Long-term results of double-door laminoplasty for cervical stenotic myelopathy

STUDY DESIGN: A retrospective study of the long-term results from double-door laminoplasty (Kurokawa's method) for patients with myelopathy caused by ossification of the posterior longitudinal ligament and cervical spondylosis was performed. OBJECTIVE: To know whether the short-term results from double-door laminoplasty were maintained over a 10-year period and, if not, the cause of late deterioration. SUMMARY OF BACKGROUND DATA: There are few long-term follow-up studies on the outcome of laminoplasty for cervical stenotic myelopathy. METHODS: In this study, 35 patients with cervical myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine and 25 patients with cervical spondylotic myelopathy, including 5 patients with athetoid cerebral palsy, underwent double-door laminoplasty from 1980 through 1988 and were followed over the next 10 years. The average follow-up period was 153 months (range, 120-200 months) in patients with ossification of the posterior longitudinal ligament and 156 months (range, 121-218 months) in patients with cervical spondylotic myelopathy. Neurologic deficits before and after surgery were assessed using a scoring system proposed by the Japanese Orthopedic Association (JOA score). Patients who showed late deterioration received further examination including computed tomography scan and magnetic resonance imaging of the cervical spine. RESULTS: In 32 of the patients with ossification of the posterior longitudinal ligament and 23 of the patients with cervical spondylotic myelopathy, myelopathy improved after surgery. The improvement of Japanese Orthopedic Association scores was maintained up to the final follow-up assessment in 26 of the patients with ossification of the posterior longitudinal ligament and 21 of the patients with cervical spondylotic myelopathy. Late neurologic deterioration occurred in 10 of the patients with ossification of the posterior longitudinal ligament an average of 8 years after surgery, and in 4 of the patients with cervical spondylotic myelopathy, including the 3 patients with athetoid cerebral palsy, an average of 11 years after surgery. The main causes of deterioration in patients with ossification of the posterior longitudinal ligament were a minor trauma in patients with residual cervical cord compression caused by ossification of the posterior longitudinal ligament and thoracic myelopathy resulting from ossification of the yellow ligament in the thoracic spine. CONCLUSIONS: The short-term results of laminoplasty for cervical stenotic myelopathy were maintained over 10years in 78% of the patients with ossification of the posterior longitudinal ligament, and in most of the patients with cervical spondylotic myelopathy, except those with athetoid cerebral palsy. Double-door laminoplasty is a reliable procedure for individuals with cervical stenotic myelopathy.     

Surgical treatment of cervical spondylotic radiculomyelopathy with abnormal involuntary neck movements. Report of three cases

Cervical spondylotic myelopathy usually arises in patients in their late 40s or early 50s, most frequently at the C5/6 and C6/7 levels. Recently, excellent results have been attained with microsurgery in cases of cervical spondylosis. On the other hand, treatment of cervical spondylotic myelopathy in patients with athetoid dystonic cerebral palsy entails several problems. The authors report three cases of such troublesome myelopathy. A 34-year-old male with severe athetoid movement showed cervical spondylotic myelopathy. Myelography and magnetic resonance (MR) imaging demonstrated compression of the spinal cord through the C3-C5 levels. A 47-year-old female with athetoid dystonic cerebral palsy presented myelopathy. Myelography and MR imaging showed instability and spinal cord compression at the C5/6 level. A 34-year-old male with spasmodic torticollis showed C6 radiculopathy due to cervical disc hernia at the C5/6 level. Cervical anterior decompression with interbody fusion brought temporary improvement in all the three patients. However, such problems as slippage of Halo-vest, difficulty in eating during Halo-vest fixation, relapse of neurological deficit, were experienced. Due to postoperative cervical instability, cervical laminectomy is considered to be contraindicated in such patients. Anterior decompression with bone fusion has been reported effective, but, if athetoid dystonia continues, there is a potential for myelopathic deterioration due to spondylotic changes adjacent to the fused vertebrae.     

