Mean Japanese Orthopaedic Association Score Research Articles

Cervical Endoscopic Laminoplasty for Cervical Myelopathy.

Prospective clinical series. The aim of this study was to evaluate the safety, feasibility, and efficacy of a new minimally invasive laminoplasty technique for patients with cervical spondylotic myelopathy (CSM). Posterior decompression is one of the most common surgical interventions for CSM. Conservative posterior approaches require extensive release and extensive retraction of paraspinal muscles and/or treatment of bone (lamina), which leads to postoperative axial neck pain and a decrease in lordosis and range of motion (ROM). A total of 45 patients with CSM received cervical microendoscopic laminoplasty (CMEL). Surgery included endoscopy-assisted bilateral laminoplasty with spinous process-ligament complex and deep extensor muscle retroposition. Bilateral titanium mini-screws and plates were used for fixation. Effects and axial symptoms were evaluated according to the Japanese Orthopedic Association (JOA) scores for neurological condition and visual analog scales (VAS) for axial neck pain, respectively. Cervical curvature index (CCI) and ROM were evaluated by X-ray. Computerized tomography and magnetic resonance imaging scans evaluated laminar healing and spinal cord decompression. Follow-up ranged from 18 to 48 months (average 28 months). The duration of surgery averaged 119 minutes (range 62-147 min). Average blood loss was 360 mL (range 250-700 mL). Mean JOA scores improved from 8.0 ± 1.72 preoperatively to 13.29 ± 1.85 postoperatively. The effects were excellent in 13 cases, good in 25 cases, and fair in 7 cases. Axial symptoms were excellent in 16 cases, good in 18 cases, and fair in 11 cases. The VAS scores of axial pain significantly improved to 2.3 ± 2.0 at the final follow-up compared with 4.3 ± 2.1 preoperatively (P < 0.05). The CMEL procedure provided stable reconstruction of expanded laminar arches with no postoperative collapse or door-close. Sagittal spinal canal diameter increased by 1 to 3 mm. There were no differences in the pre- and postoperative CCI and ROM. The new CMEL provides stable reconstruction of an expanded laminar arch and causes less damage to the spinous process-ligament complex and the deep extensor muscles than conventional surgical approaches. The CMEL procedure can be used efficiently and safely to treat CSM. N/A.

Outcome of laminoplasty in cervical spinal cord injury with stable spine.

Background and Objective:Cervical spinal cord injury (CSCI) with a stable spine has been increasing as the elderly population is dramatically increasing all over the world. In this study, we evaluated the neurological outcome of decompression surgery (laminoplasty) for these patients.Materials and Methods:Forty-one patients with CSCI with stable spine who underwent decompression surgery (laminoplasty) were retrospectively studied. Inclusion criteria were as follows: CSCI without instability, spinal cord contusion in magnetic resonance image (MRI), spinal cord compression rate more than 20%, neurologic deficit American Spinal Cord Injury Association ([ASIA] scale from A to D), and follow-up of at least 12 months. Preoperative neurological state, clinical outcome, and neurological function were measured using the ASIA impairment scale, Japanese Orthopaedic Association (JOA) grading scale, and Hirabayashi recovering rate, respectively.Results:Thirty-three (80.4%) patients showed improvement in ASIA grade at 12-month follow-up. Four (9.7%) patients in ASIA Grade A and 4 (9.7%) patients in ASIA Grade D remain unchanged. The mean JOA score improved from 8.4 ± 6.1 points preoperatively to 11.2 ± 5.4 points at 12 months postoperatively. Improvement in JOA was statistically significant (P < 0.05). The mean Hirabayashi recovery rate was 37.4 ± 25.3%.Conclusion:Surgical decompression (laminoplasty) is helpful in relieving cord compromise and neurological deficit in CSCI with stable spine.

