Cervical Laminoplasty Research Articles

Analysis of the risk factors for increasing cervical sagittal vertical axis after cervical laminoplasty for cervical spondylotic myelopathy.

The cervical sagittal vertical axis (cSVA) as another aspect of cervical alignment been recognized as one of the important factors affecting the pain and disability outcomes of cervical spine surgery. The purpose of the present study was to analyze the risk factors for increasing cSVA after cervical laminoplasty for cervical spondylotic myelopathy (CSM). This retrospective study included 110 consecutive patients (68 males and 42 females, average age 72.6years) who underwent laminoplasty for CSM between January 2007 and June 2018. We recorded the operative time, blood loss, Japanese Orthopaedic Association (JOA) score and the recovery rate. Radiological measurements were performed to analyze the following parameters: pre- and 1-year postoperative McGregor's slope (McGS), occiput to C2 Cobb angle (O-C2 angle), C2-C7 Cobb angle (C2-7 angle), T1-slope (T1S), C2-7 SVA (cSVA) and calculated the change (Δ). Patients were divided into two groups according to whether ΔcSVA was positive or negative. We also used Spearman's correlation coefficient and multiple regression analysis. ΔC2-7 angle, ΔT1S-preoperative C2-7 angle, ΔO-C2 angle were different between the two groups significantly. Correlation analysis between the ΔcSVA and the various sagittal parameters showed some independent explanatory factors including the ΔC2-7 angle (r = -0.25, p = 0.010), T1S-preoperative C2-7 angle (r = -0.28, p = 0.004), postoperative O-C2 angle (r = 0.26, p = 0.007), ΔO-C2 angle (r = 0.37, p = 0.001). Multiple regression analysis revealed that ΔcSVA was associated with the T1S-preoperative C2-7 angle (β = -0.25, p = 0.034) and ΔO-C2 angle (β = 0.32, p = 0.001). The imbalance between T1S and preoperative C2-7 angle influences the change of cSVA after cervical laminoplasty. If cSVA increases postoperatively, the O-C2 angle increases to compensate and maintain the horizontal gaze.

Association between Changes in Sagittal X-ray Measurements and Neck Extensor Muscle Atrophy after Cervical Laminoplasty

BackgroundTo investigate the association between neck extensor muscles (NEM) atrophy and changes in the sagittal cervical X-ray measurements after cervical laminoplasty. Basic proceduresThis retrospective analysis was conducted on 64 patients who underwent cervical laminoplasty from March 2016 to March 2019. The preoperative and postoperative sagittal cervical X-ray images were measured, including the C2-C7 cobb angle, the C2-7 sagittal vertical axis (SVA), and the angle between the plane of the upper endplate of T1 vertebra and the horizontal plane (T1 slope). The preoperative and postoperative steatosis ratios of the NEM were measured using magnetic resonance images. Main findingsThere were significant differences between the preoperative and postoperative measurements of the C2-7 cobb angle, the C2-7 SVA, and the T1 slope (P<0.05). The preoperative and postoperative steatosis ratios of each intervertebral level of the NEM also differed significantly (P<0.05). The muscle atrophy ratio at C3/4 was positively correlated with the change in the C2-7 SVA (R=0.646, P<0.001) and negatively correlated with the change in the C2-7 cobb angle (R=-0.445, P<0.001). The muscle atrophy ratio at C7/T1 was positively correlated with the T1 slope (R=0.446, P<0.001). ConclusionsMuscle atrophy was more severe at the attachment points of the NEM (C3/4, C7T1). There was a significant association between the muscle atrophy ratio and the changes in sagittal cervical X-ray measurements.

Nomogram for predicting kyphotic deformity after laminoplasty in cervical spondylotic myelopathy patients without preoperative kyphotic alignment

