Results Of Open-door Laminoplasty Research Articles

Novel Three-Holed Titanium Plate Fixation during Open Door Laminoplasty for Cervical Spondylotic Myelopathy: Comparison with Conventional Titanium Plate.

For reconstructing the posterior cervical muscular-ligament complex, attachment points and various modified techniques were designed and applied in clinical practice. This study investigated the clinical and radiographic outcomes of open door laminoplasty with modified centerpiece mini-plate fixation and extensor attachment point reconstruction in the treatment of cervical spondylotic myelopathy (CSM). Sixty-nine patients with CSM who underwent C3-C7 open door laminoplasty at our hospital from January 2016 to May 2018 were divided into two groups: 37 and 32 patients underwent laminoplasty with modified and conventional centerpiece titanium plate fixation (MPF and CPF groups), respectively. Changes in cervical spinal angle (CSA), cervical range of motion (ROM), posterior cervical muscle atrophy, neurological function (Japanese Orthopaedic Association [JOA] score), Neck Disability Index (NDI), and axial symptom severity were compared between the two groups. There were no significant differences in operative duration (136.7± 23.9 vs 128.3± 21.5 min, t=1.525, p > 0.05), volume of intraoperative blood loss (275.9± 33.1 vs 268.2± 31.6ml, t=0.984, p > 0.05), lamina open angle (41.2° ± 4.5° vs 39.4° ± 4.1°, t=1.726, p > 0.05), and spinal cord drift distance (2.4± 0.3 vs 2.3± 0.4 mm, t=1.184, p > 0.05) between the two groups. After surgery, JOA score significantly increased (p < 0.05), and neurological recovery rates were similar (62.7% vs 63.4%, t=0.208, p > 0.05). The NDI score was significantly decreased in both the groups (p< 0.05); however, the MPF group recovered to a greater degree than the CPF group (8.3± 1.2 vs 9.8± 1.4) (t=4.793, p< 0.05). There was no significant change in cervical ROM postoperatively compared with preoperatively in either group (p > 0.05). CSA decreased from 21.7° ± 2.8° to 18.3° ± 2.1°, and posterior cervical muscle cross-sectional area decreased from 35.2± 4.9 cm2 to 31.0 ± 4.1 cm2 in the CPF group (p < 0.05), but no significant change was observed in the MPF group (20.6° ± 2.5° to 20.4° ± 2.6°and 35.9± 5.1 to 34.1± 4.6 cm2 , respectively) (p> 0.05). Postoperative axial symptom severity was significantly worse in the CPF group than in the MPF group (Z=-2.357, p < 0.05). As an improvement to the conventional titanium plate, the modified centerpiece titanium plate effectively provides an attachment point for the posterior muscle-ligament complex, reducing posterior cervical muscle atrophy and improving neck function, without inflicting additional surgical trauma.

Treatment of Myelopathy Due to Cervicothoracic OPLL Via Open Door Laminoplasty

Postoperative long-term follow-up study of open door laminoplasty for the ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine. Techniques and outcomes of open door laminoplasty were described. The efficacy of this procedure was discussed and compared with other surgical methods for thoracic OPLL reported in the literature. OPLL of the thoracic spine is often associated with cervical OPLL or ossification of the yellow ligament (OYL) of the thoracic spine; therefore, it is extremely difficult to determine the most appropriate surgical therapeutic procedure. There are very few detailed reports about extensive laminoplasty for OPLL of the thoracic spine. The subjects included in this study consisted of 13 consecutive patients of thoracic OPLL who were surgically treated between 1994 and 2003 by the open door laminoplasty using the spinal processes and ligament complex as spacers for the open side. The number of manipulated lamina, including the cervical spine, was from 7 to 14 (mean 10 laminae), the follow-up period was 75 months on average. We evaluated the clinical symptoms by the JOA scoring method and postoperative bone union and thoracic kyphosis by plain x-ray photograph and computed tomography. Postoperatively, the JOA score improved from an average of 5.5 to 8.5 out of a maximum of 11 points and the mean recovery rate by Hirabayashi method was 54.5%. In all cases, bone union was seen at the hinge side between the opened lamina and the lateral mass. Neither restenosis of the opened lamina nor marked progression of kyphosis were seen on the final follow-up observation in any patient. There was no postoperative spinal cord injury. Open door laminoplasty is a useful procedure for OPLL of the thoracic spine. This method enables wide-range posterior decompression, especially for the continuous type OPLL extending from the cervical spine to the thoracic spine, even if the apex of the thoracic kyphosis is included.

Long-term Results of Expansive Open-Door Laminoplasty for Cervical Myelopathy−Average 14-Year Follow-up Study

Retrospective case series on long-term follow-up results of original expansive open-door laminoplasty for cervical myelopathy due to cervical spondylosis (CSM) and ossification of posterior longitudinal ligament (OPLL). To elucidate efficacy and problems of original open-door laminoplasty to improve future surgical outcomes. Little information is available on long-term outcomes of original open-door laminoplasty without grafts, implants, or instruments. The study group included 80 patients who underwent original open-door laminoplasty and were followed for minimum 10 years. Clinical results, including Japanese Orthopedic Association scores, recovery rates, occurrences of complications, and long-term deterioration were investigated. Cervical alignments, type of OPLL, cervical range of motion, anteroposterior diameter of spinal canal, and progression of OPLL were assessed on plain radiographs. Spinal cord decompression was verified on magnetic resonance imaging. Average Japanese Orthopedic Association score and recovery rate improved significantly until 3 years after surgery and remained at an acceptable level in both cervical spondylosis and OPLL patients with slight deterioration after 5 years. Segmental motor palsy developed in 8 patients. Late deterioration, mainly lower extremity motor score decline, developed in 8 CSM and 16 OPLL patients. Overall cervical range of motion decreased by 36%. Patients with cervical lordosis decreased gradually in both patient groups. Such changes in alignments did not affect surgical results in CSM patients, while OPLL patients with preoperative kyphosis had lower recovery rates than those with straight and lordotic alignments. OPLL progression that was detected in 66% of patients did not affect clinical results. Although infrequent, magnetic resonance imaging revealed atrophy of spinal cord, spinal cord compression at adjacent segments due to degenerative changes and OPLL progression. Long-term results of open-door laminoplasty without bone graft, graft substitutes, or instruments were satisfactory. However, segmental motor paralysis, kyphosis, established before and after surgery, OPLL progression, and late deterioration due to age-related degeneration remain challenging problems.

Results of Open-door laminoplasty with reconstruction of posterior ligamentous complex

Results of Open-door laminoplasty with reconstruction of posterior ligamentous complex

Clinical results of open door laminoplasty for cervical myelopathy

Clinical results of open door laminoplasty for cervical myelopathy