Outcome of posterior decompression with instrumented fusion surgery for K-line (−) cervical ossification of the longitudinal ligament

We investigated the outcome of posterior decompression and instrumented fusion (PDF) surgery for patients with K-line (−) ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, who may have a poor surgical prognosis. We retrospectively analyzed the outcome of a series of 27 patients who underwent PDF without correction of cervical alignment for K-line (−) OPLL and were followed-up for at least 1 year after surgery. We had performed double-door laminoplasty followed by posterior instrumented fusion without excessive correction of cervical spine alignment. The preoperative Japanese Orthopedic Association (JOA) score for cervical myelopathy was 8.0 points and postoperative JOA score was 11.9 points on average. The mean JOA score recovery rate was 43.6%. The average C2–C7 angle was 2.2° preoperatively and 3.1° postoperatively. The average maximum occupation ratio of OPLL was 56.7%. In conclusion, PDF without correcting cervical alignment for patients with K-line (−) OPLL showed moderate neurological recovery, which was acceptable considering K-line (−) predicts poor surgical outcomes. Thus, PDF is a surgical option for such patients with OPLL.

Lamina Fenestration Technique for Treatment of Thoracic Ossified Ligamentum Flavum: 2-Year Follow-Up Result.

Background The incidence of thoracic ossification of ligamentum flavum (OLF) is increasing, and the available surgical techniques were invasive. Study Aims To evaluate the surgical outcome and prognostic factors in relation to clinicoradiologic variables with a novel minimally invasive lamina fenestration technique in patients with thoracic OLF. Patients and Methods Between July 2005 and November 2010, 27 levels with 50 lesions in 17 patients were treated with the lamina fenestration technique for the decompression of thoracic OLF. This technique creates a keyhole in the lamina, preserving lower lamina bone, facet joint, and ligamentum flavum. Patient outcome was analyzed using the Japanese Orthopaedic Association (JOA) score and progression of kyphosis on simple X-ray. Results All patients were successfully treated with the laminar fenestration technique. There was one dural tear but no neural complication or injury. Mean length of follow-up was 49 months. Mean JOA score improved from 4.88 to 7 (p = 0.000). Six patients had an excellent surgical outcome; 10 had a good surgical outcome according to JOA scoring. Conclusion The lamina fenestration technique for the treatment of thoracic OLF had a successful outcome with few complications. This technique can be a minimally invasive surgical option for the treatment of thoracic OLF.

Surgical Outcomes of Thoracic Myelopathy Secondary to Ossification of Ligamentum Flavum in a Regional Hospital: A Primitive Report and Literature Review: 在一所地區醫院用手術治療由黃韌帶骨化引起的胸椎脊髓病的效果 - 報告及文獻回顧

IntroductionSymptomatic thoracic stenosis is an uncommon disease in contrast to cervical and lumbar stenosis. It has been reported that ossification of ligamentum flavum (OLF) is the most common cause of thoracic myelopathy in our locality. Materials and methodsAll patients with symptomatic thoracic spinal stenosis secondary to OLF who underwent operative treatment in our institution between January 1999 and December 2013 were retrospectively reviewed for demographic data, causes, complications and surgical outcomes. ResultsTwenty-six patients who underwent surgical treatment for symptomatic OLF were followed up for an average period of 71.3 months. All patients received decompression with concomitant instrumented fusion in 2 patients (7.7%). In our series, we had 2 cases (7.7%) of early post-operative neurological deterioration secondary to haematoma formation. Four cases (15.4%) were complicated with cerebrospinal fluid leakage. Operative outcome was reported in Frankel classification and modified Japanese Orthopedic Association (JOA) scale for thoracic myelopathy. After operation, 8 patients (30.8%) showed improvement in their Frankel grade, while 16 patients (61.5% ) had no change and 2 patients (7.7%) reported deterioration. Mean JOA score showed significant improvement from 5.1 (range 2–8) to 6.9 post-operatively (range 2–11). Discussion and conclusionOLF is the most common cause of thoracic myelopathy in our locality. Early accurate diagnosis and adequate surgical decompression are important for favourable outcomes despite operative difficulties and possible complications.