BackgroundKyphotic deformity occurrence after cervical laminoplasty is not rare. Several studies have emphasized the development of postoperative kyphotic deformity (PKD) will impair the functional outcome of cervical laminoplasty. We established and validated a nomogram prediction model for kyphotic deformity after laminoplasty in cervical spondylotic myelopathy patients (CSM) without preoperative kyphotic alignment. MethodsPreoperative and 1-year postoperative data of 369 patients who underwent single-door cervical laminoplasty (SDCL) at the author’s hospital between July 2010 and February 2018 were collected. Using the least absolute shrinkage and selection operator (LASSO) method, significant parameters were selected to develop a nomogram prediction model. The prognostic performance of the model was evaluated using concordance index (C-index) and calibration curve. The discriminatory ability of the prediction model was evaluated by the area under (receiver operating characteristic) curve (AUC). ResultsOf the 369 patients, 31 developed PKD in 1 year after the surgery. Using the LASSO regression, six significant variables composed the final model: age, C2-7 sagittal vertical axis, C7 slope, C2-7 angle, flexion range of motion and operation level were selected. The AUC of the nomogram was 0.771. The C-index for the prediction nomogram was 0.771 (95 % CI: 0.672−0.870). The calibration curve also indicated good consistency. ConclusionA nomogram for predicting PKD after SDCL was established and validated. For patients evaluated by this model with predictive high risk of developing postoperative kyphosis, an alternative approach to the subaxial cervical spine such as anterior surgery should be considered.

A Multicenter Observational Study on the Postoperative Outcomes of C3 Laminectomy in Cervical Double-door Laminoplasty.

Multicenter retrospective observational study. To determine the differences between C3 laminectomy (LN) and C3 laminoplasty (LP) in cervical LP. Interlaminar bony fusion after cervical LP is reported to be related to a decrease in postoperative range of motion (ROM) or neurological disorder. However, it remains uncertain whether C3 LN affects patient-reported outcomes, especially after double-door LPs. Therefore, this study aimed to investigate the effect of C3 LN compared with C3 LP in cervical double-door LP. Using our prospective database, consecutive patients with degenerative cervical myelopathy undergoing cervical double-door LP in 7 hospitals between April 2017 and May 2018 were enrolled. Before and 1 year after the surgeries, we collected the details of patient background data, operative factors, radiologic findings such as C2-C7 ROM angle and C2-C3 interlaminar bony fusion, the Japanese Orthopaedic Association (JOA) score, postoperative satisfaction, neck pain, and patient-reported outcomes such as Short Form-12 (SF-12), EuroQol 5 Dimension (EQ-5D), Neck Disability Index (NDI), and the Core Outcome Measures Index (COMI) for the neck. In all, 152 patients were enrolled, including 97 undergoing C3 LP and 55 undergoing C3 LN. There were no significant differences in patient background data, complications, and operative factors. C2-C3 interlaminar bony fusion occurred more often in the C3 LP group (22.6% vs. 5.7%). There were also no differences in the C2-C7 angle, C2-C7 ROM angle, the JOA score, patient satisfaction, neck pain, SF-12, EQ-5D, NDI, and COMI between the groups. C2-C3 bony fusion after cervical double-door LP occurred more often in the C3 LP group than in the C3 LN group. C3 LN resulted in similar outcomes in complication rate, radiographic outcomes, and clinical outcomes compared with those of C3 LP. Level III.

Feasibility of Outpatient Cervical Laminoplasty

Cervical laminoplasty was initially introduced as an effective alternative to laminectomy procedures but advances in surgical techniques and perioperative protocols have allowed its use to expand. As the utilization of ambulatory surgical centers continues to grow, so too will the transition of mandatory inpatient procedures such as cervical laminoplasty to the outpatient setting. Successful transition of such involved procedures requires a host of adjustments to facilitate this change. This article reviews the key aspects of our medical practice that have enabled us to find success in the outpatient setting and outlines the potential for successful transition of cervical laminoplasty.

Direct Involvement of Concomitant Foraminotomy for Radiculomyelopathy in Postoperative Upper Limb Palsy in Cervical Laminoplasty

