Cervical Expansive Laminoplasty Research Articles

The application of the concept of minimal invasive spine surgery in the development and innovation of cervical expansive laminoplasty

Posterior cervical decompression is an important method for the treatment of cervical myelopathy resulting from cervical stenosis due to various pathology.Over the past 40 years,scholars from all over the world have made unremitting efforts in exploring the posterior decompression of the cervical spine and the protection and reconstruction of the cervical spine function,and have achieved remarkable results.The new concept of minimally invasive spinal surgery has stimulated the development of the new technology of cervical expansive laminoplasty via trans-muscular space approach and brought about new progress in the surgical treatment of cervical spondylosis.Cervical expansive laminoplasty via trans-muscular space approach provided a better solution for the posterior decompression while protecting and reconstructing the structure and function of the cervical spine.These achievements are not only the concrete embodiment and practice of the concept of minimally invasive spine surgery in posterior cervical spine surgery,but also show the persistent and endless pursuit of spinal surgeons to realize the concept of original ecological surgery in the cervical spine.

A Novel Method of Making Hinges Using a Newly Designed Sharp Rongeur to Enhance Radiological and Clinical Outcomes in French-Door Cervical Expansive Laminoplasty.

Although the lamina open angle of making hinges is closely related to the outcomes of French-door laminoplasty (FDL) for treatment of cervical spondylosis, there have been no methods to predict the lamina open angle preoperatively as yet. The aim of this study was to investigate the accuracy of predicting the laminal open angle using our newly designed sharp rongeur, and to compare the postoperative outcomes and complications between the methods of making hinges using the newly designed sharp rongeur and the traditional high-speed micro-drill during the FDL. This was a single-center retrospective study. Following the approval of the institutional ethics committee, a total of 39 patients (Male: 28; Female: 11) diagnosed with cervical spondylos who underwent FDL in our institution between January 2018 and May 2019 were enrolled. Patients were divided into two groups based on the method of making hinges (sharp rongeur: 22 cases; high-speed micro-drill: 17 cases). The average age at surgery was 59.1 years (range: 16-85 years). The radiological parameters, clinical outcomes, modified Japanese Orthopaedic Association (mJOA) scale score, and the recovery rate of mJOA were recorded and compared between the groups, respectively. The radiological parameters and clinical measurements at pre- and post-operation stages were compared using the paired-sample t-test, the Wilcoxon signed-rank test, and the Friedman's test, and variables in the two groups were analyzed using an unpaired Student's t-test or a Mann-Whitney U test. The average follow-up period was 20.4 months (range: 14.0-25.9 months), the postoperative open angle was 60.13° ± 3.69° in the rongeur group with 22.78° ± 4.34° of angular enlargement, which was significantly lower than that of 68.96° ± 1.00° in the micro-drill group with 32.75° ± 4.22° of angular enlargement (U=19.000, p < 0.001). The rongeur group showed a higher fusion rate (34.1% vs 14.7%, χ2 =11.340, p=0.001), and a lower fracture rate of the lamina (7.8% vs 25.5%, χ2 =14.185, p < 0.001) at 1-month post-surgery, compared to the micro-drill group. There were no significant differences in the clinical outcomes and postoperative complications between the two groups (p > 0.05), except in the recovery rate of mJOA scores (0.836 ± 0.138 vs 0.724 ± 0.180, U=115.000, p=0.042) and neck disability index (NDI) at the final follow-up (7.55 ± 10.65 vs 14.71 ± 8.72, U=94.000, p=0.008). The special sharp rongeur with a tip angle of 20° could be a preferred method to make hinges during FDL, which can predict the laminal open angle accurately and enlarge it to about 23°, thus reducing the fracture rate and accelerating the bony fusion of hinges compared with the outcomes of the traditional micro-drill method.

