Recurrence Of Myelopathy Research Articles

Cases requiring reoperation for recurrence of myelopathy by lamina closure after a double-door laminoplasty using a modified Kirita–Miyazaki suture method

BackgroundProgression of kyphosis after laminoplasty sometimes results in the recurrence of myelopathy with lamina closure. However, only a few case reports have been published on the reoperation of double-door laminoplasty using the suture method. This study investigated the incidence and clinical features of reoperation cases caused by the recurrence of myelopathy with lamina closure after double-door laminoplasty using a modified Kirita–Miyazaki suture method. MethodsA total of 169 patients who underwent double-door laminoplasty were included in this study, with a mean follow-up duration of 6.6 years (range: 2–16). All surgeries were double-door laminoplasties in which the open lamina was sutured to the paravertebral muscle. The reoperation rate for myelopathy recurrence due to lamina closure and the associated risk factors were investigated. The risk factors included age, history, cervical alignment, C2–7 lordosis, the cervical sagittal vertical axis, and C7 slope. ResultsThe reoperation rate for recurrence of myelopathy by lamina closure was 3.0% (5/169). All patients showed kyphosis progression after surgery; the spinal cord was more compressed by closed lamina than before the initial surgery. The reoperation group had more patients with neuromuscular or psychiatric disorders (60% [3/5] vs. 2% [4/164]; p < 0.001), kyphotic alignments (60% [3/5] vs. 10% [16/164]; p < 0.001), and cases with less than −10° of C2–7 lordosis (60% [3/5] vs. 7% [11/164]; p < 0.001). ConclusionsDouble-door laminoplasty with the suture method may not be suitable for patients with a neuromuscular or psychiatric disease or those with preoperative C2–7 lordosis less than −10°.

P23 A STRANGE CASE OF CERVICALGIA

Abstract 65–year–old patient with a history of Type 2 Diabetes Mellitus on oral hypoglycaemic therapy, hypercholesterolemia, previous diagnosis of non–secreting K–chain micronodular myeloma undergone heterologous marrow transplantation. From January 2022, he presented persistent mild–moderate neck pain and feverish episodes, therefore he started empiric antibiotic therapy at home. Since June 2022, he complained a worsening of the neck pain partially controlled by non–steroidal anti–inflammatories. Magnetic resonance imaging was therefore performed which highlighted findings consistent with spondylitis of probable infectious nature and subsequent start of empiric antibiotic. A bone marrow biopsy was also performed which showed no recurrence of myelopathy. In July 2022 new feverish episode with shaking chills lasting about 3 days. In this circumstance he underwent a blood culture which resulted positive for the presence of Str. Bovis. In addition, a transthoracic echocardiogram was performed and showed evident floating serpiginous vegetation on the anterior mitral leaflet measuring approximately 1.2 cm x 2.5 cm with a mild mitral regurgitation. Targeted antibiotic therapy was set up and abdominal ultrasound and brain MRI were performed which excluded splenic and brain embolization. A close echocardiographic follow–up showed no reduction of the vegetation. So the patient underwent cardiac surgery in thoracotomy to remove the vegetation adhered to the anterior mitral flap in A2 on the atrial side (3 cm x 1.5 cm x 0.5 cm), and also removal of millimetric lesions on the posterior flap and abrasion of the implantation areas. The post–surgery clinical course passed without any complications, the patient remained stably afebrile with a progressive reduction of the inflammation indexes. Approximately 10 days post–surgery, the patient was then discharged with indications for echocardiographic follow–up.

Long-Term Clinical Course of Patients After Decompression and Posterior Instrumented Fusion Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament: An Average Follow-Up of 18 years.

