Laminoplasty For Cervical Spondylotic Myelopathy Research Articles

Preservation of C7 spinous process does not influence the long-term outcome after laminoplasty for cervical spondylotic myelopathy

Axial pain is one of the major complications after laminoplasty, and preservation of C7 spinous process during the procedure can reduce the axial pain. However, it has not been elucidated whether laminoplasty preserving the C7 spinous process can maintain neurological improvement for a long time. The purpose of our retrospective study was to investigate the long-term neurological outcome after open-door laminoplasty preserving the C7 spinous process for cervical spondylotic myelopathy (CSM). Clinical and radiological outcomes were analysed in 42 patients who underwent open-door laminoplasty preserving C7 spinous process and followed up for more than 5 years. Neurological function was evaluated by means of the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. Axial pain was assessed using a visual analog scale (VAS) at the last examination. Alignment and motion of the cervical spine were measured from radiographs, and magnetic resonance imaging (MRI) was used to evaluate postoperative compression at C7. The mean JOA score was 9.4 before surgery and 12.0 at the latest follow-up. The mean VAS score in 26 patients score was 9.7/100. No compression of the spinal cord was observed in any MRI at the latest follow-up. Preservation of the C7 spinous process does not influence the long-term outcome of CSM after laminoplasty. Although we did not have a comparative group, the procedure described here should be considered as the solution.

P158. Results of open-door laminoplasty for cervical spondylotic myelopathy in a North American population

BACKGROUND CONTEXT: Cervical laminoplasty is an accepted technique for achieving canal expansion in patients with cervical spondylotic myelopathy. This technique has been studied extensively in certain patient populations, such as Asians and patients with ossification of the posterior longitudinal ligament. There are few reports, however, evaluating the results of cervical laminoplasty for multi-level cervical spondylosis and myelopathy in a North American population.

Postoperative Instability After Laminoplasty for Cervical Myelopathy with Spondylolisthesis

76 patients who underwent laminoplasty for cervical spondylotic myelopathy were investigated regarding the impact of preoperative and postoperative degenerative spondylolisthesis on their neurologic outcome. Radiographs were obtained 1 year postoperatively to investigate range of motion (ROM), lordotic curvature, and postoperative spondylolisthesis. By 1 year after surgery, 85% of those spondylolistheses present preoperatively had either resolved or improved on neutral lateral radiographs. The cross-sectional area of the spinal cord at the site of spondylolisthesis was measured using preoperative computed tomography myelography. Clinical results were evaluated by the recovery rate using Japanese Orthopaedic Association score. Patients with posterior spondylolisthesis showed a significantly poorer postoperative recovery rate. Intervertebral ROM in patients with preoperative spondylolisthesis was reduced, whereas cervical alignment had not deteriorated after laminoplasty. The group with posterior spondylolisthesis showed a significant reduction in the cross-sectional area of the spinal cord at the site of spondylolisthesis. Postoperative spondylolisthesis appeared in 15 patients, 10 of whom had preoperative spondylolisthesis at an adjacent site. The cause of poorer surgical results of those patients with preoperative posterior spondylolisthesis appears to be related to a higher degree of spinal cord compression than with preoperative anterior spondylolisthesis.

Radiographic changes of the cervical spine after laminoplasty for cervical spondylotic myelopathy and their effects on clinical outcome

Radiographic changes of the cervical spine after laminoplasty for cervical spondylotic myelopathy and their effects on clinical outcome

Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy.

This retrospective study analyzed the effects of cervical alignment on surgical results of expansive laminoplasty (ELAP) for cervical spondylotic myelopathy (CSM). To determine the limitation of posterior decompression by ELAP for CSM in the presence of local kyphosis. Several studies have reported that cervical malalignment affected surgical outcomes of ELAP. However, there has been no report to demonstrate crucial determinants of surgical outcomes of ELAP for CSM in relation to cervical sagittal alignment. The study group comprised 114 patients who underwent ELAP for CSM. All were followed up for more than 2 years. The Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy (full score, 17 points) was used to evaluate surgical outcomes for each patient 2 years after surgery. Statistical analysis with multivariate logistic regression models was used to ascertain the risk factors affecting postoperative surgical outcomes. The average JOA scores were 9.9 points before surgery and 14 points 2 years after surgery. The recovery rate was 60.2%. Statistical analysis showed that signal intensity change on MRI and local kyphosis were the most crucial risk factors for poor surgical outcomes. Calculated with the logistic regression model, the highest risk of poor recovery was local kyphosis exceeding 13 degrees. The influence of cervical malalignment on neurologic recovery after ELAP for CSM was shown. When patients have local kyphosis exceeding 13 degrees, anterior decompression or posterior correction of kyphosis as well as ELAP should be considered. Expansive laminoplasty for CSM is best indicated for patients with local kyphosis less than 13 degrees.