Although concomitant foraminotomy has been reported to increase the risk of postoperative upper limb palsy (ULP) in cervical laminoplasty, the specific effects of concomitant foraminotomy on ULP remain uncertain. This study aimed to clarify the effect of concomitant foraminotomy on ULP in cervical laminoplasty. We identified 19 patients who developed ULP after laminoplasty with concomitant foraminotomy for radiculomyelopathy with nerve root impingement (laminoplasty with concomitant foraminotomy group [F-group]) from 4080 patients who underwent primary cervical laminoplasty at 27 affiliated institutions between 2012 and 2018. An age- and sex-matched control group comprised patients who developed ULP after laminoplasty without concomitant foraminotomy (n= 76, 4:1 ratio with F-group). Collected data included the time of onset and distribution of ULP (side and level). The site of foraminotomy was recorded in the F-group. The F-group showed a significantly higher incidence of ULP than the candidates for the control group (15.1% vs. 3.1%, P < 0.001). The site of foraminotomy was consistent with the distribution of ULP in 79% (15 of 19 patients) of the F-group. The F-group showed a significantly higher proportion of preoperative upper-limb muscle weakness (74% vs. 37%, P= 0.005) and early-onset ULP occurring by postoperative day 1 (63% vs. 33%, P= 0.02) compared with the control group. Our results indicate that the foraminotomy procedure in the stenotic foramen is directly involved in ULP. Combined with a previous report suggesting that early-onset ULP is associated with thermal nerve damage, our results indicate that thermal nerve damage partly explains the increased incidence of ULP in the F-group.

Ten-Year Long-term Results of Modified Cervical Double-door Laminoplasty With C3 Laminectomy Preserving the Semispinalis Cervicis Inserted Into the Axis Compared With Those of Conventional Cervical Laminoplasty.

A retrospective study. To compare long-term clinical and radiologic outcomes between conventional double-door laminoplasty (LP) (group A) and cervical LP with C3 laminectomy (group B). Cervical LP with C3 laminectomy preserving the semispinalis cervicis inserted into the axis decreased the patients' postoperative axial pain and muscle atrophy, prevented interlaminar bony fusion, decreased limitations of daily living activity, including reduced postoperative neck mobility, and maintained the cervical range of motion (ROM) more effectively than conventional cervical LP reattaching the semispinalis cervicis in the short-term. Group A included 14 patients with an average age of 56.6 years at the time of surgery (follow-up rate 58.1%), and group B included 21 patients with an average age of 56.3 years at the time of surgery (follow-up rate 29.1%). We evaluated the clinical results, which included the Japanese Orthopaedic Association (JOA) score, JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and radiologic results, including C2-C7 ROM, number of interlaminar bony fusions and presence of new spondylolisthesis at C3. There were no significant differences in preoperative and postoperative JOA scores, recovery rate of JOA score, and JOACMEQ. Significantly fewer patients in group B experienced interlaminar bony fusion at C2-C3 compared with those in group A. There was no significant difference in the presence of new spondylolisthesis at C3. In patients with cervical spondylotic myelopathy, the rate of decrease of C2-C7 ROM was significantly less in group B than in group A. In patients with ossification of the posterior longitudinal ligament, there was no significant difference in the rate of decrease of C2-C7 ROM between the groups. C3 laminectomy prevented interlaminar bony fusion at C2-C3. C3 laminectomy maintained cervical ROM in patients with cervical spondylotic myelopathy. There were no adverse events due to C3 laminectomy at 10 years postsurgery.

21. The safety and efficacy of cervical laminectomy and fusion vs cervical laminoplasty surgery in degenerative cervical myelopathy: a prospective randomized trial

BACKGROUND CONTEXT There is a lack of evidence of whether degenerative cervical myelopathy (DCM) is best treated via cervical laminoplasty or cervical laminectomy with lateral mass fusion due to the lack of prospective randomized studies that are well designed. PURPOSE We conducted the largest prospective randomized trial to date to determine the comparative effectiveness and safety of both approaches. STUDY DESIGN/SETTING In this prospective, randomized trial, we randomly assigned patients who had symptoms or signs of DCM to undergo either cervical laminectomy and lateral mass fixation (CLF) or cervical laminoplasty (CLP). PATIENT SAMPLE A total of 39 patients (mean age, 55.7±5.5 years, 69.2% men) underwent prospective randomization. OUTCOME MEASURES The primary outcome measures were the change in the visual analog scale (VAS), Neck Disability Index (NDI), modified Japanese Orthopedic Association (mJOA) score, and Nurick's myelopathy grading one year after surgery. The secondary outcome measures were the intraoperative, postoperative complications, hospital stay, C2-7 Cobb's angle, and Odom's criteria. METHODS In this prospective, randomized trial, we randomly assigned patients who had symptoms or signs of DCM to undergo either cervical laminectomy and lateral mass fixation (CLF) or cervical laminoplasty (CLP). The primary outcome measures were the change in the visual analogue scale (VAS), neck disability index (NDI), modified Japanese Orthopedic Association (mJOA) score, and Nurick's myelopathy grading one year after surgery. The secondary outcome measures were the intraoperative, postoperative complications, hospital stay, C2-7 Cobb's angle, and Odom's criteria. The follow-up period was at least one year. RESULTS There was a significantly greater improvement in the NDI and VAS in the CLF group at one year (p CONCLUSIONS Among patients with multilevel DCM, the CLF approach was significantly better regarding the postoperative pain, NDI, and one-year Cobb's angle improvement, while the posterior approach was significantly better in terms of shorter hospital stay and operative time. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Neurological Disturbance of the Upper Extremities After Cervical Laminoplasty: A Morphological Assessment Focused on the Intervertebral Foramen.