Mid-term Outcomes of Anterior Cervical Fusion for Cervical Spondylosis With Sympathetic Symptoms

Prospective study. The purpose of this study is to elucidate mid-term outcomes of anterior cervical fusion for cervical spondylosis with sympathetic symptoms (CSSS). The terminology, pathogenesis, diagnosis, and treatment of CSSS remain controversial. Surgical treatment of CSSS has been rarely reported. This is the first prospective study to evaluate the mid-term outcome of surgical treatment of CSSS. Thirty-one patients who were diagnosed with CSSS in 2006 were evaluated prospectively. All patients were assigned to undergo anterior cervical fusion with posterior longitudinal ligament (PLL) resection and followed up for ≥5 years. Sympathetic symptoms such as vertigo, headache, and tinnitus, etc. were evaluated using the sympathetic symptom 20-point score. Neurological status was assessed using the Japanese Orthopedic Association (JOA) score. Clinical and radiologic data were prospectively collected before surgery, and at 1 week, 2 months, 6 months, 2 years, and 5 years after surgery. Surgical complications and morbidities of other diseases during the follow-up were also recorded. The mean 20-point score decreased significantly from 7.3±3.5 before surgery to 2.2±2.7 at the final follow-up (P<0.001), giving a mean recovery rate of 66.1%±50.3%. Good to excellent results were attained in 80.6% of these patients. The sympathetic symptoms were relieved in 23 of the 31 patients in the early postoperative period, and 5 patients in 2 months. No relief of sympathetic symptoms was found in 3 patients. The mean JOA score improved significantly from 12.0±1.9 before surgery to 14.8±1.5 by the end of the follow-up (P<0.001). No late neurological deterioration was found in this group. The mid-term outcomes of anterior cervical fusion with PLL resection for CSSS have been satisfactory. Differential diagnosis before surgery is of great importance. PLL may play a role in presenting sympathetic symptoms.

One-staged combined decompression for the patients with cervico-thoracic tandem spinal stenosis

PurposeTo report the techniques and safety of one-staged combined decompression for the patients with tandem spinal stenosis (TSS) at cervical and thoracic spine.MethodsSixteen TSS subjects, who received combined decompression from Aug 2005 to Feb 2012, were reviewed. The essentials of our surgical strategy included: choosing patients with TSS from cervical to upper or middle thoracic spine, using one single posterior incision, simplifying surgical maneuvers and performing circumferential decompression for thoracic compression if it was indicated. The Japanese Orthopedic Association (JOA) scale for cervical myelopathy was employed to evaluate the neurological status, and Hirabayashi’s system to assess neurological recovery rate.ResultsThe average operation duration, blood loss and postoperative hospitalization were 242.8 ± 89.9 min, 1581.3 ± 1237.2 ml and 11.9 ± 7.5 days, respectively. Six subjects (37.5 %) suffered instant neurological deterioration. Other complications included cerebrospinal fluid leakage (10 subjects, 62.5 %), new radiculopathy (two subjects), urinary infection, lung infection and pulmonary thromboembolism. Four subjects received extra-thoracic decompression due to the remaining anterior compression in one subject and new emerging compression in other three subjects. Eventually, mean JOA score was elevated from 9.8 ± 2.1 to 13.7 ± 2.7 after this procedure, and the neurological recovery of seven subjects was rated as excellent, four as good, two as fair, three as unchanged or deteriorated. The overall recovery rate was 53.7 %.ConclusionCombined cervico-thoracic decompression could provide fair neurological outcomes for patients with cervico-thoracic TSS, but it was complicated with high rate of undesirable postoperative events. So, more efforts should be done against its eventful postoperative course before its wide application.

Clinical outcomes after decompressive laminectomy for symptomatic ossification of ligamentum flavum at the thoracic spine