Retrospective observational study. To evaluate the long-term recurrence rates and functional status of patients with thoracic ossification of the posterior longitudinal ligament (OPLL) after decompression and posterior fusion surgery. Thirty-seven consecutive patients who underwent posterior thoracic spine surgery at a single institution were retrospectively reviewed. The long-term neurological and functional outcomes of 25 patients who were followed up for ≥10years after surgery were assessed. Factors associated with the recurrence of myelopathy were also analyzed. The mean preoperative Japanese Orthopaedic Association score was 3.7, which improved to 6.5 at postoperative year 2 and declined to 6.0 at a mean follow-up of 18years. No patient experienced a relapse of myelopathy due to OPLL within the instrumented spinal segments. However, 15 (60%) patients experienced late neurological deterioration, 10 of whom had a relapse of myelopathy due to OPLL or ossification of the ligamentum flavum (OLF) in the region outside the primary operative lesion, while 4 developed myelopathy due to traumatic vertebral fracture of the ankylosed spine. Young age, a high body mass index, and lumbar OPLL are likely associated with late neurological deterioration. Decompression and posterior instrumented fusion surgery is a reliable surgical procedure with stable long-term clinical outcomes for thoracic OPLL. However, as OPLL may progress through the spine, attention should be paid to the recurrence of paralysis due to OPLL or OLF in regions other than the primary operative lesion and vertebral fractures of the ankylosed spine after surgery for thoracic OPLL.

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.

Transoral release to realign postoperative loss of reduction following occipitocervical fixation for congenital basilar invagination.

Revision surgery in an irreducible atlantoaxial dislocation (IAAD) previously operated with a posterior approach is challenging. Multiple modalities using anterior, posterior, and dual approaches have been described. We report a so far unreported technique of revision surgery by posterior implant removal and decompression with anterior transoral release followed by posterior instrumentation. 14-year male with basilar invagination (BI) with IAAD, previously operated with posterior decompression and instrumented occipitocervical fusion presented three months later with post-traumatic recurrence of myelopathy with quadriparesis with Di Lorenzo grade 4 and loss of reduction. He was operated with a posterior implant and early fusion mass removal with extended foramen magnum decompression (FMD), followed by anterior transoral release with a satisfactory reduction on traction, and finally, a posterior revision instrumented occipitocervical fusion. At 2-year follow-up, the patient was symptom-free with Di Lorenzo grade 1 and cervicomedullary angle improvement from 97.4° to 141.2°; achieving bony fusion. Single-stage posterior-anterior transoral-posterior approach can be used to achieve satisfactory reduction for a revision BI with IAAD with prior posterior instrumentation.

Anterior Decompression and Fusion Versus Laminoplasty for Cervical Myelopathy Caused by Soft Disk Herniation: A Long-term Prospective Multicenter Study.

A prospective multicenter study. The purpose of this study was to determine whether laminoplasty (LP) is comparable for myelopathy caused by cervical disk herniation (CDH). Anterior decompression and fusion (ADF) has conventionally been used for myelopathy caused by CDH with stable outcomes. However, recurrence of myelopathy due to adjacent segment degeneration are its drawbacks. The efficacy of LP without discectomy has been sporadically reported, but no long-term prospective study has been conducted to verify it. Patients with cervical myelopathy caused by CDH were studied. The first 30 patients and the next 30 patients were treated with ADF and LP, respectively. The outcomes were compared between the 22 ADF patients and the 20 LP patients who had completed the follow-up examination scheduled 10 years after surgery. There was no statistically significant difference in the postoperative severity or recovery rate of myelopathy between the 2 groups 10 years after surgery. One patient in the ADF group underwent LP for secondary myelopathy due to adjacent segment degeneration 2 years after the surgery. Reoperation was not required for patients in the LP group. Postoperative neck pain was significantly more severe in the LP group than in the ADF group. ADF and LP for cervical myelopathy caused by CDH achieve similarly favorable outcomes. Recurrence of myelopathy caused by adjacent segment degeneration is a disadvantage of ADF while residual neck pain is a disadvantage of LP.

Intradural tumor and concomitant disc herniation of cervical spine

We report a rare patient of a simultaneous extradural and intradural compression of the cervical spinal cord due to co-existent intervertebral disc herniation and an intradural schwannoma at the same level. The intradural lesion was missed resulting in recurrence of myelopathy after a surprisingly complete functional recovery following anterior cervical discectomy. Retrospectively, it was noted that the initial cord swelling noticed was tumor being masked by the compression produced by the herniated disc. A contrast magnetic resonance imaging scan is important in differentiating intradural tumors of the spinal cord. A high index of suspicion is often successful in unmasking both the pathologies.

