Long-term results of tension-band laminoplasty for cervical stenotic myelopathy: a ten-year follow-up

We reviewed 75 patients (57 men and 18 women), who had undergone tension-band laminoplasty for cervical spondylotic myelopathy (42 patients) or compression myelopathy due to ossification of the posterior longitudinal ligament (33 patients) and had been followed for more than ten years. Clinical and functional results were estimated using the Japanese Orthopaedic Association score. The rate of recovery and the level of postoperative axial neck pain were also recorded. The pre- and post-operative alignment of the cervical spine (Ishihara curve index indicating lordosis of the cervical spine) and the range of movement (ROM) of the cervical spine were also measured. The mean rate of recovery of the Japanese Orthopaedic Association score at final follow-up was 52.1% (SD 24.6) and significant axial pain was reported by 19 patients (25.3%). Axial pain was reported more frequently in patients with ossification of the posterior longitudinal ligament than in those with cervical spondylotic myelopathy (p = 0.027). A kyphotic deformity was not seen post-operatively in any patient. The mean ROM decreased post-operatively from 32.8° (SD 12.3) to 16.2° (SD 12.3) (p < 0.001). The mean ROM ratio was 46.9% (SD 28.1) for all the patients. The mean ROM ratio was lower in patients with ossification of the posterior longitudinal ligament than in those with cervical spondylotic myelopathy (p < 0.001). Compared to those with cervical spondylotic myelopathy, patients with ossification of the posterior longitudinal ligament had less ROM and more post-operative axial neck pain.     

Long-term results of double-door laminoplasty using hydroxyapatite spacers in patients with compressive cervical myelopathy

No previous studies have reported 10-year follow-up results for double-door laminoplasty using hydroxyapatite (HA) spacers. The purpose of this study was therefore to explore the long-term results of double-door laminoplasty using HA spacers and to determine if non-union or breakage of HA spacers is related to restenosis of the enlarged cervical canal. The study group consisted of 68 patients with a minimum of 10 years of follow-up after double-door laminoplasty using HA spacers. The average postoperative Japanese Orthopaedic Association score improved significantly after surgery and was maintained until the final follow-up. The average range of motion decreased by 42.6% in patients with cervical spondylotic myelopathy (CSM) and 65.8% in patients with ossification of the posterior longitudinal ligament (OPLL). The enlarged cervical canal area was preserved almost until the final follow-up. The average non-union rates of HA spacers were 21% in CSM and 17% in OPLL, and the average breakage rates were 24 in CSM and 21% in OPLL at the final follow-up. Although non-union and breakage of HA spacers were common, neither of these factors were correlated with restenosis of the enlarged cervical canal.     

Expansive open-door laminoplasty for cervical spinal stenotic myelopathy

Although the operative results have been improving since the air drill was introduced for cervical laminectomy instead of an ordinary rongeur, post-laminectomy complications, such as postoperative fragility of the cervical spine to acute neck trauma, posterior spur formation at the vertebral body, and malalignment of the lateral curvature have still remained as unsolved problems. In order to avoid these disadvantages, a new surgical technique called "expansive open-door laminoplasty" was devised by the author in 1977, which is relatively easier, safer, and better than the ordinary laminectomy from the standpoint of structural mechanics of the cervical spine. The operative procedure is described in detail. Operative results in the patients with cervical OPLL, spondylosis, and canal stenosis were satisfactory, and optimal widening of the AP diameter of the spinal canal is considered to be over 4 mm. From this procedure a bilateral, open-door laminoplasty has been devised for extensive exploration at the intradural space.     

Short-term complications and long-term results of expansive open-door laminoplasty for cervical stenotic myelopathy.