Ossification of the ligamentum flavum (OLF) is a rare disease that causes acquired thoracic spinal canal stenosis and thoracic myelopathy. The aim of this study was to investigate clinical outcomes of symptomatic thoracic OLF treated using posterior decompressive laminectomy. We retrospectively analyzed the medical records of 22 patients who underwent posterior decompressive laminectomy for symptomatic thoracic OLF. The surgical results were evaluated using the modified Japanese Orthopaedic Association (JOA) scoring system and Hirabayashi recovery rate. The intensity of pain was evaluated using a visual analog scale (VAS). The mean duration of follow-up was 35.6months. The mean JOA score was significantly improved at final follow-up (9.18±standard deviation of 1.53 points [range, 6–11 points]) compared with before surgery (5.64±2.04 points [range, 3–9 points]) (P<0.001). The mean Hirabayashi recovery rate was 65.49% (range, 20–100%). Recovery outcomes were excellent in nine patients, good in eight patients, fair in four patients and unchanged in one patient. No patient was classified as deteriorated. The VAS scores were 2.82±3.08 before surgery and 0.59±1.05 at final follow-up (P=0.001). Surgical complications, which resolved after appropriate and prompt treatment, included dural tear in five patients, cerebrospinal fluid leakage in one patient, immediate postoperative neurologic deterioration in one patient, epidural hematoma in one patient, and wound infection in one patient. Our findings suggest that posterior decompressive laminectomy is an effective treatment for symptomatic thoracic OLF and provides satisfactory clinical improvement, but surgery for thoracic OLF is associated with a relatively high incidence of complications.

Cervical anterior hybrid technique with bi-level Bryan artificial disc replacement and adjacent segment fusion for cervical myelopathy over three consecutive segments

This study aimed to assess the preliminary clinical efficacy and feasibility of the hybrid technique for multilevel cervical myelopathy. Considering the many shortcomings of traditional treatment methods for multilevel cervical degenerative myelopathy, hybrid surgery (bi-level Bryan artificial disc [Medtronic Sofamor Danek, Memphis, TN, USA] replacement and anterior cervical discectomy and fusion) should be considered. Between March 2006 and November 2012, 108 patients (68 men and 40 women, average age 45years) underwent hybrid surgery. Based on the Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and Odom’s criteria, the clinical symptoms and neurological function before and after surgery were evaluated. Mean surgery duration was 90minutes, with average blood loss of 30mL. Mean follow-up duration was 36months. At the final follow-up, the mean JOA (± standard deviation) scores were significantly higher compared with preoperative values (15.08±1.47 versus 9.18±1.22; P<0.01); meanwhile, NDI values were markedly decreased (12.32±1.03 versus 42.68±1.83; P<0.01). Using Odom’s criteria, the clinical outcomes were rated as excellent (76 patients), good (22 patients), fair (six patients), and poor (four patients). These findings indicate that the hybrid method provides an effective treatment for cervical myelopathy over three consecutive segments, ensuring a good clinical outcome.

Spinal Instrumented Fusion in Combination with Botulinum Toxin Treatment for Cervical Myelopathy in Patients with Athetoid Cerebral Palsy

Objective. To report the surgical outcomes and the details of perioperative botulinum toxin treatment of patients with cervical myelopathy associated with athetoid cerebral palsy.Summary of Background Data. Recently, injections of botulinum toxin have been widely used to decrease spasticity and involuntary movements associated with athetosis or dystonia. Studies focusing on the details of botulinum toxin treatment are rare.Methods. For patients who underwent surgery with spinal instrumented fusion in combination with perioperative botulinum toxin treatment, surgical outcomes, the details of botulinum toxin treatment and perioperative complications were investigated retrospectively.Results: Of 17 patients, 15 underwent surgery by posterior methods, and 2 underwent anterior and posterior combined procedures. The mean preoperative Japanese Orthopedic Association (JOA) score was 6.9±2.4. At the final follow-up visit, the mean JOA score was 9.2±3.3, and the mean recovery rate was 23%. Botulinum toxin treatment suppressed involuntary neck movements in all patients. Halo vest immobilization was adapted for six patients preoperatively and for four patients postoperatively. The major complication in relation to surgery was implant failure. One patient developed mild dysphasia after an injection of botulinum toxin, but it improved after conservative therapy.Discussion & Conclusion: Botulinum toxin treatment was performed safely and was effective in the management of involuntary neck movements. With botulinum toxin treatment, we were able to obtain relatively good surgical outcomes even if we did not use halo vest immobilization in many cases. However, we still faced a high rate of implant failures in the postoperative period. Using relatively strong external fixation, such as halo vest immobilization, together with botulinum toxin treatment may be an option for cervical myelopathy in patients with severe involuntary neck movements.

Hybrid Solutions for the Surgical Treatment of Multilevel Degenerative Cervical Disk Disease.