Comparison of blood loss between tranexamic acid-soaked absorbable Gelfoam and topical retrograde injection via drainage catheter plus clamping in cervical laminoplasty surgery

BackgroundTo compare the safety and efficacy of tranexamic acid (TXA)-soaked absorbable Gelfoam and the retrograde injection of TXA through a drain with drain-clamping in degenerative cervical laminoplasty patients.MethodsPatients were assigned into either TXA retrograde injection (TXA-RI), TXA-soaked absorbable Gelfoam (TXA-Gel), or control groups. The demographics, operative measurements, volume and length of drainage, length of hospital stay, complete blood cell count, coagulopathy, postoperative complications, and blood transfusion were recorded.ResultsWe enrolled 133 patients, with 44, 44, and 45 in the TXA-RI, TXA-Gel, and control groups, respectively. The baseline characteristics did not differ significantly among the three groups. The TXA-RI group exhibited a lower volume and length of postoperative drainage compared to the TXA-Gel and control groups (126.60 ± 31.27 vs. 156.60 ± 38.63 and 275.45 ± 75.27 mL; 49.45 ± 9.70 vs 58.70 ± 10.46 and 89.31 ± 8.50 hours, all P < 0.01). The TXA-RI group also had significantly shorter hospital stays compared to the control group (5.31 ± 1.18 vs 7.50 ± 1.25 days, P < 0.05) and higher hemoglobin and hematocrit levels (12.58 ± 1.67 vs 11.28 ± 1.76 g/dL; 36.62 ± 3.66% vs 33.82 ± 3.57%, both P < 0.05) at hospital discharge. In the TXA-RI and TXA-Gel groups, the D-dimmer (DD) and fibrinogen (FIB) were significantly lower than those in the control group after surgery (P < 0.05). None of the patients required blood transfusion. No complications, including thromboembolic events, were reported.ConclusionTopical retrograde injection of TXA through a drain with drain-clamping at the conclusion of unilateral posterior cervical expansive open-door laminoplasty may effectively reduce postoperative blood loss and the length of hospital stays without increasing postoperative complications.

Progressive Kyphosis Deformity with Facet Subluxation after Cervical Expansive Laminoplasty: A Case Report

In Japan, laminoplasty is often chosen over anterior surgery for the treatment cervical spondylotic myelopathy because most patients are the elderly with multiple stenoses. Laminoplasty is associated with lower perioperative risk, and it can be executed by inexperienced surgeons with relative ease. However, it is also associated with progression of kyphosis, which can result in the deterioration of neck pain and recurrence of myelopathy. Herein, we present a case in which kyphosis deformity progressed post-laminoplasty, resulting in intervertebral joint dislocation and worsening myelopathy. A 70-year-old Japanese man who underwent laminoplasty 10 months ago, presented with worsening myelopathy symptoms that had recurred after previously persisting for several days. These symptoms were associated with restenosis of the spinal canal at the C4/5 level due to spondylolisthesis and facet dislocation. As a corrective surgery, we performed anterior-posterior surgery. His post-operative course was almost satisfactory, and post-operative magnetic resonance imaging showed an improvement in spinal cord compression. Progressive kyphosis deformity can rarely lead to dislocation of the intervertebral joints, worsening myelopathy. Although the prevention of kyphotic deformity is still difficult, laminoplasty should be performed in patients with a high risk of post-operative kyphosis, such as in this case, considering the possibility of deterioration of myelopathy associated with kyphosis.

C7 Fracture as a Complication of C7 Dome-Like Laminectomy : Impact on Clinical and Radiological Outcomes and Evaluation of the Risk Factors.