BACKGROUND CONTEXT: Laminoplasty has been reported to achieve good operative results for treatment of cervical stenotic myelopathy. However, long-term results and prognostic factors have not been well documented. Among postoperative complications, weakness of the shoulder girdle muscles has been reported as a particular complication of laminoplasty, but the cause is still poorly understood. PURPOSE: Our aim was to clarify the short-term complications and long-term operative results after unilateral open-door laminoplasty and to identify the predictors for operative outcome. STUDY DESIGN: We retrospectively reviewed short-term complications and long-term operative results associated with cervical stenotic myelopathy treated by unilateral open-door laminoplasty. PATIENT SAMPLE: There were 162 men and 42 women with an average age of 57 years who were treated by unilateral open-door laminoplasty in the two institutions. Pathogenesis of myelopathy was cervical spondylosis in 88 patients, cervical disk herniation with a narrow spinal canal in 10, and ossification of the posterior longitudinal ligament in 106. OUTCOME MEASURES: Postoperative complications and their outcomes were examined clinically in 204 patients, and causes of motor paresis were sought with postoperative computed tomography after myelography. Postoperative improvement of clinical symptoms was assessed by recovery rate calculated with the scores of the Japanese Orthopaedic Scoring System in 80 patients. METHODS: The occurrence rate of short-term postoperative complications, causes of motor paresis, and their outcomes were reviewed in 204 patients. Clinical condition was assessed with the Japanese Orthopaedic Scoring System, recovery rate was calculated with the score, and prognostic factors for outcome were studied in 80 patients who were followed up for 5 years or longer (average, 8 years; range, 5-17 years). RESULTS: Occurrence rate of complications, such as muscle weakness, deep infection, closure of opened laminae, and others, was 10.8%. Muscle weakness was observed in 7.8% of the patients. However, this rate decreased in recent years. The cause of motor paresis is not known with certainty, but it may be secondary to operative trauma, posterior shift of the spinal cord, or to displacement of the lamina in the hinge side. Recovery rate of clinical symptoms was 62.1% at the final follow-up. Rates were 63.6% for cervical spondylosis, 87.1% for cervical disk herniation, and 61.3% for ossification of the posterior longitudinal ligament. There was no significant difference between pathologies. Patient age younger than 60 years at the time of operation and less than 1 year's duration of symptoms before surgery were significantly associated with recovery rate of clinical symptoms. Recovery rate was not correlated with either preoperative function judged by the Japanese Orthopaedic Association score or spinal sagittal diameter. CONCLUSIONS: The main cause of postoperative motor paresis of upper extremities is thought to be operative trauma, resulting from such procedures as air-drill and Kerrison rongeur handling. Short-term complications may decrease with the use of nontraumatic procedures. Better operative outcomes may be achieved with careful operative procedures and early operative treatment in the patients with myelopathy.     

Contact of hydroxyapatite spacers with split spinous processes in double-door laminoplasty for cervical myelopathy

We developed a new type of spacer made of hydroxyapatite (the STSS spacer) for double-door laminoplasty, and evaluated the contact of 93 STSS spacers with the split spinous processes in 20 patients with double-door laminoplasty. Contact was assessed by measuring the extent of touch of the spacer to the spinous processes, classified into four categories based on computed tomography (CT) images: excellent, complete touch on both sides of the spacer to the spinous process; good, complete touch on one side and more than half touch on the other side; fair, more than half touch on both sides; poor, half or less touch on at least one side. Excellent contact was achieved in 65 spacers (69.9%); good, in 13 (14.0%); fair, in 11 (11.8%); and poor, in 4 (4.3%). The percentages of excellent or good categories were 75.0% at the C3 level, 73.7% at the C4 level, 78.9% at the C5 level, 90.0% at the C6 level, and 100% at the C7 level. The contact rate of the STSS spacer with the spinous process was better than that achieved with other spacers, probably because the characteristic shape of the STSS spacer was compatible with the widened space between the bilateral spinous processes; i.e., it is trapezoidal on both the axial and the frontal sections. However, the appropriate size of the spacer must be selected in accordance with the size of the spinous process to obtain higher percentages of excellent or good contact. Received for publication on Feb. 9, 1998; accepted on Dec. 4, 1998     