高齢者頚部脊髄症に対する脊柱管拡大術の検討

We studied elderly patients over 70 years old who underwent laminoplasty for cervical spondylotic myelopathy. Operations were performed on 21 patients over 70 years old at the time of operation from 1995 at the Kumamoto City Hospital. These patients were reviewed and compared with patients below 69 years old in this study. Clinical results were evaluated by the Japanese Orthopaedic Association scoring system. The operative results of patients over 70 were not significantly different from those of patients below 69. But we found that the recovery of the lower motor function of elderly patients was apparently worse than that of younger patients statistically.

脊柱管拡大術を行った高齢者 (70歳以上) 頚部脊髄症例の検討

脊柱管拡大術を行った高齢者 (70歳以上) 頚部脊髄症例の検討

New evaluation method using preoperative magnetic resonance imaging for cervical spondylotic myelopathy.

A new method based on the score of preoperative magnetic resonance images (MRI) was devised to evaluate cervical spondylotic myelopathy and predict the results of cervical laminoplasty. On T1- and T2-weighted sagittal MRI, the intervertebral disc spaces at each level from the axis to the first thoracic spine were examined as to whether the anterior or posterior subarachnoid space would be maintained or not, and for the presence or absence of spinal cord deformity. The data were divided into six grades and rated, and the total score for all sites was regarded as the preoperative MRI cumulative score. In conclusion, our method was highly reliable and useful for a preoperative evaluation and prediction of results after cervical laminoplasty for cervical spondylotic myelopathy.

Evaluation of spinal cord blood flow during prostaglandin E1-induced hypotension with power Doppler ultrasonography

Intraoperative power Doppler ultrasonography was used to evaluate the spinal cord blood flow in cervical spondylotic myelopathy patients during hypotensive anesthesia. To evaluate the effect of prostaglandin E1 (PGE1) induced hypotension on spinal cord blood flow (SBF) during spinal surgery. Hypotension is frequently induced to decrease blood loss during surgery and to diminish the need for blood transfusion. Prostaglandin E1 (PGE1) is reported to maintain cerebral, liver, and renal blood flow during surgery. However, there are few reports on spinal cord blood flow. Eleven patients underwent laminoplasty for cervical spondylotic myelopathy. After a French door type laminoplasty was carried out, hypotension was induced with PGE1. Before and during hypotension, we evaluated blood flow in the anterior spinal cord artery by determining the pulsatility index (PI) and resistance index (RI) using power Doppler ultrasonography. Before hypotension, the mean blood pressure was 80 mmHg. The blood pressure decreased to 60 mmHg using PGE1 (P<0.01), although the PI and RI were significantly higher than before hypotension (PI, P=0.0076 RI, P=0.02). The pulsatility and resistance indices during hypotension were significantly higher than before hypotension, suggesting that the autoregulation of the anterior spinal cord artery and anterior spinal cord blood flow were maintained with hypotension using PGE1. Prostaglandin E1 may be a useful drug for hypotensive anesthesia in spinal surgery.

経皮的レーザー椎間板減圧術（ＰＬＤＤ）後の手術例の検討

Between 1996 and 1999, eleven males underwent salvaged operation after Percutaneous Laser Disc Decompression (PLDD) at other hospitals. Their age ranged from 28 to 92 years old (mean: 56.6 years) and follow-up period from 1 month to 37 months (mean: 19 months). PLDD was performed on the cervical spine in 4 cases and lumbar spine in 7 cases. The numbar of PLDDs ranged from 1 to 8 times (mean: 3.3). At the time of salvaged operation, our diagnosis was lumbar herniated intervertebral disc (LHID) in 4 cases, cervical pyogenic discitis (CPD) in 2, and indivisual cases of cervical spondylotic myelopathy (CSM), cervical ossification of the posterior longitudinal ligament (OPLL), lumbar canal stenosis (LCS), lumbar discopathy, and lumbar extradural abscess (LEA).Salvaged operations were posterior discectomy in 4 cases of LHID, anterior decompression and fusion in 2 cases of CPD and OPLL, laminoplasty for CSM, PILF for LCS, PL-F for lumbar discopathy and laminectomy and debridement for LEA in one each.The snspected causes for requiring salvaged operations were no improvement after PLDD with appropriate indication in 4 patients, no improvement with inappropriate indication in 3, infection in 3, and in one case the cause was unknown.