A retrospective study. The aim of this study was to explore the relationship between postoperative neurological disturbance of the upper extremities (NDUE) after cervical laminoplasty and intervertebral foraminal stenosis. The relationship between foraminal stenosis and neurological disturbance in the C5 segment (C5 palsy) has been reported, but the relationship at other levels has not been examined before. We evaluated foraminal stenosis morphologically using three-dimensional computed tomography (3D-CT), alongside other risk factors for NDUE. We retrospectively reviewed patients treated by open-door laminoplasty at the authors' institution between January and June 2016. NDUE was defined as postoperative motor deterioration and/or newly emerged sensory disturbance within 2 weeks of surgery. Radiological measurements were performed in bilateral intervertebral foramina from C5 to C8, using 3D-CT. Investigation using magnetic resonance imaging (MRI) was also performed. Thirty-one patients were reviewed, and 10 (32.3%) developed NDUE. Nineteen NDUE were observed: seven were in the C5 segment, five in the C6 segment, three in the C7 segment, and four in the C8 segment. Four patients (40%) had NDUE from multiple segments. The mean width of the foramen was 2.60 ± 1.26 mm and 3.66 ± 1.66 mm (P = 0.007), and cross-sectional area was 32.8 ± 10.8 mm and 41.6 ± 12.4 mm (P = 0.003), in symptomatic (n = 19) and nonsymptomatic (n = 187) foramina, respectively. The mean transverse diameter of bony spurs and the maximum shift of the spinal cord on MRI was significantly larger in the NDUE group. The odds ratio of having a foraminal cross-sectional area under 28.0 mm in combination with a maximum spinal shift over 3.10 mm was 14.6 (P < 0.001). Stenosis of the intervertebral foramen could be a risk factor for NDUE after cervical laminoplasty, and could be aggravated by excessive posterior spinal cord shift. 3.

Residual numbness of the upper extremity after cervical surgery in patients with cervical spondylotic myelopathy.

Although numbness is one of the chief complaints of patients with cervical spondylotic myelopathy (CSM), preoperative factors relating to residual numbness of the upper extremity (UE) and impact of the outcomes on cervical surgery are not well established. The authors hypothesized that severe preoperative UE numbness could be a risk factor for residual UE numbness after surgery and that the residual UE numbness could have a negative impact on postoperative outcomes. Therefore, this study aimed to identify the preoperative factors that are predictive of residual UE numbness after cervical surgery and demonstrate the effects of residual UE numbness on clinical scores and radiographic parameters. The study design was a retrospective cohort study. The authors analyzed data of 103 patients who underwent cervical laminoplasty from January 2012 to December 2014 and were followed up for more than 2 years postoperatively. The patients were divided into two groups: the severe residual-numbness group (postoperative visual analog scale [VAS] score for UE numbness > 40 mm) and the no/mild residual-numbness group (VAS score ≤ 40 mm). The outcome measures were VAS score, Japanese Orthopaedic Association scores for cervical myelopathy, physical and mental component summaries of the 36-Item Short-Form Health Survey (SF-36), radiographic film parameters (C2-7 sagittal vertical axis, range of motion, C2-7 lordotic angle, and C7 slope), and MRI findings (severity of cervical canal stenosis, snake-eye appearance, severity of foraminal stenosis). Following univariate analysis, which compared the preoperative factors between groups, the variables with p values < 0.1 were included in the multivariate linear regression analysis. Additionally, the changes in clinical scores and radiographic parameters after 2 years of surgery were compared using a mixed-effects model. Among 103 patients, 42 (40.8%) had residual UE numbness. In the multivariate analysis, sex and preoperative UE pain were found to be independent variables correlating with residual UE numbness (p = 0.017 and 0.046, respectively). The severity of preoperative UE numbness did not relate to the residual UE numbness (p = 0.153). The improvement in neck pain VAS score and physical component summary of the SF-36 was significantly low in the severe residual-numbness group (p < 0.001 and 0.040, respectively). Forty-one percent of the CSM patients experienced residual UE numbness for at least 2 years after cervical posterior decompression surgery. Female sex and preoperative severe UE pain were the predictive factors for residual UE numbness. The patients with residual UE numbness showed less improvement of neck pain and lower physical status compared to the patients without numbness.