后路单/双开门椎管扩大椎板成形术并内固定术治疗多节段脊髓型颈椎病

目的对比后路单开门椎管扩大椎板成形术并微型钛板内固定与双开门椎管扩大椎板成形术并LA椎板夹内固定治疗多节段脊髓型颈椎病(MCSM)的临床疗效。方法回顾性分析2015年4月—2017年9月山东中医药大学附属医院采用后路单开门椎管扩大椎板成形术并微型钛板内固定术(31例)和双开门椎管扩大椎板成形术并LA椎板夹内固定术(30例)治疗的MCSM患者临床资料。记录并比较2组手术时间、出血量、引流量和并发症发生情况,以及手术前后日本骨科学会(JOA)评分、颈椎Cobb角、C2～7矢状位平衡(SVA)。结果双开门组手术时间、出血量及引流量均低于单开门组,差异有统计学意义(P 0.05)。术后2组患者神经功能均显著改善,术后3个月及末次随访时2组JOA评分改善率差异无统计学意义(P 0.05)。2组患者术后颈椎Cobb角及C2～7 SVA与术前相比,差异均无统计学意义(P 0.05),组间比较差异也无统计学意义(P 0.05)。单开门组发生轴性疼痛9例,后凸畸形8例,C5神经根麻痹1例,血管损伤1例。双开门组发生轴性疼痛5例,后凸畸形5例。结论 2种术式对改善MCSM患者神经功能均有较好的临床疗效,且安全性及可重复性好。双开门较单开门术式手术创伤小,远期疗效更佳,但手术难度较高;临床可结合患者病情及术者熟练程度选择最为适宜的手术方案。     

双开门颈椎椎板成形术(Kurokawa法)治疗颈椎管狭窄症的随访研究

目的观察双开门颈椎椎板成形术 (Kurokawa法 )治疗颈椎管狭窄症的效果。方法分析近 6年来在上海中山医院采用颈椎后路双开门椎板成形术治疗的 67例颈椎管狭窄症患者并进行随访。随访时间 10个月～ 6年 10个月。患者手术时平均年龄为 55.2岁。比较患者术前及术后 1、 3、 5年的 JOA评分及恢复率。结果 JOA评分从术前的平均 7.1分增加到术后 1年的 12.5分、 3年的 12.9分和 5年的 12.8分,差异有非常显著性意义 (P< 0.001)。颈椎矢状径术后平均增加 4.9 mm,差异有非常显著性意义 (P< 0.001)。术后恢复率达到 60％,但颈椎的伸屈活动度却减小。结论双开门颈椎椎板成形术是一种简单、安全的治疗颈椎管狭窄症的手术方法。手术后随访 5年效果明显。     

Alternating cervical laminoplasty for cervical spondylotic myelopathy

We present a novel method of performing an 'open-door' cervical laminoplasty. The complete laminotomy is sited on alternate sides at successive levels, thereby allowing the posterior arch to be elevated to alternate sides. Foraminotomies can be carried out on either side to relieve root compression. The midline structures are preserved. We undertook this procedure in 23 elderly patients with a spondylotic myelopathy. Each was assessed clinically and radiologically before and after their operation. Follow-up was for a minimum of three years (mean 4.5 years; 3 to 7). Using the modified Japanese Orthopaedic Association scoring system, the mean pre-operative score was 8.1 (6 to 10), which improved post-operatively to a mean of 12.7 (11 to 14). The mean percentage improvement was 61% (50% to 85.7%) after three years. The canal/vertebral body ratio improved from a mean of 0.65 (0.33 to 0.73) pre-operatively to 0.94 (0.5 to 1.07) postoperatively. Alternating cervical laminoplasty can be performed safely in elderly patients with minimal morbidity and good results.     

单开门椎管扩大成形术治疗多节段脊髓型颈椎病远期疗效

目的探讨单开门椎管扩大成形术治疗多节段脊髓型颈椎病的远期疗效。方法回顾分析我院自1992-1999年采用单开门椎管扩大成形术治疗的多节段脊髓型颈椎病患者85例的临床资料。结果平均随访7.5年(5～12年),术前JOA评分9.3±0.4,术后JOA评分11.4±0.4,末次随访JOA评分14.3±0.5,神经功能改善率65.2%。随着术前病程的延长,术后改善率逐步下降。结论单开门椎管扩大成形术是治疗多节段脊髓型颈椎病较好的术式,远期疗效确实。     

Operative results of canal-expansive laminoplasty for cervical spondylotic myelopathy in elderly patients