A systematic review and meta-analysis comparing anterior decompression with fusion and posterior laminoplasty for cervical spondylotic myelopathy

BackgroundThe optimal surgical procedure for the treatment of cervical spondylotic myelopathy (CSM) remains controversial because there are few comprehensive studies that have investigated the surgical methods. Therefore, we conducted a systematic review and meta-analysis to evaluate evidence in the literature and to compare the surgical outcomes between anterior decompression with fusion (ADF) and laminoplasty, which are representative procedures for CSM.MethodsAn extensive literature search was performed using PubMed, Embase, and the Cochrane Library to identify comparative studies of ADF and laminoplasty for CSM. The language was restricted to English, and the publication period was from January 2001 to July 2019. We only included studies of CSM and excluded studies that involved patients with ossification of the posterior longitudinal ligament and treatments with posterior instrumented fusion. We extracted outcomes from the studies, such as preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, cervical alignment, surgical complications and reoperation rates. Then, a meta-analysis was performed on these surgical outcomes.ResultsNine studies were obtained, and the quality of the studies was acceptable. In the meta-analysis, the preoperative JOA score was similar between the ADF and laminoplasty groups. The postoperative JOA scores and neurological recovery rates were not different between the ADF and laminoplasty groups. ADF exhibited more favorable results than laminoplasty in terms of postoperative cervical alignment. In contrast, overall complications were more frequently observed in the ADF group than in the laminoplasty group, leading to higher rates of reoperation. However, postoperative neck pain was more frequently observed in the laminoplasty group than in the ADF group.ConclusionsThis systematic review and meta-analysis showed both the merits and shortcomings of ADF and laminoplasty. ADF and laminoplasty showed similar results in terms of neurological recovery. Postoperative cervical lordosis was better preserved with ADF than with laminoplasty. However, ADF was associated with a higher incidence of surgical complications than laminoplasty.     

Results of surgical treatment of cervical spondylotic myelopathy in patients aged 75 years or more: a comparative study of operative methods

Introduction

The number of surgical procedures in elderly patients has been increasing as the population has grown older; recently, spine surgeons have been more likely to encounter elderly patients with cervical myelopathy in need of surgical treatment. There are many reports about surgical treatment of elderly patients with cervical spondylotic myelopathy (CSM); however, there are no studies about the proper selection of surgical methods and comparison of their results in CSM patients aged ≥75 years. The objective of this study was to review the results of operative methods in CSM patients aged ≥75 years.

Methods

Forty-three consecutive cases with an average age of 79 years that underwent surgical treatment were included in this study. The neurological severity was assessed using the Japanese Orthopaedic Association score for cervical myelopathy (JOA). The JOA scores were evaluated before surgery and at final follow-up. There were 21 laminoplasty procedures (from C3 to C7), 13 selective laminoplasty procedures (one above and one below the affected intervertebral level), and nine anterior decompression and fusion procedures. A selective laminoplasty was performed in cases with general complications and was diagnosed as one intervertebral level both clinically and electrophysiologically. Surgical results were compared among the three treatment groups.

Results

The average preoperative JOA score was 7.7 points and the average JOA recovery rate was 45 %. There were three cases of C5 palsy and one wound infection. Operative time and intraoperative bleeding in the selective laminoplasty group were significantly smaller than those in the other groups. There was no significant difference in the JOA recovery rates among the groups.

Conclusions

Selective laminoplasty is less invasive and the surgical results in our study were almost good. It also has good short-term results. However, the indication for surgery has to be selected carefully in elderly CSM patients.     

Anterior decompressive surgery after cervical laminoplasty in patients with ossification of the posterior longitudinal ligament