Background In different stages of cervical degenerative disk disease, the combination of dynamic and nondynamic implants may be considered. The aim of this study was to investigate the applicability of criteria to assist decision making in these cases. Methods Thirty patients with spondylotic cervical radiculopathy and a coincidence of soft disk and hard disk herniation were surgically treated with a hybrid solution (combination of total disk replacement and cage fusion). The control group included 32 patients who underwent two-level cage fusion. Pre- and postoperative Japanese Orthopaedic Association (JOA) scores and range of motion (ROM) were compared. Results Twenty-three patients underwent two-level hybrid solution and 7 underwent three-level treatment. The most frequent solution (n = 13) was a combination of a dynamic implant at C5-C6 and a nondynamic implant at C6-C7. The mean JOA score improved from 13.9 to 15.6 points after surgery (mean deviation [MD] 1.6, 95% confidence interval [CI] 2.1 to 1.2, p < 0.001). ROM showed a slight trend to increase (MD 0.8, 95% CI -0.9 to 2.6, p = 0.193). In the control group, the mean JOA score improved from 13.3 to 15.1 points after surgery (MD 1.4, 95% CI 2.1 to 1.2, p < 0.001). The comparison of the postoperative JOA scores and recovery rates between the hybrid treatment group and the control group did not show significant differences. Conclusions In cases of coincident soft and hard degenerative cervical disk disease at adjacent levels, the combination of a disk prosthesis and a nondynamic implant is a safe and effective treatment option and an alternative to multilevel fusion.

Clinical and radiographic evaluation of cemented socket fixation concomitant to acetabular bone grafting fixed with absorbable hydroxyapatite-poly-l-lactide composite screws

BackgroundThe durability of uncalcined and unsintered hydroxyapatite-poly-l-lactide composite screws is unclear when used for the fixation of acetabular bone graft in total hip arthroplasty under full-weight conditions. We have used this type of screw for the fixation of acetabular bone graft in cemented or reverse-hybrid total hip arthroplasty since 2003. Hence, we conducted a follow-up study to assess the safety and efficacy of these screws when used for cemented socket fixation. MethodsIn this study, 98 patients (106 cases) who underwent fixation of acetabular bone graft in cemented or reverse-hybrid total hip arthroplasty using hydroxyapatite-poly-l-lactide composite screws were followed up for over 5 years and evaluated clinically and radiographically. The patient population comprised 10 men and 88 women with a mean age of 60.3 years (range, 41–81 years) at the time of surgery. The original diagnosis for primary total hip arthroplasty was secondary osteoarthritis in 97 cases and high hip dislocation in nine cases. ResultsThe mean follow-up period was 7.6 years (range, 5–11 years). No patient in this series required revision surgery, and no radiographical loosening occurred during the follow-up period. The mean Japanese Orthopaedic Association score improved from 48 (range, 7–73) preoperatively to 87 (range, 50–100) at the final follow-up. Radiographically bone graft consolidation was confirmed in all cases, and no apparent osteolysis around the cemented socket or composite screws was detected. Kaplan–Meier survival analyses with socket revision surgery for any reason, socket loosening, and appearance of a radiolucent line >1 mm in any zone as the endpoints yielded survival rates of 100%, 100%, and 86.8% at 5 years, and 100%, 100%, and 81.0% at 10 years, respectively. ConclusionThis absorbable screw seems to have no negative effects on the mid-term clinical results of cemented socket fixation.

Mixed Fixation and Interbody Fusion for Treatment Single-Segment Lower Lumbar Vertebral Disease: Midterm Follow-up Results.