Operative Results of Canal-Expansive Laminoplasty for Cervical Spondylotic Myelopathy in Elderly Patients

The study involved elderly patients (age > or = 65), who underwent treatment for cervical spondylotic myelopathy by canal-expansive laminoplasty. To determine the factors that influence the operative results of canal-expansive laminoplasty for treatment of cervical spondylotic myelopathy in elderly patients. Although there have been previous reports of many operative procedures, to the authors' knowledge there are no reports on the results of surgical treatment for cervical spondylotic myelopathy in elderly patients, treated by a unified surgical procedure. To date, no attempts have been made to predict the results of these procedures. Forty-seven patients (age > or = 65) who underwent canal-expansive laminoplasty were reviewed in this study. The severity of the clinical picture and the quality of operative results were graded according to the Japanese Orthopaedic Association scoring system. Of the 13 patients whose period of disability persisted for less than 3 months before the operation, 12 were able to walk after surgery. The operative results of patients more than 80 years of age were not significantly different from those of patients aged between 65 and 79 years. Results of multiple regression analysis indicate that the predictive probability of the postoperative motor function score of the lower extremities was 70%. The severity of the clinical picture and the duration of symptoms influenced the outcome of the operation. Despite the advanced age of some patients (> 80), the operation increased the chance of recovery from the disease.

Expansive laminoplasty for myelopathy in ossification of the longitudinal ligament.

Laminectomy, which had long been used for treatment of cervical spondylotic myelopathy, including ossification of the longitudinal ligament in the cervical spine, had numerous complications such as postoperative malalignment of the cervical spine and vulnerability of the spinal cord caused by total removal of the posterior structures. In 1977 Hirabayashi devised an open door expansive laminoplasty, which is a relatively easier and safer procedure than laminectomy, that eliminated such problems by preserving the posterior elements. The decompression effect of the expansive laminoplasty against a compressed spinal cord is comparable with that of laminectomy and anterior decompression followed by fusion, whereas the expansive laminoplasty has no structural problems and adverse effects on adjacent disc levels that often are associated with anterior decompression followed by fusion. Average recovery rate of expansive laminoplasty for cervical spondylotic myelopathy has been reported to be approximately 60% (Japanese Orthopaedic Association score) and with long term stability. At present, authors consider all patients with cervical spondylotic myelopathy candidates for expansive laminoplasty except for those having preoperative kyphosis and single level lesion without canal stenosis. Two remaining problems of expansive laminoplasty to be solved are prevention of C5,C6 radicular pain and/or paresis, the most frequent complication that occurs in approximately 5% to 10% of the patients, although most complications resolve spontaneously within 2 years, and correction of nonlordotic alignment to lordosis which are essential for posterior decompression effect of expansive laminoplasty by allowing the spinal cord to shift dorsally.

En bloc laminoplasty for cervical spondylotic myelopathy in patients more than 80 years of age

En bloc laminoplasty for cervical spondylotic myelopathy in patients more than 80 years of age

Over five years follow-up results of en bloc laminoplasty for cervical spondylotic myelopathy

Over five years follow-up results of en bloc laminoplasty for cervical spondylotic myelopathy

Long-term follow-up of cervical spondylotic myelopathy treated by canal-expansive laminoplasty

We have studied 29 patients for at least five years after canal-expansive laminoplasty for cervical spondylotic myelopathy. The short- and long-term clinical results were compared, and successive radiographs assessed. The long-term clinical outcome was excellent in five patients, good in 12, fair in 11 and poor in one. The mean short- and long-term improvements were 54.4% and 48.5% but patients with focal kyphotic, kyphotic and S-shaped cervical spines did less well, as did those who had a decrease in the index of curvature of the cervical spine of more than 10 at follow-up. Canal-expansive laminoplasty with reconstitution of the posterior soft tissues may help to prevent postoperative malalignment and late neurological deterioration.