Effectiveness of tranexamic acid in reducing blood loss in cervical laminoplasty: A retrospective observational study

Background: Tranexamic acid (TXA) has been proved effective in reducing perioperative blood loss in patients undergoing orthopedic operations. However, given the heterogeneity in the diagnoses and spinal operations, there are only limited studies comparing patients with uniform diagnoses and procedures performed. Methods: A comparative observational control study was performed on 62 patients with cervical myelopathy. They were divided into control (32) and TXA (30) groups according to whether they had received TXA before and during surgery. Cervical laminoplasty from C3 to C6/7 was performed for all patients using a consistent procedure. Preoperative and postoperative hematological data and perioperative blood loss were compared. Results: There were no statistically significant differences between the two groups in terms of age, gender, body mass index, and operating time. The TXA group had significantly less intraoperative (310 ± 215 ml vs. 144 ± 90 ml, p &lt; 0.05) and postoperative blood loss than the control group (150 ± 50 ml vs. 249 ± 94 ml, p &lt; 0.01). The drop of hemoglobin (Hb) level in the TXA group was also significantly lower (0.5 ± 0.42 g/dl vs. 2.1 ± 1.03 g/dl, p &lt; 0.01). No thromboembolic complications found. Conclusion: TXA significantly reduced perioperative blood loss and reduced drop of postoperative Hb level in cervical laminoplasty.

Cervical Laminoplasty in the Elderly: Report of a Single Center Experience and Review of the Literature

Cervical Laminoplasty in the Elderly: Report of a Single Center Experience and Review of the Literature

Preoperative Parameters for Predicting the Loss of Lordosis After Cervical Laminoplasty.

Retrospective study. The preoperative parameters for predicting the loss of lordosis after cervical laminoplasty were investigated in the present study. Cervical laminoplasty is an effective surgical method to decompress the cervical spinal cord. Maintaining cervical lordosis after laminoplasty is an important factor to ensure the successful surgical treatment. To know the preoperative parameters for predicting loss of lordosis after cervical laminoplasty is important for better outcome after laminoplasty. In this retrospective study, 106 patients who underwent cervical laminoplasty from 2011 to 2015 were reviewed. The preoperative parameters; T1 slope (TS), Cobb lordotic angle (CLA) and sagittal vertical axis (SVA) at C2-C7, relative cross-sectional area (RCSA), and fatty degeneration of deep extensor muscles (DEMs) were measured. Visual analogue scale (VAS) and modified Japanese Orthopedic Association (mJOA) scores were used for clinical assessment. Correlation analysis was performed between the postoperative CLA change and preoperative parameters. The patients were divided into the decreased- or maintained-lordosis groups based on the difference between postoperative and preoperative CLA. All preoperative parameters were compared between groups. Based on correlation analysis, preoperative TS (P = 0.001), TS-CLA (P = 0.046), RCSA at C7-T1 (P < 0.001), and fatty degeneration of DEMs (P < 0.001) were correlated with loss of lordosis. Among the 106 patients, 68 showed decreased-lordosis and 38 maintained-lordosis. Preoperative TS (P = 0.003), SVA (P = 0.014), TS-CLA (P = 0.015), and RCSA at C7-T1 (P = 0.005) were significantly different between groups. In both correlation and comparative analyses, higher TS and TS-CLA and less RCSA at C7-T1 were associated with loss of lordosis. Neck pain VAS (P < 0.001) and mJOA scores (P < 0.001) were significantly improved in the maintained-lordosis group. Maintaining cervical lordosis is important for clinical outcomes after laminoplasty. Preoperative higher TS, TS-CLA, and less RCSA at C7-T1 were considered as predictors for loss of lordosis. These characteristics should be considered when choosing the surgical method to help maintain cervical lordosis. 3.