ObjectiveCervical expansive laminoplasty is an effective surgical method to address multilevel cervical spinal stenosis. During surgery, the spinous processes of C2 and C7 are usually preserved to keep the insertion points of the cervical musculature and nuchal ligament intact. In this regard, dome-like laminectomy (undercutting of C7 lamina) instead of laminoplasty is performed on C7 in selected cases. However, resection of the lamina can weaken the C7 lamina, and stress fractures may occur, but this complication has not been characterized in the literature. The objective of the present study was to investigate the incidence and risk factors for C7 laminar fracture after C7 dome-like laminectomy and its impact on clinical and radiological outcomes. MethodsPatients who underwent cervical open-door laminoplasty combined with C7 dome-like laminectomy (n=123) were classified according to the presence of C7 laminar fracture. Clinical parameters (neck/arm pain score and neck disability index) and radiologic parameters (C2–7 angle, C2–7 sagittal vertical axis, and C7–T1 angle) were compared between the groups preoperatively and at postoperatively at 3, 6, 12, and 24 months. Risk factors for complications were evaluated, and a formula estimating C7 fracture risk was suggested. ResultsC7 lamina fracture occurred in 32/123 (26%) patients and occurred at the bilateral isthmus in 29 patients and at the spinolaminar junction in three patients. All fractures appeared on X-ray within 3 months postoperatively, but patients did not present any neurological deterioration. The fracture spontaneously healed in 27/32 (84%) patients at 1 year and in 29/32 (91%) at 2 years. During follow-up, clinical outcomes were not significantly different between the groups. However, patients with C7 fractures showed a more lordotic C2–7 angle and kyphotic C7–T1 angle than patients without C7 fractures. C7 fracture was significantly associated with the extent of bone removal. By incorporating significant factors, the probability of C7 laminar fracture could be assessed with the formula 'Risk score = 1.08 × depth (%) + 1.03 × length (%, of the posterior height of C7 vertebral body)', and a cut-off value of 167.9% demonstrated a sensitivity of 90.3% and a specificity of 65.1% (area under the curve, 0.81). ConclusionC7 laminar fracture can occur after C7 dome-like laminectomy when a substantial amount of lamina is resected. Although C7 fractures may not cause deleterious clinical outcomes, they can lead to an unharmonized cervical curvature. The chance of C7 fracture should be discussed in the shared decision-making process.

Radiological Imaging Analysis of Cervical Expansive Open-door Laminoplasty Causing C5 Palsy

The aim of this research is to explore the difference of imaging parameters in patients with C5 palsy after cervical expansive open-door laminoplasty. A retrospective analysis was made on the clinical data of 62 patients who were diagnosed as multiple cervical spondylotic myelopathy and operated with cervical expansive open-door laminoplasty using Centerpiece titanium miniplate fixation. According to weather C5 nerve root palsy occurred after surgery, the patients were divided into normal group (group A with 8 cases) and paralysis group (group B with 54 cases). The preoperative and postoperative cervical spine angle (C2–7) enlargement rate of spinal canal, distance of spine cord shifting and cervical curvature between two groups were measured. Compare with group A (27.38±1.99°), the average lamina open angle of group B (34.56±5.55°) was larger, which were found statistically significant difference (P<0.05). In addition, there were no significant differences between two groups in C3 or C7 lamina open angle. However, significant differences were found between two groups in C4, C5 and C6 lamina open angle. The average enlargement rate of spinal canal and distance of spine cord shifting of group B were larger than group A, which was statistically differences (P<0.05). The opening angle of the lamina, the expansion rate of the spinal canal, and the distance of the spinal cord may prevent the occurrence of cervical 5 nerve root palsy in cervical expansive open-door laminoplasty.

P120. The efficacy and safety of applying ultrasonic osteotome in cervical expansive open-door laminoplasty