Background contextTwo surgical procedures, posterior decompressive surgery (PDS) and anterior decompressive surgery (ADS), are the treatment options for cervical ossification of the posterior longitudinal ligament (OPLL). Each procedure has advantages and disadvantages. Cervical laminoplasty, a type of PDS, is relatively easy to perform and can be used for patients with multilevel cord compression. ADS can often be more technically demanding.ObjectiveThe purpose of this study was to clarify the clinical characteristics and surgical results of the patients for whom ADS was necessary after PDS.Study designRetrospective study.MethodsA total of 144 patients, followed for more than 3 years after cervical laminoplasty, were included. The neurologic status was graded using the Japanese Orthopedic Association (JOA score). Eleven patients underwent ADS after PDS. The clinical background and surgical outcomes were evaluated. Radiological findings of the 11 patients requiring ADS after PDS (PA group) and the 133 PDS patients not requiring ADS (P group) were compared.ResultsIn the PA group, the JOA score was slightly deteriorated during follow-up after cervical laminoplasty. Severe pain in the unilateral upper extremity and deterioration of cervical myelopathy were the most typical symptoms necessitating ADS. The incidence of the mixed type of OPLL was significantly higher in this group. The JOA score improved in all patients after ADS as a second surgery.ConclusionsIn our strategy for the surgical treatment of cervical OPLL, PDS with laminoplasty remains as the initial treatment, and in patients with neurological deterioration and newly developed clinical symptoms during follow-up, ADS is considered as a salvage procedure.     

Cervical myelo-radiculopathy in athetoid cerebral palsy

Cervical myelopathy complicating athetoid cerebral palsy has not been adequately highlighted in the literature. We report two cases of patients with athetoid cerebral palsy and long histories of involuntary movements who developed cervical myelo-radiculopathy. Dystonic athetoid neck movements may cause excessive axial neck rotation as well as flexion and extension movements of the spine. These repetitive exaggerated movements may result in early degenerative changes of the vertebrae which may enhance the myelo-radiculopathy. The two patients were treated with combined anterior and posterior fusion with satisfactory results. They were bedridden preoperatively but have since started walking with or without a cane. We conclude that combined anterior and posterior fusion is the treatment of choice for severe myelopathy complicating athetoid cerebral palsy.     

C5 nerve root palsy after cervical laminoplasty and posterior fusion with instrumentation

STUDY DESIGN: Consecutive case series. OBJECTIVE: To compare the incidence and clinical characteristics of postoperative fifth cervical nerve root palsy (C5 palsy) in patients with cervical myelopathy treated by laminoplasty alone and laminoplasty with posterior instrumentation. SUMMARY OF BACKGROUND DATA: In patients who have multilevel cervical myelopathy with reducible kyphosis or instability, the authors have performed laminoplasty together with instrumented fusion to restore lordosis and stability. There seems to be a high incidence of postoperative C5 palsy in these patients. METHODS: Seventy-three patients with a mean age of 60.5 years and multilevel cervical myelopathy treated by laminoplasty from 1995 to 2005 were reviewed. Incidence, side, and severity of muscle weakness from patients with C5 palsy after posterior instrumented fusion (instrumented group) was compared with those without instrumentation (noninstrumented group). Radiologic parameters were assessed to identify predisposing factors. RESULTS: Overall 10 of 73 (14%) patients developed the C5 palsy, of which 5 (50%) of 10 patients were in instrumented group, and 5 of 63 (8%) patients were in noninstrumented. Three of 5 (60%) had the palsy on the same side of the opened lamina in the instrumented group, in the same proportion as the noninstrumented. Three (60%) patients in instrumented group developed deltoid weakness grade 1, but none in the noninstrumented had weaker than grade 3. All of the palsied in the instrumented group recovered within 2 years after surgery without removal of implant. Of the 5 patients with the palsy in the instrumented group, 3 had anterolisthesis before surgery and posterior translation of C4 on C5 by the surgery, and no patient without the palsy had the anterolisthesis. CONCLUSIONS: Posterior cervical fusion using instrumentation for restoration of lordotic alignment combined with laminoplasty is highly associated with severe postoperative C5 palsy in patients with multilevel cervical myelopathy and C4 anterolisthesis.     