Application of piezosurgery osteotomy in cervical laminoplasty: prospective, randomized, single-blind, clinical comparison study

Objective: To compare and analyze the clinical efficacy of piezosurgery osteotomy and high-speed drilling respectively in cervical laminoplasty, so as to explore the operability, safety and clinical application value of piezosurgery osteotomy in cervical laminoplasty. Methods: A total of 60 patients with multilevel cervical stenosis from the Inner Mongolia Autonomous Region People's Hospital were randomly divided into two groups (piezosurgery osteotomy group and high-speed drill group) with 30 patients in each group. Operation time, intraoperative blood loss, postoperative drainage, complication rate, Japanese orthopaedic association (JOA) score and JOA improvement rate were compared and analyzed. Results: The operation time in piezosurgery osteotomy group and high-speed drill group was (87 ± 22 min) and (96 ± 35 min), respectively, and the difference between two groups was not statistically significant (P > 0.05). The intraoperative blood loss in the piezosurgery osteotomy group was (121 ± 86 mL) lower than that (172 ± 93 mL) in the high-speed drill group (P 0.05). Dural injury developed 1 patient in high-speed drill group and cerebrospinal fluid leakage occurred after surgery. No serious complications such as spinal cord injury occurred in either group. Conclusion: Piezosurgery osteotomy in cervical laminoplasty is safe and effective, and is superior in operation time, intraoperative blood, and postoperative drainage. Its safety and efficacy are similar to high-speed drill in cervical laminoplasty. Keywords: Cervical laminoplasty; piezosurgery osteotomy; high-speed drill; cervical spondylotic myelopathy; safety; efficacy

Comparison of single versus double door posterior cervical laminoplasty for patients with cervical spondylotic myelopathy: A systematic review and meta-analysis.

Objective:We undertook a meta-analysis to compare the efficacy and safety of single versus double door posterior cervical laminoplasty for cervical spondylotic myelopathy.Methods:PubMed, Embase, and Cochrane Central Register of controlled trials were searched for randomized controlled trials investigating single and double door posterior cervical laminoplasty for cervical spondylotic myelopathy. The Mantel–Haenszel method with the fixed-effects or random-effects model was used to calculate relative risks and 95% confidence intervals (CIs).Results:Seven studies with 224 patients met the eligibility criteria and were included. There was a significant difference in Japanese Orthopedic Association score (MD = 0.79, 95%CI [0.09, 1.49], P = .03; P for heterogeneity = .09, I2 = 45%), and adverse events (OR = 0.32, 95%CI [0.11, 0.95], P = .04; P for heterogeneity = 1.00, I2 = 0%) between the double door posterior cervical laminoplasty group and the single door posterior cervical laminoplasty group. There was no significance in operative time (MD = 0.56, 95%CI [–11.86, 12.98], P = .93; P for heterogeneity = 0.001, I2 = 73%) and length of hospital stay (OR = –0.75, 95%CI [–1.78, 0.27], P = .15; P for heterogeneity = 1.00, I2 = 0%) between the 2 groups.Conclusion:Double door posterior cervical laminoplasty is more effective and safer than single door laminoplasty in the treatment of cervical spondylotic myelopathy.

Clinical outcomes of epidural and intradural decompression for treatment of degenerative cervical myelopathy.

ObjectiveThis study was performed to examine the clinical outcomes of epidural and intradural decompression for degenerative cervical myelopathy.MethodsThe data for 13 patients who underwent epidural and intradural decompression for treatment of degenerative cervical myelopathy (study group) and 20 patients who underwent only cervical laminoplasty, fusion, and epidural decompression (historical control group) were retrospectively reviewed. The preoperative and postoperative neurological status was evaluated using the Japanese Orthopaedic Association (JOA) score.ResultsAll patients’ neurological symptoms were significantly improved at the final follow-up. In the study group, the patients’ mean preoperative JOA score was 8.07 ± 1.80, and the final score improved by 70.88% ± 21.18%. The blood loss and operation time were significantly greater in the study group than control group. The recovery time was shorter in the study group than control group. The improvement rate was not significantly different between the two groups.ConclusionsA pia mater incision with separation of the arachnoid adhesion can significantly improve the cerebrospinal fluid flow and spinal blood flow in degenerative cervical myelopathy. Arachnoid adhesion can lead to intradural spinal scar compression. The surgical intervention described herein can achieve satisfactory neurological outcomes and shorten the recovery time.