BACKGROUND CONTEXT Ultrasonic osteotome is a tissue-specific device which offers potential advantages of more precise bone resection, reduced soft-tissue injury, and less demand in surgical skill, and have been used widely in spinal surgery. Yet few studies have investigated its safety and efficacy until now. PURPOSE To investigate the safety and efficacy of applying ultrasonic osteotome in patients undergoing cervical expansive open-door laminoplasty. STUDY DESIGN/SETTING Retrospectiviely we collected the patients' clinical data and the follow-up image. All the patients were diagnosed as multilevel cervical spondylosis myelopathy and underwent cervical expansive open-door laminoplasty. Then we divided these patients into two groups: ultrasonic osteotome group and traditional group, by whether the ultrasonic osteotome device was used in operation. PATIENT SAMPLE From March 2015 to March 2016, 94 consecutive patients who were administrated in the spine group of orthopedic department of Peking University Third Hospital were reviewed retrospectiviely. OUTCOME MEASURES Comparison was made between the traditional method using bone rongeur or high-speed grinding, and the piezosurgery group. Duration of operation (from skin incision to closure), blood loss during surgery, volume of drainage first day after operation, remaining of drainage tube, and occurrence of cerebrospinal fluid leak were assessed between the two groups. JOA spinal cord function scoring system (17-point method) was adopted to evaluation neurological function. JOA score before operation, 3 months after operation, 12 months after operation and JOA improvement rate was compared between two groups. JOA improvement rate = (postoperative JOA score - preoperative JOA score) / (17 - preoperative JOA score) × 100%. Three months and 12 months follow-up CT scans were used to evaluate portal shaft healing by assessing C4, C5, and C6 portal bones. METHODS From March 2015 to March 2016, 94 consecutive patients who were administrated in the spine group of orthopedic department of Peking University Third Hospital were reviewed retrospectiviely. All the patients were diagnosed as multilevel cervical spondylosis myelopathy and were underwent cervical expansive open-door laminoplasty. These patients were divided into two groups: ultrasonic osteotome group and traditional group, by whether the ultrasonic osteotome device was used in operation. The parameters we studied were as follows: the duration of operation, blood loss in operation, volume of drainage at the first postoperative day, days of remaining the drainage tube, preoperative and postoperative JOA score, complication of cerebrospinal fluid leak and hinge bone nonunion. RESULTS Comparing to the traditional group, the duration of operation of the ultrasonic osteotome group was increased, but the blood loss in operation, volume of drainage at the first postoperative day and days of remaining the drainage tube of the ultrasonic osteotome group were all reduced. There is no obvious difference between the two groups when considering the cerebrospinal fluid leak. At the 3 month follow-up, the JOA score and improvement rate of JOA score showed no obvious difference between the two groups. But the hinge bone union of the traditional group is better than the ultrasonic osteotome group. At the 12 month follow-up, all the JOA score, the improvement rate of JOA score and the hinge bone union were not obviously different between the two groups. CONCLUSIONS Applying ultrasonic osteotome in patients undergoing cervical expansive open-door laminoplasty is both safe and effective. Comparing with the rongeur, ultrasonic osteotome caused the delayed union of the hinge bone, but it reduces the blood loss in operation, volume of postoperative drainage and days of remaining the drainage tube. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

The time course of cervical alignment after cervical expansive laminoplasty: Determining optimal cut-off preoperative angle for predicting postoperative kyphosis.

Retrospective Cohort studyTo analyze cervical lordosis angle (CLA) change after cervical expansive laminoplasty (CEL) over time, and to determine optimal cut-off angle for predicting postoperative kyphosisPostoperative development of sagittal malalignment after laminoplasty is associated with neurological dysfunction and neck pain. However, there is no information on the serial CLA change over time and cut-off angle for predicting postoperative kyphosisThe Cobb angle between C2 and C7 in a series of lateral cervical X-rays in the neutral position was retrospectively reviewed for 36 months. And, the effect of time on CLA after CEL and the risk factors associated with postoperative cervical kyphosis (Cobb's angle ≤0°) were analyzed. Also, the optimal cut-off angle for predicting postoperative kyphosis was determined.A total of 110 cases of CEL for cervical myelopathy were enrolled from February 2005 to May 2010. The mean cervical alignment changed from 12.3 ± 10.4° (mean ± standard deviation [SD]) at the preoperative evaluation to 8.2 ± 11.6°, 10.6 ± 10.1°, 9.1 ± 10.0°, 8.4 ± 11.2°, 8.5 ± 10.5°, 8.1 ± 9.9°, and 8.7 ± 10.1° at 1, 3, 6, 12, 18, 24, and 36 postoperative months, respectively. The cervical lordosis showed statistically significant decreased at the 1st month, then the lordotic angle was partially restored at the 3rd, and 6th, and then no significant changes after the 6th. The only risk factor for kyphosis development was the preoperative CLA. The optimal cut-off preoperative angle for predicting postoperative kyphosis was 8.5°.The decrease of CLA after expansive laminoplasty peaked in the 1st month. Some of the lordotic angles were restored in the 3rd and 6th months, before reaching a plateau after the 6th month. The optimal cut-off preoperative angle for predicting postoperative kyphosis was 8.5°.Level of Evidence of their study: Level 4.