颈椎前路减压分段融合术和后路椎管扩大成形术治疗多节段脊髓型颈椎病的病例对照研究

目的 :比较颈椎前路减压分段融合术和后路椎管扩大成形术治疗多节段脊髓型颈椎病的临床疗效。方法:对2009年7月至2012年6月收治的56例多节段脊髓型颈椎病病例进行回顾性分析,男32例,女24例;年龄42~79岁,平均(56.9±12.8)岁,病程2个月~16年,平均(10.6±3.2)年。所有患者术前经影像学检查显示有多节段颈椎间盘突出,并具有脊髓型颈椎病的临床表现。其中34例采用颈椎前路减压分段融合术(前路组),22例采用后路椎管扩大成形术(后路组)。通过影像学资料对两组患者手术前后的病变节段前柱高度和颈椎前曲度进行比较,并采用JOA评分评价手术效果。结果:两组患者无神经血管并发症发生,并获得24~36个月的随访(平均28.6个月)。前路组,术后2周时颈椎病变节段前柱高度较术前明显增高(P0.05),颈椎前曲度较术前明显降低(P0.05)。后路组,术后2周及末次随访时,病变节段前柱高度和颈椎前曲度较术前差异均无统计学意义(P0.05)。两组间在术后2周及末次随访时颈椎前曲度差异有统计学意义(P0.05)。术后两组JOA评分均出现了明显恢复,术后3个月及末次随访时,前路组明显高于后路组(P0.05),且JOA评分改善率前路组也优于后路组(P0.05)。结论:这种分段式前路融合手术可以有效地恢复颈椎前柱高度,并且与颈椎后路椎管扩大成形术相比,可以显著地改善脊髓功能,是治疗多节段脊髓型颈椎病的有效方案。     

Surgically treated cervical myelopathy: a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty

Background contextMultilevel cervical myelopathy can be treated with anterior cervical discectomy and fusion (ACDF) or corpectomy via the anterior approach and laminoplasty via the posterior approach. Till date, there is no proven superior approach.PurposeTo elucidate any potential advantage of one approach over the other with regard to clinical midterm outcomes in this study.Study designA prospective, 2-year follow-up of patients with cervical myelopathy treated with multilevel anterior cervical decompression fusion and plating and posterior laminoplasty.Patient sampleIn total, 116 patients were studied. Sixty-four patients underwent ACDF two levels and above or anterior cervical corpectomy and fusion one level and above. Fifty-two patients underwent posterior cervical surgery (laminoplasty C3–C6 and C3–C7).Outcome measuresSelf-report measures: Japan Orthopedic Association (JOA) score, JOA recovery rate, visual analog scale for neck pain (VASNP), neck disability index (NDI), and American Academy of Orthopaedic Surgeons (AAOS) neurogenic symptom score (AAOS-NSS). Physiologic measures: range of motion (ROM) flexion and extension of neck. Functional measures: short-form 36 (SF-36) score comprising physical functioning, physical role function, bodily pain, general health, vitality, social role function, emotional role function, and mental health scales.MethodsComparison of the JOA scores, JOA recovery rates, NDI scores, SF-36 scores, VASNP, and ROM preoperatively to 2 years. Chi-square and two-sided Student t tests were used to analyze the variables.ResultsPosterior surgery took an hour shorter (p<.05) and had better improvement in JOA scores at early follow-up of 6 months (p=.025). Anterior surgery group had better improvement of NDI scores at early follow-up of 6 months (p=.024) and was associated with less blood loss intraoperatively compared with posterior surgery. There was no statistical difference between the two groups for JOA scores, JOA recovery rates, SF-36 quality-of-life scores, NDI, AAOS-NSS, VAS neck pain, and ROM at 2 years. Complications were higher for anterior surgery group: two hematoma postoperation, one vocal cord paresis, and one new onset C6/C7 dermatome numbness versus one dura leak in posterior surgery group.ConclusionsOur study showed that patients with multilevel disease treated with laminoplasty do well and compare favorably with patients treated with an anterior approach. Notably, posterior surgery was associated with shorter operating time, better improvement in JOA scores at 6 months, and a tendency toward lesser complications. Posterior surgery was not associated with increased neck disability and neck pain at 2 years. Anterior surgery had better NDI improvement at early follow-up. There is a need for a larger study that is prospectively randomized with long-term follow-up before we can confidently advocate one approach over the other in the management of cervical myelopathy.     