The relationship between preoperative cervical sagittal balance and clinical outcome of laminoplasty treated cervical ossification of the posterior longitudinal ligament patients

Laminoplasty is a common surgical method used to treat patients with cervical ossification of the posterior longitudinal ligament (OPLL). Although laminoplasty is preferred over traditional laminectomy, the factors affecting the complications and outcomes are unclear. Recently, sagittal balance indexes have been revealed to be predictors of clinical outcomes in patients with cervical degenerative diseases, but their relationships with laminoplasty-treated OPLL outcomes remains unknown. The purpose of this study is to evaluate the relationship of preoperative cervical sagittal balance indexes and clinical outcome in laminoplasty treated OPLL patients. This is a retrospective case study. Between January 2015 and January 2017, 181 consecutively included patients who underwent cervical laminoplasty for OPLL were enrolled (male:female ratio=126:75; mean age=60.2 years). Cervical spine lateral radiographs in neutral, flexion, and extension positions were taken before and 2 years after the surgery. The C2-C7 Cobb angle, T1 slope, C1-C7 sagittal vertical axis (SVA), C2-C7 SVA, CGH (center of gravity of the head)-C7 SVA, cervical JOA (Japanese Orthopedic Association) score, and neck VAS (visual analogue scale) score were measured preoperatively and postoperatively at the 2-year follow-up. The patients were divided into two groups according to changes in the lordotic angle or the recovery rate of the JOA score. The relationships between the postoperative lordosis loss or the clinical outcome and the preoperative variables, including the patient's age, JOA score, C2-C7 Cobb angle, T1 slope, C1-C7 SVA, C2-C7 SVA, and CGH-C7 SVA, were investigated. The patients were divided into two groups according to the postoperative change in the C2-C7 Cobb angle. There were no differences in the age, preoperative C2-C7 Cobb angle, C1-C7 SVA, or C2-C7 SVA; there was only a difference in the preoperative CGH-C7 SVA and T1 slope level (p=.038, p=.042). The postoperative JOA and JOA recovery rate were related to the postoperative lordosis loss in cervical alignment (p=.048, p=.031). We again divided the patients into two groups according to the JOA recovery rate and found that only the preoperative CGH-C7 SVA and C1-C7 SVA were related to the neurological outcome (p=.011, p=.047). According to the multivariate logistic regression analysis, higher preoperative CGH-C7 SVA levels were significantly associated with decreases in the lordosis angle postoperatively and the clinical outcome (p=.018, OR=1.225; p=.034, OR=1.654). The ROC (receiver operating characteristic) analysis revealed that the proper cutoff value of preoperative CGH-C7 SVA for predicting the postoperative loss of lordosis and clinical outcomes is 3.8 cm. Preoperative cervical sagittal balance indexes are related to the outcomes of OPLL patients after laminoplasty. Patients with high preoperative CGH-C7 SVA levels have a high probability of developing sagittal imbalances and neurological symptoms of the cervical spine, and this measurement can be used as a predictor of outcomes in laminoplasty-treated cervical OPLL patients.

Intra- and Post-Complications of Cervical Laminoplasty for the Treatment of Cervical Myelopathy: An Analysis of a Nationwide Database.