Cervical Expansive Laminoplasty versus Laminectomy with Fusion for Cervical Ossification of the Posterior Longitudinal Ligament (OPLL)

Cervical Expansive Laminoplasty versus Laminectomy with Fusion for Cervical Ossification of the Posterior Longitudinal Ligament (OPLL)

Probe Laminotomy: A Simple Technique for Precise Lateral Gutter Placement in Cervical Expansive Laminoplasty

In cervical expansive laminoplasty, precise placement of lateral gutters is important. Placing them too medially results in suboptimal canal expansion, and placing them too laterally results in facet joint violation. However, precise placement is often difficult. We have included a simple procedure called probe laminotomy in cervical expansive laminoplasty since 2013. This technique consisted of identifying the location of the pedicles through a small laminotomy with medial facetectomy before making lateral gutters. A case-control study was performed to compare the achieved postoperative canal area and duration of surgery between the original technique and the added probe laminotomy. The postoperative canal area was 21% larger in the probe laminotomy group compared with the standard technique group (P= 0.0003). There was no significant difference in duration of surgery between the groups. This technique facilitated more precise placement of the lateral gutter in cervical expansive laminoplasty, which resulted in a larger postoperative canal. This technique should be considered as an option in cervical expansive laminoplasty.

Analysis of clinical effects of absorbable hemostatic fluid gelatin and absorbable gelatin sponge on the hemostasis during operation of unilateral open-door cervical expansive laminoplasty

To compare the hemostatic effect between absorbable hemostatic fluid gelatin (HFG) and absorbable gelatin sponge(GS) during operation of unilateral open-door cervical expansive laminoplasty. The clinical data of 83 patients underwent unilateral open-door cervical expansive laminoplasty from February 2014 to May 2016 were retrospectively analyzed. According to the used hemostatic materials, patients were divided into two groups. In HFG group, there were 30 males and 11 females, ranging in age from 29 to 81 years, with an average of(55.6±11.6)years; 14 cases were simple cervical spinal stenosis, 9 were cervical spinal stenosis and ossification of posterior longitudinal ligament, and 18 were cervical spinal stenosis complicated with multiple cervical disc herniation. And in GS group, there were 32 males and 10 females, ranging in age from 36 to 78 years, with an average of (55.4±11.1) years; 12 cases were simple cervical spinal stenosis, 10 were cervical spinal stenosis complicated with ossification of posterior longitudinal ligament, and 20 were cervical spinal stenosis complicated with multiple cervical disc herniation. There was no significant difference in the age, gender, and disease categories of patients between two groups (P>0.05). The operative time, intraoperative bleeding, postoperative drainage, and postoperative complications were compared between two groups. The average operative time, intraoperative bleeding, and postoperative drainage in HFG group were(137.2±30.0) min, (156.1±74.6) ml, and (212.1±67.6) ml, respectively; and in GS group were (154.8±33.5) min, (242.9±120.7) ml, and(303.3±115.5) ml, respectively. There were significantly differences in above items between two groups(P<0.05). No acute heamatoma or related complications was found postoperatively. Compared with GS, HFG can obviously decrease operative time, intraoperative bleeding, and postoperative drainage. It is a safe and effective hemostatic material for the operation of unilateral open-door cervical expansive laminoplasty.

Cervical expensive open-door laminoplasty combined with vitamin B12 treatment for patients of cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord

Objective To investigate the clinical outcome of cervical expensive open-door laminoplasty combined with vitamin B12 treatment for patients of cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord. Methods Data of 10 patients with cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord in February 2013 to August 2013 were retrospectively analyzed. There were 7 males and 3 females with an average age of 46 years (range, 32-73 years). Eight patients’ history was in six months, and others’ was beyond six months. All patients had undergone cervical expansive open-door laminoplasty with mini-plate fixation combined with intramuscular injection or pre os vitamin B12. Patient imaging data were used to assess the stability of the cervical spine, and spinal cord compression in the fixed position before and after their surgery. Japanese Orthopaedic Association (JOA) score was used to evaluate function, and the rate of neurological improvement was calculated. The American Spinal Injury Association was used to evaluate the neurological function inpatients be-fore and after surgery. The preoperative and postoperative numerical changes of SEP and vitamin B12 were compared using corre-lation analysis. Each dimension of preoperative and postoperative scores change was compared by Life quality evaluation F-36 scale. Results All patients were followed up for an average period of 15 months (range, 6-26 months). There were no complica-tions related to the internal fixation, such as fixation loosened or broken. Cerebrospinal fluid surrounding the spinal cord within the C3-7 range of the signal on MRI T2WI of the continuous had been recovered. JOA score increased from preoperative 9.6±2.04 to postoperative 14.7±2.04, and postoperative neurological improvement rate was 20%-80%. The excellent and good rate was 90% (9/10) including 4 excellent and 5 good. Vitamin B12 level before operation: 78.30±42.82 pg/ml, postoperative: 176.50±85.77 pg/ml. Electromyography and SEP had been all recovered. There was correlation between preoperative and postoperative vitamin B12 lev-els with spinal cord function score. According to ASIA score, there were 4 cases in C level, 6 in D level preoperatively, while 2 in C level, 5 in D level, 3 in E level postoperatively. Conclusion Cervical spondylotic myelopathy with subacute combined degen- eration of the spinal cord could be treated by surgery. Vitamin B12 by per os or intramuscular injection with removal of the cervi-cal spinal cord compression which creates a space for recovery of spinal cord could improve the surgical curative effect. Key words: Cervical vertebrae; Vitamin B12 deficiency; Subacute combined degeneration

Efficacy of Cervical Expansive Laminoplasty for Quadriplegic Patients Without Cervical Bony Injury

Efficacy of Cervical Expansive Laminoplasty for Quadriplegic Patients Without Cervical Bony Injury

Efficacy of Cervical Expansive Laminoplasty for Quadriplegic Patients Without Cervical Bony Injury

Efficacy of Cervical Expansive Laminoplasty for Quadriplegic Patients Without Cervical Bony Injury

Effect of Mini-plate Fixation on Hinge Fracture and Bony Fusion in Unilateral Open-door Cervical Expansive Laminoplasty

Study Design: This was a retrospective study. Objective: The aim of this study was to investigate the effect of Centerpiece mini-plate fixation on the complete fracture and bony fusion of the hinge side in unilateral open-door cervical expansive laminoplasty. Summary of Background Data: Cervical laminoplasty is an effective and safe surgery for cervical canal stenosis. The Centerpiece mini-plate is an instrument used to secure the laminae and maintain the cervical canal expansion. Stability of the new laminae is largely dependent on healing of the hinge side bone fracture and the degree of bony fusion. To date, few studies have reported on the effects of mini-plate fixation on these 2 important factors. Materials and Methods: Between September 2009 and March 2011, 58 patients received unilateral open-door cervical expansive laminoplasty at the authors’ hospital. The group included 47 male and 11 female patients, with a mean age of 61 (range, 35–81) years. Two hundred twenty-five laminae were fixed using the Centerpiece mini-plate (group A), whereas 62 laminae were fixed using suture suspension (group B). The rates of fracture and bony fusion of the hinge were observed using computed tomography scan and compared between the 2 groups. The complete fractures were subdivided into 4 groups based on the degree of displacement of the fractured ends: type I (no displacement), type II (mild to moderate displacement), type III (complete displacement or separation), or type IV (the hinge had collapsed into the cervical canal). Results: The number of incomplete fractures and type I to IV fractures in group A were 95, 93, 25, 8, and 4 and 29, 25, 4, 2, 2 in group B, respectively. There were no significant differences between the 2 groups in terms of complete fracture rates (P=0.309) and complete fracture type distribution (P=0.694). Group A had a significantly higher rate of bony fusion of the hinge 3 months after surgery (82% vs. 70%, P=0.042); however, this rate was not statistically significant 6 months after surgery (P=0.141). For type I complete hinge fracture, group A had higher bony fusion rates, both 3 months (86% vs. 57%, P=0.004) and 6 months (92% vs. 85%, P=0.048) postoperatively. The rates of bony fusion were also significantly different among all complete fracture types 3 months (P&lt;0.001) and 6 months (P&lt;0.001) postoperatively. Conclusions: Centerpiece mini-plate fixation in unilateral open-door cervical expansive laminoplasty might not increase the complete fracture rate compared with suture suspension and might promote bony fusion of type I complete hinge fractures.