前路联合术式与后路单开门治疗3节段脊髓型颈椎病的疗效观察

目的:比较前路颈椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)联合前路椎体次全切钛网植骨融合术(anterior cervical corpectomy and fusion,ACCF)与颈后路单开门微型钛板内固定术治疗3节段脊髓型颈椎病的临床疗效。方法:对2014年3月至2016年3月手术治疗的63例(男39例,女24例)3节段脊髓型颈椎病患者的临床资料进行回顾性分析,其中43例行ACDF联合ACCF(前路组),20例行颈后路单开门微型钛板内固定术(后路组)。比较两组患者的手术时间、术中出血量、术后并发症发生率,并按照JOA评分标准评定两组患者的临床疗效。结果:所有病例获得随访,时间16~40个月,平均25.8个月。前路组与后路组患者手术时间分别为(123.70±6.21)min和(118.70±5.41)min,差异无统计学意义(P0.05);术中出血量分别(85.23±7.51)ml和(107.18±9.41)ml,差异有统计学意义(P0.05)。前路组发生轴性症状6例,吞咽困难1例,未发生C5神经根麻痹、声音嘶哑及呛咳等并发症,并发症发生率为16.3℅(7/43);后路组发生轴性症状5例,C5神经根麻痹1例,未发生吞咽困难、声音嘶哑及呛咳等并发症,并发症发生率为30.0℅(6/20),两组并发症发生率比较差异有统计学意义(P0.05)。前路组术后1周及末次随访时的JOA评分均优于后路组(P0.05)。结论 :两种手术方式治疗脊髓型颈椎病均能提供即刻的稳定性,前路联合手术在术中出血量、并发症发生率、临床疗效方面均优于后路组,因此对于连续性3节段脊髓型颈椎病的治疗倾向于前路联合手术。     

Risk factors associated with upper extremity palsy after expansive open-door laminoplasty for cervical myelopathy

Background contextPostoperative paresis, so-called C5 palsy, of the upper extremities is a common complication of cervical surgery. There have been several reports about upper extremity palsy after cervical laminoplasty for patients with cervical myelopathy. However, the possible risk factors remain unclear.PurposeTo investigate the factors associated with the development of upper extremity palsy after expansive open-door laminoplasty for cervical myelopathy.Study designA retrospective review of medical records.Patient sampleA total of 102 patients (76 men and 26 women) were eligible for analysis in this study. The mean age of the patients was 58.7 years (range 35–81 years). Sixteen patients (13 men and 3 women, average age 62.8 years) with palsy were categorized as Group P, and eighty-six patients (63 men and 23 women, average age 57.8 years) without palsy as Group C.Outcome measuresThe demographic data collected from both groups were age, sex, duration of symptoms, disease, and type of surgical procedure. Cervical curvature index, width of the intervertebral foramen (WIF) at C5, anterior protrusion of the superior articular process (APSAP), number of compressed segments, high–signal intensity zone at the level corresponding to C3–C5 (HIZ:C3–C5), and posterior shift of the spinal cord (PSSC) were also evaluated.MethodsUpper extremity palsy was defined as weakness of Grade 4 or less of the key muscles in the upper extremity by manual muscle test without any deterioration of myelopathic symptoms after surgery. Comparisons were made with screen for the parameters with significant differences, and then we further analyzed these parameters by logistic regression analysis (the forward method) to verify the risk factors of the upper extremity palsy.ResultsSignificant differences in diagnosis, the type of procedure, WIF, APSAP, and HIZ:C3–C5 were observed between the two groups. No statistical difference in PSSC between the groups was noted (2.06 vs. 2.53 mm, p=.247). In logistic regression analysis, ossification of the posterior longitudinal ligament (OPLL), cervical open-door laminoplasty together with posterior instrumented fusion (CLP+PIF), and WIF were found to be significant risk factors for postoperative upper extremity palsy.ConclusionsPatients with preoperative foraminal stenosis, OPLL, and additional iatrogenic foraminal stenosis because of CLP+PIF were more likely to develop postoperative upper extremity palsy. Attention should be given to the WIF determined on preoperative computed tomography of the C5 root. To prevent iatrogenic foraminal stenosis, appropriate distraction between spine segments should be provided during placement of the rod.     