Retrospective database study. To assess the intra- and postoperative complications of cervical laminoplasty and to evaluate the effect of intraoperative neuromonitoring use on postoperative limb paralysis incidence. Cervical laminoplasty is a known procedure for the management of cervical spondylotic myelopathy (CSM). This was a retrospective study of 532 patients with CSM who underwent cervical laminoplasty between 2007 and the first quarter of 2016 using the Humana subset of the PearlDiver Database. The database was queried using the relevant International Classification of Diseases (ICD-9 and ICD-10) codes for CSM and Current Procedural Terminology (CPT) codes for cervical laminoplasty. The intra- and postoperative incidence of surgical and medical complications and reoperations was then determined and was compared with a propensity score-matched cohort of patients who had posterior laminectomy and fusion (490 patients in each group), using multivariate logistic regression analysis. Laminoplasty was associated with a lower incidence of dysphagia (odds ratio [OR] = 0.37, 95% confidence interval [CI] = 0.16-0.79; P = 0.014), 30-day readmission (OR = 0.51, 95% CI = 0.35-0.75; P < 0.001), urinary tract infection (OR = 0.58, 95% CI = 0.37-0.93; P = 0.023), and incision and drainage, exploration or evacuation (OR = 0.28, 95% CI = 0.08-0.79; P = 0.026). The use of intraoperative neuromonitoring was associated with a non-significant lower incidence of limb paralysis within 1 and 3 months postoperatively (OR = 0.52 and 0.51, 95% CI = 0.23-1.19 and 0.23-1.11; P = 0.119 and 0.091, respectively). Compared with posterior laminectomy and fusion, laminoplasty had lower rates of dysphagia, urinary tract infection, and 30-day readmission. The use of intraoperative neuromonitoring was associated with a lower risk of postoperative limb paralysis, but it did not achieve statistical significance. 4.

Accuracy of the Gutter Position in Cervical Double-door Laminoplasty Using Intraoperative Computed Tomography Navigation and the Factors Associated With C5 Palsy.

This was a prospective study. This study aimed to investigate the accuracy of the gutter position after cervical double-door laminoplasty (LP) using intraoperative computed tomography (CT) navigation and the factors associated with C5 palsy. There were some reports in which the gutter position and the width of decompression in cervical LP were associated with C5 palsy; however, there were few reports about the accuracy of the gutter position. Thirty-three patients treated with cervical LP were enrolled. We marked our targeted gutter position on the lamina with a high-speed drill using intraoperative CT navigation and performed the LP procedure. The accuracy of the gutter position was evaluated with a postoperative CT scan. We measured the angle of the opened lamina (AOL), the proportion of the distance between the gutters and the distance of transverse diameter of spinal canal (PGSC) with a postoperative CT scan and spinal cord posterior shifting (SCPS) with preoperative and postoperative magnetic resonance imaging scans. We investigated the incidence of C5 palsy and analyzed AOL, PGSC, and SCPS between the C5 palsy (+) and (-) groups. The accuracy of all gutter positions was 78.4% (182/232). The accuracy of the gutter position at the right C4 and right C7 was lower than that at the other levels. The AOL in all cases was ~60 degrees. The PGSC was 90.1%-97.2%. The SCPS at C5 was the largest with 2.2 mm. C5 palsy occurred in 3 of 33 patients (9.1%). There were no significant differences in the AOL, PGSC, or SCPS between the 2 groups. The accuracy of the gutter position using intraoperative CT navigation was good. The incidence of C5 palsy was higher in this study than in the previous reports.

Clinical and Radiologic Features of Degenerative Cervical Myelopathy Depending on the Presence of Cord Signal Change

Cord signal change (CSC) on magnetic resonance (MR) imaging is an important radiologic feature of degenerative cervical myelopathy (DCM). Occasionally, DCMs correlate with clinical symptoms with no CSC. The aim of this study was to evaluate clinical and radiologic features, depending on the presence of CSC in DCM. This retrospective study included 73 patients who underwent cervical laminoplasty for DCM. They were divided into 2 groups based on the presence of CSC on static MR imaging (positive CSC in group A and negative CSC in group B). Preoperative radiologic parameters on lateral radiographs and the severity of canal stenosis on MR imaging were analyzed. The functional outcomes were evaluated using the modified Japanese Orthopedic Association score and Nurick grade. Group A showed more deteriorated canal stenosis (P < 0.001) and kyphotic change than did group B. C2-7 sagittal vertical axis (P= 0.003) of group A and C2-7 range of motion (C27ROM; P < 0.001) of group B were greater than in the opposite groups, respectively. In a multivariate analysis, greater width of the cervical canal (P= 0.002) and increased C27ROM (P= 0.002) were statistically significant radiologic parameters related to negative CSC. Group B showed better functional outcomes until 6 months postoperatively, with statistical significance. DCM with negative CSC can be caused by a well-preserved cervical ROM, even with less deteriorated canal stenosis and kyphosis. C27ROM may be a helpful radiologic parameter in diagnosing DCM before CSC appears.