Surgical Outcome of Cervical Spondylotic Myelopathy with Athetoid Cerebral Palsy

Repetitive exaggerated neck movements in ACP may result in early degeneration of cervical spine requires operative managements. Moreover, these abnormal involuntary movements give rise to earlier instrument failure requires additional operative treatment and increase the incidence of recurrence of myelopathy. Understanding the outcome of operative management can aid in this decision-making process for the treatment of CSM in ACP.

Anterior decompression and fusion versus laminoplasty for cervical myelopathy caused by soft disc herniation: a prospective multicenter study

BackgroundAnterior decompression and fusion (ADF) has conventionally been used, with stable outcomes, for cervical myelopathy caused by soft disc herniation. However, complications related to bone grafting and recurrence of myelopathy due to adjacent segment degeneration are its drawbacks. The efficacy of laminoplasty as an alternative has been sporadically reported, but no prospective study has been conducted to verify it. The purpose of this study was to determine whether laminoplasty is comparable for this condition. MethodsPatients with cervical myelopathy caused by soft disc herniation whose preoperative disease period was less than 1 year were studied. The first 30 patients and the next 30 patients were treated by ADF and laminoplasty, respectively. All patients were given the same postoperative management. The outcomes were compared between the ADF and the laminoplasty groups consisting of 25 patients each who completed a follow-up examination 1 year after surgery. ResultsThe two groups were found statistically matched regarding age at surgery, sex, disc level of herniation, anteroposterior diameter of the spinal canal, preoperative severity of myelopathy, cervical lordosis angle, and cervical range of motion (ROM). There was no statistically significant difference in the postoperative severity or recovery rate of myelopathy between the two groups. The amount of blood loss during surgery was significantly less in the laminoplasty group. Donor site pain and neck pain was minimal in all patients. Cervical lordosis angle and ROM were diminished postoperatively without a significant difference between the two groups. ConclusionsThere was no critical difference between the ADF and laminoplasty groups with regard to neurological recovery and other surgery-related factors 1 year after surgery. Laminoplasty can be employed for cervical myelopathy caused by soft disc herniation in particular combined with multilevel spinal canal stenosis to avoid secondary myelopathy.

Anterior Decompression and Interbody Fusion With BAK/C for Cervical Disc Degenerative Disorders

A retrospective clinical study of 64 patients who underwent anterior cervical discectomy and fusion (ACDF) with BAK/C for disc degenerative disorders. To evaluate the long-term outcome of BAK/C in the treatment of cervical disc degenerative disorders. ACDF has been demonstrated to be effective in the treatment of cervical disc degenerative disorders. BAK/C, a kind of thread cage widely used for interbody fusion in the lumbar spine, was used in the cervical spine to avoid the donor site complications of traditional autologous bone graft. Sixty-four patients with cervical disc degenerative disorders underwent ACDF with BAK/C technique in our institution between September 1997 and December 2000. All the patients were followed up for at least 6 years. The changes of segmental stability, bone fusion, cervical lordosis, and intervertebral height on radiographs were evaluated in detail immediately after operation, at 6 and 12 months postoperatively, and yearly thereafter. The clinical outcome of neurologic improvement and pain relief was also investigated. Solid fusion was achieved at 1 year postoperatively in all patients, and the segmental stability was maintained during the whole follow-up. The cervical lordosis and intervertebral height were well restored immediately after operation, and gradually lost during the follow-up. Especially, the anterior height of intervertebral space decreased significantly after 1 year, when compared with the anterior height immediately after operation. BAK/C subsidence was observed in 9 patients, including 5 with 1-level fusion, 1 with 2-separated-level fusion, and 3 with 2-adjacent-level fusion, according to the standard of loss of intervertebral height more than 3 mm. BAK/C fusion was generally effective in the treatment of cervical disc degenerative disorders, according to the evaluation of neurologic improvement and pain relief. However, neck pain tended to reoccur in the patients with cage subsidence, and 2 of them even needed revision surgery because of the recurrence of myelopathy and progressive neck pain. Although BAK/C technique was generally effective and safe in the treatment of cervical disc degenerative disorders, the pitfalls of cage design resulted in the disability of maintenance of cervical lordosis and intervertebral height in the long-term follow-up. Cage subsidence, which tended to develop in the patients with 2-level fusion, was possibly responsible for the recurrence of neck pain.