单开门颈椎管成形联合单侧侧块固定术治疗颈椎伤病

目的探讨单开门颈椎管扩大成形单侧侧块内固定联合植骨术治疗颈椎伤病的可行性和疗效。方法利用单开门颈椎管扩大成形单侧侧块内固定联合植骨术治疗颈椎伤病患者16例,手术减压节段包括C3~53个节段2例,C3~64个节段5例,C3~75个节段9例。手术方式均采用单开门颈椎管扩大成形,门轴侧行侧块螺钉钢板内固定,并大量植骨。结果术中及术后均未发生脊髓、神经根及血管副损伤。全部患者平均随访18个月,术后3个月时JOA评分从术前的7.9分提高到13.1分。随访期间未见内固定物移位断裂及椎板再关门现象,门轴侧骨折处骨质融合。结论单开门颈椎管扩大成形单侧侧块内固定联合植骨术治疗颈椎伤病疗效安全可靠,经济实用,在椎管扩大成形获得即刻稳定的同时,提高植骨融合率,减少后凸畸形及失稳的发生率,减少椎板再关门现象。     

多节段脊髓型颈椎病术前颈椎曲度对椎管扩大椎板成形术术后神经功能恢复影响

目的探讨多节段脊髓型颈椎病患者术前颈椎曲度与椎管扩大椎板成形术术后神经功能之间的相关性。方法选取2013年1月—2015年12月在第二军医大学附属长征医院实施椎管扩大椎板成形术的70例多节段脊髓型颈椎病患者作为研究对象进行回顾性分析。按照患者术前X线片中的颈椎曲度将患者分为曲度正常组(A组)、曲度变直组(B组)、轻度曲度后凸组(C组),比较3组患者术后各节段脊髓后移距离、神经功能恢复率,并探讨术前颈椎曲度、术后脊髓后移距离与神经功能恢复率之间的相关性。结果 3组患者术后各节段脊髓后移距离组间差异无统计学意义(P0.05)。3组患者术前、术后的组间日本骨科学会(JOA)评分、神经功能恢复率差异均无统计学意义(P0.05);与术前相比,术后3组患者的JOA评分均明显增高,差异具有统计学意义(P0.05)。颈椎曲度与神经功能恢复率、脊髓后移距离之间无相关性。结论术前颈椎曲度变直及轻度后凸的多节段脊髓型颈椎病患者在实施椎管扩大椎板成形术后脊髓神经功能均可改善,曲度变直及轻度后凸可能不再是多节段脊髓型颈椎病行椎管扩大椎板成形术的禁忌证。     

颈前路椎间盘切除椎间融合器融合术加颈后路单开门术治疗脊髓型颈椎病

[目的]探讨颈椎前路椎间盘切除椎间融合器融合术加颈椎后路单开门椎管扩大成形术治疗脊髓型颈椎病在临床上的应用价值。[方法]应用Cervical Cage行颈椎前路椎间盘切除椎间融合术，同时，颈椎后路行单开门椎管扩大成形术11例，平均随访6个月。按40分法和JOA评分对手术前后脊髓功能进行评分，并测量颈椎术前术后前柱高度及椎管宽度和进行相关性分析．[结果]颈椎前路椎间盘切除椎间融合器融合术加颈椎后路单开门椎管扩大成形术，明显改善脊髓型颈椎病的脊髓功能。40分法平均37分，改善率83％；JOA评分16．5分，改善率91％；前柱高度平均增加1．28mm；椎管宽度平均增加2．22mm。[结论]颈椎前路椎间盘切除椎间融合器融合术加颈椎后路单开门椎管扩大成形术，有效恢复了颈椎前柱高度、增加椎管宽度，明显改善了脊髓型颈椎病的脊髓功能。     

Place de la laminoplastie dans le traitement de la myélopathie cervicale d’origine arthrosique