To investigate the midterm outcomes of unilateral pedicle screws combined with contralateral gunsight-guided translaminar facet screw fixation and interbody fusion for treatment of single-segment lower lumbar vertebral disease. A total of 78 patients with various lower lumbar single-segment vertebral diseases were treated in our department from January 2008 to December 2011. There were 21 males and 57 females, with an average age of 52.5 years, including lumbar disc degeneration (28 cases), local recurrence of lumbar disc herniation (9 cases), huge lumbar disc herniation (11 cases), lumbar disc herniation with spinal stenosis (13 cases), and lumbar degenerative spondylolisthesis (degree I) (17 cases). All patients were treated by unilateral pedicle screws in the median incision combined with contralateral gunsight-guided translaminar facet screw fixation and interbody fusion. No wound infection or skin necrosis around incision was observed after operation. No leakage of cerebrospinal fluid or nerve injury occurred during and after operation. Excepting 4 cases, 74 cases were followed up for 18-60 months, averaged 33.5 months. All but one patient (98.6%) received interbody fusion. The intervertebral height of the indexed level was well restored and maintained. At final follow-up. During follow-up, there was no screw loosening or pedicle fracture observed. No apparent degeneration of adjacent segments. The mean Japanese Orthopaedic Association (JOA) scores was increased significantly from 12.79 ± 2.12 preoperatively to 25.8 ± 2.87 at the final follow-up. Unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation and interbody fusion showed good mid-term outcomes in the treatment of single-segment lower lumbar vertebral disease, and can be used as an optimal choice for fixation and fusion of some single-segment lower lumbar vertebral diseases.

The validity of the classification for lateral hinge fractures in open wedge high tibial osteotomy.

The objective of this study was to validate the efficacy of Takeuchi classification for lateral hinge fractures (LHFs) in open wedge high tibial osteotomy (OWHTO). In all 74 osteoarthritic knees (58 females, 16 males; mean age 62.9 years, standard deviation 7.5, 42 to 77) were treated with OWHTO using a TomoFix plate. The knees were divided into non-fracture (59 knees) and LHF (15 knees) groups, and the LHF group was further divided into Takeuchi types I, II, and III (seven, two, and six knees, respectively). The outcomes were assessed pre-operatively and one year after OWHTO. Pre-operative characteristics (age, gender and body mass index) showed no significant difference between the two groups. The mean Japanese Orthopaedic Association score was significantly improved one year after operation regardless of the presence or absence of LHF (p = 0.0015, p < 0.001, respectively). However, six of seven type I cases had no LHF-related complications; both type II cases had delayed union; and of six type III cases, two had delayed union with correction loss and one had overcorrection. These results suggest that Takeuchi type II and III LHFs are structurally unstable compared with type I. Cite this article: Bone Joint J 2015;97-B:1226-31.

Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases.

A retrospective comparative study. To describe the clinical features and radiological findings, to assess the safety and effectiveness of posterior decompressive laminectomy and resection of the ossification of the ligamentum flavum (OLF), and to determine which presurgical and surgical variables were most closely related to postsurgical prognosis of thoracic myelopathy (TM) caused by OLF in China. Eighty-five patients with the diagnosis of TM caused by OLF received surgical treatment from July 1998 to May 2012. Clinical data were collected from medical and operative records. Correlations between the surgical outcome and various factors were also analyzed. All cases were followed up for a mean of 49.2 months (range, 24-190 months) postoperatively. The mean Japanese Orthopaedic Association score was 3.8 points preoperatively and 8.2 points at the final follow-up, yielding a mean recovery rate of 63.0%. Postoperative complications included transient neurological deficits (9 cases), persistent neurological deficits (4 cases), dural tears (17 cases), cerebrospinal fluid leakage (9 cases), wound dehiscence (2 cases) and wound infection (3 cases). The OLF level (middle thoracic), preoperative duration of symptoms, intramedullary signal change on T2WI and preoperative severity of myelopathy were important predictors of surgical outcome. Biomechanical and anatomical factors may have a key role in thoracic OLF progression. Posterior decompressive laminectomy and resection of the OLF can be considered an effective, reliable and safe alternative procedure. The OLF level, preoperative duration of symptoms, intramedullary signal change on T2WI and preoperative severity of myelopathy were confirmed and significantly correlated with the surgical outcome.

Single-door cervical laminoplasty using titanium miniplates alone.

