multiple cervical discs herniation (MCDH) and degenerative cervical spinal canal stenosis (DCSS) [1]
There are extensive studies to explore the relationship among opening size, door shaft position, opening angle, sagittal canal diameter (SCD), spinal canal area and axial pain after SDCL [5,6,7,8]
All of the patients included in the study were diagnosed with OPLL, MCDH or DCSS according to their clinical manifestations and results of x-rays and computed tomography (CT) and magnetic resonance imaging (MRI) scans before SDCL with miniplate fixation
Summary
Single-door cervical laminoplasty (SDCL) has been widely used for patients with ossification of the posterior longitudinal ligament (OPLL), multiple cervical discs herniation (MCDH) and degenerative cervical spinal canal stenosis (DCSS) [1]. The purpose of cervical laminoplasty is to indirectly relieve the compression of the spinal cord by posterior enlargement of the spinal canal, which enables a better recovery for patients, as well as a longterm effectiveness of the surgery [3, 4]. The increased spinal cord area after open-door surgery can indirectly reflect the effect of decompression, which is a problem worthy of our attention. Few studies focused on the increased spinal cord area after surgery, especially for the cervical laminoplasty with miniplate fixation [10]. The objective of the current study was to observe the increased spinal cord area and to elucidate the potential factors associated with it after SDCL with miniplate fixation
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