Cervical spondylotic myelopathy (CSM) is a common condition. Uninstrumented laminectomy may be complicated by postoperative instability, whereas anterior or posterior decompression with fusion may be associated with stiffness and adjacent segment disease. Cervical laminoplasty, initially oriented towards pediatric patients and ossification of the posterior longitudinal ligament, becomes an interesting surgical alternative to decompress and reconstruct cervical anatomy without fusion. Eighteen patients (12 men, 6 women), mean age 64.2 who presented with CSM were treated surgically using multilevel laminoplasty, and reviewed after 1 month, 6 months, 1 year and 2 years. Clinical evaluation was performed based on the Benzel-JOA and Nurick scores. The preoperative mean Benzel-JOA score was 13.55; Preoperative mean Nurick score was 1.88. Preoperative MRI was carried-out in 16/18 patients. Intramedullary hyperintensity in T2 was observed in 6 patients. The operation was performed on 2 levels (4 patients) 3 levels (11 patients) and 4 levels (3 patients). We used the open-door hinged laminoplasty technique, using metallic implants, without bone graft. At one month FU, mean JOA score was 15.44, and Nurick dropped to 1.05. At 6 months, mean JOA was 16.28 and Nurick was 0.71. At one year, the mean JOA score was 16.16, and Nurick was 0.83. At 2 years, mean JOA was 17.5, and Nurick was 0.25. One infection, one dural tear and one transient episode of C5 paresthesia were observed. We conclude that spinal cord decompression by open-door laminoplasty for CSM allows significant clinical improvement observed progressively in the two years following surgery.     

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. Received: July 27, 1999 / Accepted: March 7, 2000     

显微镜下减压融合术治疗脊髓型颈椎病

目的:探讨显微镜下颈前路减压融合术治疗脊髓型颈椎病的疗效。方法:2005年2月至2010年3月,在显微镜辅助下经颈前路减压融合术治疗脊髓型颈椎病21例,男13例,女8例;年龄32～71岁,平均51.5岁;病程6个月～3年,平均12.5个月。手术操作:在显微镜下应用高速磨钻等工具进行减压操作,脊髓充分减压后取自体髂骨植骨融合加内固定。对手术前后JOA颈椎病评分进行比较并评价其疗效。结果:21例患者均获随访,时间18～24个月,平均20个月。患者脊髓神经功能均有不同程度提高,JOA评分由术前9.26±1.72增加至术后的13.64±1.38(t=2.452,P=0.000)。根据JOA评分评定疗效:优12例,良7例,一般2例。结论:显微镜下颈前路减压融合术具有操作精细、减压充分等优点,治疗脊髓型颈椎病安全、有效。     

Comparison of anterior decompression with fusion and posterior decompression with fusion for cervical spondylotic myelopathy—A systematic review and meta-analysis

BackgroundThe optimal surgical procedure for the treatment of cervical spondylotic myelopathy (CSM) remains controversial. Recently, laminectomy/laminoplasty with instrumented fusion (LAMF) has been increasingly applied to treat CSM. However, few comprehensive studies have compared anterior decompression with fusion (ADF) and LAMF. Therefore, we conducted a meta-analysis to evaluate the evidence in the literature and to compare the surgical outcomes between the 2 procedures. Since the surgical outcomes and risks differ between patients with CSM and ossification of the posterior longitudinal ligament (OPLL) and between only posterior decompression and decompression with fusion treatments, we excluded patients with OPLL and patients with only posterior decompression in this review.MethodsAn extensive literature search was performed using PubMed, Embase, and the Cochrane Library to identify comparative studies of ADF and LAMF for the treatment of CSM. The language was restricted to English, and the publication period was from January 2001 to July 2019. We only included studies about CSM and excluded studies that involved patients with ossification of the posterior longitudinal ligament and with the treatment of posterior decompression without fusion. We extracted outcomes from the studies, such as preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, neck disability index (NDI) scores, cervical alignment data, and surgical complications. Then, a meta-analysis was performed on these surgical outcomes.ResultsEleven studies were obtained, and the quality of the studies was acceptable. In the meta-analysis, the pre- and postoperative JOA scores were similar between the ADF and LAMF groups. The ADF group exhibited more favorable results than the LAMF group in terms of postoperative cervical alignment and the NDI. Overall complications were similar between the ADF and LAMF groups; however, C5 palsy was more frequently observed in the LAMF group than in the ADF group.ConclusionsWhile the ADF and LAMF groups demonstrated similar results in terms of neurological recovery, postoperative cervical lordosis and NDI scores were more favorable with ADF than with LAMF. The overall complication rate was similar between the ADF and LAMF groups. Surgeons should understand the merits and shortcomings of both procedures when deciding on a surgical procedure.     