To review outcome of 29 patients who underwent single-door cervical laminoplasty for myelopathy using titanium miniplates alone. Records of 20 men and 9 women aged 35 to 79 (mean, 64.3) years who underwent single-door cervical laminoplasty for myelopathy using titanium miniplates alone were reviewed. A total of 125 laminae were opened; 97 of them were fixed with a titanium miniplate. In 19 patients, a 20-hole titanium miniplate bent to the contour of a lamina was used and fixed into 3 laminae at alternate levels. In the remaining 10 patients, the pre-contoured ARCH Laminoplasty System was used and fixed into all laminae. In most patients, screw fixation was unicortical, and no spacer or bone graft was used. The mean follow-up duration was 4 (range, 2-9) years. At one-year follow-up, the mean Japanese Orthopaedic Association (JOA) score improved from 9.2 to 13.2 (p<0.001). The mean JOA recovery rate was 64%. No patient had neurological deterioration. The mean anteroposterior diameter increased from 14.3 mm to 19.7 mm; the mean increase was 6.1 mm in the plated laminae and 5.3 mm in the unplated laminae (p=0.11). Out of the 125 laminae, there were 2 hinge non-unions in the unplated laminae, and 2 screw pullouts (not associated with plate loosening). No patient had penetration into the vertebral foramen or neuroforamen. Spring-back closure occurred in 5 (18%) of the 28 unplated laminae, with a mean of <3 mm loss of the initial expansion. Two patients developed transient C5 palsy presenting as shoulder abduction weakness. One patient had a delayed dural tear due to a sharp spike at the edge of the opened C6 lamina. Single-door cervical laminoplasty using miniplates alone is a safe technique and achieves a high hinge union rate, good canal expansion, and neurological recovery.

Incidence and Risk Factors for Late Neurologic Deterioration after C3-C6 Laminoplasty for Cervical Spondylotic Myelopathy.

Study Design Retrospective study. Objective We previously reported that the long-term neurologic outcomes of C3–C6 laminoplasty for cervical spondylotic myelopathy (CSM) are satisfactory, with reduced frequencies of postoperative axial neck pain and kyphotic deformity. However, only 20 patients were included, which is a limitation in that study. The present study investigated the incidence of late neurologic deterioration (LND) of myelopathic symptoms after C3–C6 laminoplasty for CSM and attempted to identify significant risk factors for LND in a larger patient population. Methods Subjects comprised 137 consecutive patients with CSM who underwent C3–C6 laminoplasty (bilateral open-door laminoplasty, n = 85; unilateral open-door laminoplasty, n = 52) and were followed for >24 months (mean follow-up, 70 months; range, 25 to 124 months). The patients' medical records were examined for evidence of LND due to cervical myelopathy. The age at time of surgery, sex, surgical procedures, anteroposterior spinal canal diameter at the C7 level, type of C6 spinous process, pre- and postoperative C2–C7 angle, C3–C6 range of motion (ROM), and disk height at the C6–C7 level were analyzed to identify risk factors for LND. Results Three patients (2.2%) developed LND of myelopathic symptoms due to caudal segment pathology adjacent to the C3–C6 laminoplasty (LND group). In these three patients, mean Japanese Orthopaedic Association (JOA) score improved from 10.2 before surgery to 12.2 at the time of maximum recovery, and declined to 9.7 just before additional surgery. On the other hand, in 134 patients without LND (non-LND group), the mean JOA score significantly improved from 10.2 before surgery to 13.4 at the time of maximum recovery and was maintained by the final follow-up (13.2). Compared with the non-LND group, the LND group showed significantly smaller anteroposterior spinal canal diameter at C7, more restricted postoperative C3–C6 ROM, and greater postoperative decrease in disk height at C6–C7, although a logistic regression analysis showed no significant differences. Conclusions In patients with CSM with more severe developmental spinal canal stenosis at C7, accelerated degeneration at the caudal segment resulting from restricted C3–C6 ROM after C3–C6 laminoplasty might lead to LND.

A study on the cervical spondylotic myelopathy treated by anterior cervical diskectomy and fusion in accordance with Modic changes with a 2-year minimum follow-up.