Commentary on article: Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: A meta-analysis of clinical and radiological outcomes by Chang-Hyun Lee et al.

Background:This is a commentary on the article laminoplasty versus laminectomy and fusion (LF) for multilevel cervical myelopathy: A meta-analysis of clinical and radiological outcomes by Chang-Hyun Lee et al. Here, the authors utilized seven studies to compare the efficacy of cervical expansive laminoplasty (EL) versus laminectomy and fusion (LF) to address three or more level multilevel cervical spondylotic myelopathy (CSM). Both procedures led to similar degrees of neurological recovery and short-term loss of lordosis, but found that LF led to more favorable long-term results.Methods:For patients with three or more level CSM, laminectomy followed by an instrumented fusion (LF) has major advantages; open bilateral decompression of the nerve roots, while minimizing the risk of inadvertent injury to the cord, and the fusion's maintenance of lordosis.Results:Some would argue that inadvertent cord/root injury is greater utilizing any of the EL techniques; e.g., unilateral, bilateral, or spinous process splitting techniques. In short, why risk cord/root injury by manipulating the compressive posterior/posterolateral elements, which are already threatening neural function.Conclusion:Although the results of EL versus LF appeared comparable in the short-term in these seven articles, LF resulted in better long-term outcomes. Some would also argue that LF, utilizing an open approach offers safer bilateral neural exposure and decompression.

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

ObjectiveThe 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®) without bone grafts in multilevel cervical stenosis.MethodsFifteen 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.ResultsThe 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±16.0° to 77.2±13.1°), 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±10.0° to 31.2±7.6°, 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.ConclusionDespite 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.

Box-shape cervical expansive laminoplasty: clinical and radiological outcomes.

ObjectiveBox-shape cervical expansive laminoplasty is a procedure that utilizes a Miniplate® or Maxpacer® to achieve maximal canal expansion. This method is expected to show much larger canal expansion and good clinical outcome. So we investigated the clinical and radiological outcome of Box-shape cervical expansive laminoplasty.MethodsBetween June 2008 and July 2013, we performed cervical expansive laminoplasty in 87 and 48 patients using the Box-shape cervical expansive laminoplasty, respectively. We analyzed the clinical results of these operations using the Japanese Orthopedic Association (JOA) scoring system and by assessing the position of intralaminar screws with postoperative computed tomography (CT) at POD-6 months.ResultsA total of 48 patients with ossification of the posterior longitudinal ligament (OPLL) (36 pts), cervical spondylotic myelopathy (CSM) (12 pts) were enrolled. Overall JOA scores improved from 11.49 to 14.22 at POD-6 months (OPLL: 11.32 -->14.3; CSM: 12-->14). Postoperative CT scans were performed in 39 patients at 177 levels for a total of 354 screws. The malpositioning rate of intralaminar screws was 3.4% and hardware-related neurologic complications did not occur.ConclusionBox-shape cervical expansive laminoplasty creates maximal spinal canal expansion and leads to improved cervical myelopathy. The use of intralaminar screws to fix the remodeled lamina-facet does not represent a significant difficulty.

Adjacent Segment Diseases Following Expansive Cervical Laminoplasty: A Report of Five Cases

Adjacent Segment Diseases Following Expansive Cervical Laminoplasty: A Report of Five Cases Expansive laminoplasty has become the gold standard for surgical treatment of cervical multilevel compressive myelopathy. The procedure preserves the motion segment, and it has been believed hitherto that adjacent segment disease would not occur following the procedure. We report the adjacent segment disease following expansive laminoplasty for compressive cervical myelopathy and postulate on the possible pathophysiologic mechanism of the disease.

Drop finger as an adjacent segment disease after cervical expansive laminoplasty

Drop finger as an adjacent segment disease after cervical expansive laminoplasty