Clinical outcomes after posterior cervical decompression and fusion surgery for destructive spondyloarthropathy in patients undergoing long-term hemodialysis: A matched case–control study

BackgroundCervical destructive spondyloarthropathy (DSA) often leads to cervical myelopathy in long-term hemodialysis patients. However, the surgical outcomes after instrumented fusion surgery for cervical DSA are still unclear. The objective of this study was to investigate the clinical outcomes of cervical DSA in comparison with a control group.Materials and methodsA consecutive series of 20 undergoing long-term hemodialysis patients who underwent instrumented fusion surgery for cervical DSA between 2010 and 2016 were included in this study (DSA group). The mean age at surgery was 65 years, and there were 11 men and 9 women. The average length of hemodialysis was 23 years. The age- and sex-matched control group consisted of 20 patients (degenerative conditions). The Japanese Orthopedic Association (JOA) score, recovery rate, complications, and loss of correction of fused level were compared between the groups.ResultsTwo of the 20 patients died due to perioperative complications. More than 1 year of follow-up data after surgery was available for 18 patients. The mean JOA score significantly increased from 5.4 before surgery to 9.7 at 1 year after surgery and 8.3 at the final follow-up (mean: 33.2 ± 21.3 months, P = 0.019). There were no significant differences in the mean recovery rate (41% vs. 37%, P = 0.44) between the DSA group and control group. Loss of correction of more than 5°was significantly higher in the DSA group (44% vs. 10%, P = 0.027). The rate of pseudarthrosis (17% vs. 5%, P = 0.328) and adjacent segment disease (22% vs. 10%, P = 0.17) tended to be higher in the DSA group.DiscussionThe clinical outcomes showed significant recovery in both groups. Therefore, posterior cervical decompression and fusion surgery was effective for treating cervical DSA.     

颈椎后前联合手术入路治疗脊髓型颈椎病

目的:探讨后前联合手术入路Ⅰ期或分期治疗脊髓型颈椎病的疗效.方法:2001年6月至2008年10月应用Ⅰ期或分期后前联合入路治疗脊髓夹持型颈椎病及合并发育性颈椎管狭窄颈椎病45例,男35例,女10例;年龄45～72岁,平均53岁.均先后路再前路,Ⅰ期联合5例,分期联合40例.均后路单开门椎管成形,前路减压植骨后均行钛板固定.术后3个月、1年采用JOA评分对其进行疗效评定.结果:44例获随访,时间13～62个月,平均30个月;1例术后21 d死于肺部感染.C5神经麻痹3例,发音嘶哑1例,轴性症状14例,髂骨供区并发症2例.钛板螺钉均无断裂、退出,无骨块、钛网移位及沉陷,无"再关门"及颈椎畸形发生.44例前路植骨及后方门轴均获骨性愈合.按JOA评分标准:术前平均(9.36±2.24)分,术后3个月平均(12.34±2.64)分,术后1年平均(12.77±2.61)分;术后3个月、1年与术前比较差异均有统计学意义.44例中,优16例,良19例,好转6例,无效3例.结论:后前联合手术是治疗脊髓夹持型颈椎病及合并发育性颈椎管狭窄颈椎病的安全有效方法,应依据患者及手术条件选择一期或分期联合,前路钛板固定可有效恢复颈椎生理曲度、椎间高度及预防植骨并发症.