BackgroundThe aim of this research is to analyze the influence of Modic types on the clinical results of cervical spondylotic myelopathy treated by anterior cervical diskectomy and fusion.MethodsA total of 106 patients with a mean age of 55.8 ± 6.5 years were included in this study. Patients with Modic changes were retrospectively reviewed. In this study, 23 patients were classified as Modic-1, 39 patients were classified as Modic-2, and 44 patients were classified as Modic-0. Clinical evaluations were performed preoperatively and repeated at 3, 6, 12, and 24 months after operation.ResultsIn this study, all patients were followed up for a mean period of 30.2 months (range, from 24 to 36 months). Significant clinical improvement (P < 0.05) was observed in Japanese Orthopaedic Association (JOA) score and axial symptoms between the preoperative evaluation and the final follow-up. Comparing the result of mean JOA score after anterior cervical diskectomy and fusion (ACDF) in the Modic-1 group and other groups, statistically significant differences could be found at 12 months after surgery (P < 0.05). Comparing the outcome visual analog scale (VAS) of axial symptoms among different groups after ACDF, patients with Modic-1 changes showed significantly lower VAS of axial symptoms postoperatively (P < 0.05).ConclusionAfter anterior cervical diskectomy and fusion, both Modic-1 and Modic-2 groups showed excellent clinical outcomes over a 2-year follow-up. Better clinical results were achieved in patients with Modic-1 changes compared to the group of patients with Modic-2 and Modic-0 changes on magnetic resonance images.

Clinical and Radiological Characteristics of Ossification of the Posterior Longitudinal Ligament of the Cervical Spine in Patients without Myelopathy: Results of a 1-year Pilot Study.

We analyzed the demographics, clinical and radiological characteristics of non-myelopathic cervical ossification of the posterior longitudinal ligament (OPLL) patients. This study included 115 patients with cervical OPLL but without myelopathy. Demographic features of age, sex, and the nature of the patient"s symptoms were evaluated. Clinically, visual analog scale (VAS) scores for the neck and arm, and Japanese Orthopaedic Association (JOA) scores were evaluated. Radiologically, the number of involved segments, type of OPLL, and the maximal compression ratio were analyzed using a computed tomography (CT) scan. The relationship between clinical scores and radiological parameters was analyzed. At the time of diagnosis, there was absence of symptoms in 23, axial neck pain in 44, radiculopathy in 40, and tingling sensation of fingers in 8. VAS score for the neck was 4.42 and that for the arm was 3.64. The mean JOA score was 16.13. Radiologically, the mean number of involved segments was 3.55. The type of OPLL mass was continuous, mixed, segmental, and local in 10, 43, 42, and 20 cases, respectively. The maximal compression ratio was 0.38. There was a significant relationship between the maximal compression ratio and the number of involved segments (p < 0.001). No relationship was found between clinical symptoms, clinical scores, and radiological findings. Some non-myelopathic cervical OPLL patients showed no symptoms, some presented axial neck pain and radiculopathy. Radiologically, a significant relationship between the maximal compression ratio and the number of involved segments was found. However, there was no relationship between clinical symptoms and radiological findings in neurologically intact patients.

Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion: Early Outcome Observations

Aim: To compare early clinical and surgical outcome of patients treated with open transforaminal lumbar interbody fusion (O-TLIF) vs minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Materials and methods: Sixty-two consecutive patients from 2011 to 2013 undergoing transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis and lumbar spinal stenosis were included in the study. For analysis, they were divided into two groups based on whether TLIF was done by a conventional open technique (O-TLIF, 31 cases) or minimally invasive tubular retractor-assisted technique (MIS-TLIF, 31 cases). The demographic profile, clinical and surgical outcome variables, including pre- and postoperative visual analog scale (VAS), Japanese orthopedic association (JOA) scores and JOA recovery rates were noted in both the groups. Results: The median duration of follow-up was 9 months in MIS-TLIF group and 14 months in O-TLIF group. Preoperative clinical variables were comparable in both the groups. MIS-TLIF group had lesser mean intraoperative blood loss, lesser analgesic requirement, shorter hospital stay and earlier return to work as compared to O-TLIF group. Improvements in postoperative VAS for leg pain were similar in both the groups. Immediate postoperative and follow-up VAS for back pain were lower while mean JOA score and mean JOA recovery rate were significantly higher in MIS-TLIF group as compared to O-TLIF group. Conclusion: Minimally invasive transforaminal lumbar interbody fusion resulted in lesser blood loss, lesser analgesic requirement, shorter hospital stay, earlier return to work and improved functional outcome in terms of higher JOA recovery rates as compared to O-TLIF.