Recurrent varicella zoster virus myelopathy

Myelopathy is an uncommon complication of VZV infection and may develop in the absence of rash. We report the rare recurrence of myelopathy in an immunocompetent adult who initially developed myelopathy after ophthalmic-distribution zoster. Recurrent myelopathy two years later caused by VZV was verified by the presence of new-onset clinical symptoms and signs consistent with myelopathy, new lesions in the spinal cord detected by MRI, and evidence of intrathecal synthesis of anti-VZV IgG antibody in CSF. After virological verification and antiviral therapy, myelopathy did not recur and anti-VZV IgG antibody could not be detected in CSF. In contrast to earlier cases of recurrent VZV myelopathy in immunocompetent adults that developed weeks to months after the first episode of myelopathy, this is the first instance of recurrence years later.

Laminoplasty for the treatment of failed anterior cervical spine surgery.

Cervical stenotic myelopathy can be treated via anterior or posterior approaches. In anterior cervical decompression and fusion (ACDF), because the risks and likelihood of pseudarthrosis increase with the number of treated segments, attempts are typically made to limit the number of treated levels. Thus, postoperative recurrence of myelopathy following ACDF may occur because stenotic levels were not treated or because adjacent segments have degenerated. Revision decompressive surgery via an anterior approach is one solution; however, if the stenosis involves multiple levels a posterior decompressive laminoplasty can be performed as an alternative. Twenty-four cases treated over an 8-year period were identified and data were retrospectively reviewed. In 15 cases posterior decompressive surgery was necessary because of progressive spinal degeneration and stenosis (five cases following initial treatment for radiculopathy, seven after initial treatment for spondylotic myelopathy, and three due to spreading of an ossified posterior longitudinal ligament). In nine cases revision surgery was undertaken because the initial decompression was inadequate. The mean follow-up period after the second surgery was 16 months. Improvements in myelopathy were seen in 83% of patients (mean improvement of 1.25 points on the Nurick Scale). Preoperative severe gait disorders were associated with poor recovery. Complications included two cases of transient C-5 nerve root palsy and two cases of new persistent axial neck pain. Laminoplasty is a straightforward and effective treatment for failed ACDF due to inadequate decompression or progressive degeneration of the spinal column, avoiding reentry through scar tissue. In terms of myelopathic pain, the recovery rate is comparable with that related to revision ACDF.

Surgical treatment for cervical spondylotic myelopathy associated with athetoid cerebral palsy

There have been several reports on surgical interventions in patients with adult cervical spondylotic myelopathy associated with athetoid cerebral palsy; however, the long-term effectiveness of these interventions has not been demonstrated. We have performed surgical treatments — posterior fusion with wave-shaped rods and anterior interbody fusion with internal fixators — in 20 patients. The present study included 17 of these patients, 16 men and 1 woman, and their mean follow-up period was 8.6 years (range, 5–15.5 years). One year after surgery, walking ability was improved in 14 patients. Pain in the upper extremities and muscle weakness of the deltoid were alleviated in all patients. One patient showed recurrence of myelopathy after 8.5 years’ follow-up. Our surgical technique is effective in patients with cervical spondylotic myelopathy secondary to athetoid cerebral palsy, even in those with severe involuntary movements. Postoperative rigid external fixations are not required.

頚椎症性脊髄症に対する頚椎亜全摘固定術の治療成績 多椎間り患例について

From 1979 through 1986, eleven patients with multisegmental cervical spondylotic myelopathy were treated with subtotal verterectomy and spinal fusion at our hospital. In 7 patients, two verterectomy and spinal fusion were carried out, and 4 patients, three verterectomy and spinal fusion were carried out.The patients were evaluated by The Japanese Orthopedic Association (JOA) score. The preoperative score ranged from five to twelve points with the mean being 8.8. The postoperative score ranged from ten to seventeen points with the mean being 13.6. Ten patients showed improvement after operation and was satisfied with the result of operation.In the present study some radiological findings of the degeneration in the adjacent vertebral segments, reduction of the cervical spine motion, and high rate of pseudoarthrosis of the grafted bone were observed. However, such findings were not so serious as a recurrence of myelopathy would occur. Thus, even for cases with multiplelevel involvement, this procedure has provided excellent results.