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

双开门椎管扩大椎板成形术中椎管矢状径增加值的预测

 目的 推导双开门椎管扩大椎板成形术中椎板开门宽度与椎管矢状径增加值关系的公式,根据椎板开门宽度预测椎管矢状径和椎管横截面积的增加值。方法 2010年9月至2013年1月期间,实施双开门椎管扩大椎板成形术治疗多节段脊髓型颈椎病20例,C₃~C₇节段9例,C₃~C₆节段11例,共89个节段。推导椎板开门宽度与椎管矢状径增加值关系的公式。根据此20例患者手术前后CT片应用pacs软件测量各项参数,应用公式预测椎板开门宽度分别为6、8、10、12 、14、16 mm时椎管矢状径和椎管横截面积的增加值。结果 C₃~C₇相同节段不同椎板开门宽度时椎管矢状径增加值、椎管横截面积增加值差异均有统计学意义;C₃~C₆相同节段不同椎板开门宽度时各椎管矢状径增加值的差异有统计学意义;C₇节段椎板开门宽度14 mm与16 mm时椎管矢状径增加值的差异无统计学意义;随着椎板开门宽度的增加,椎管矢状径增加值相应增加,但椎管矢状径增加值的增加趋势逐渐减弱。结论 在双开门椎管扩大椎板成形术中,应用公式根据椎板开门宽度能准确预测椎管矢状径与椎管横截面积的增加值,从而指导术者进行精确地选择个体化的开门宽度,能避免过分开门或开门不足。     

Factors affecting the surgical results of expansive laminoplasty for cervical spondylotic myelopathy

We studied the outcome of expansive laminoplasty in 37 patients with cervical spondylotic myelopathy. Patients were divided into two groups according to the recovery rate (RR) - a 'good' group ( n=19), and a 'fair' group ( n=18). Patients in the good group showed a greater pre-operative Japanese Orthopaedic Association (JOA) score, a greater compression ratio, and a larger Pavlov ratio ( P<0.05). The presence of high signal intensity on MRI proved to be of no prognostic importance.     

Technical improvements and results of laminoplasty for compressive myelopathy in the cervical spine

The laminoplasty reported in Spine 1982 by the author (H.T.) was modified by a technical improvement to obtain a more reliable enlargement of the cervical spinal canal. The technical improvements and results are described in detail. The osteotomized laminae that floated en bloc like a hinged door must be stabilized by bone blocks with wire ligatures. Thirty patients with severe cervical myelopathy due to multisegmental spondylosis or ossification of posterior longitudinal ligament underwent surgery. The extent of the enlargement of the canal was 4.1 mm on the average in the anteroposterior diameter, and in no case was a significant reduction in the diameter of the canal noted during the follow-up period. A stable and thorough decompression of the spinal canal was noted on the postoperative computed tomograms with satisfactory surgical results.     

单开门椎板成型术治疗老年脊髓型颈椎病

[目的]探讨老年脊髓型颈椎病的主要病理机制并对单开门椎板成型术在治疗老年脊髓型颈椎病中疗效予以评价。[方法]2000年3月~2008年3月,40例年龄在70岁以上的老年脊髓型颈椎病患者,平均75.4岁(70~85岁)于本科行单开门椎板成型术。在此同一时期内选择40例年龄在60岁以下脊髓型颈椎病患者作为对照组,平均51.2岁(33~60岁)。所有患者至少随访3年,平均6.7年(3~10年)。分别对手术前后JOA评分、改善率、影像学表现及术后并发症进行统计分析。[结果]两组患者术后JOA评分均有显著改善,老年组术后2年效果最佳,术后5年改善率略低与对照组,但无统计学差异。老年组术前颈椎动力位X线片示颈椎不稳发生率明显高于对照组。[结论]单开门椎板成形术可以达到解除神经压迫,维持颈椎稳定性的目的,并在治疗老年脊髓型颈椎病中有良好的疗效。     

选择性椎板成形术和传统椎板成形术治疗脊髓型颈椎病的中期疗效

目的对比选择性椎板成形术和传统椎板成形术治疗脊髓型颈椎病的中期疗效。方法回顾性分析2010年9月—2015年12月收治的130例脊髓型颈椎病(CSM)患者临床资料,其中67例采用选择性椎板成形术治疗(试验组),63例采用传统椎板成形术治疗(对照组)。记录并比较2组手术时间、术中出血量、并发症发生情况,以及手术前后双手10 s握拳次数、双手握力、日本骨科学会(JOA)评分、C_(2～7) Cobb角、C2～5 Cobb角、C_(5～7) Cobb角、C7倾斜角、T1倾斜角、C_(2～7)矢状位平衡(SVA)和K线角。结果试验组手术时间、术中出血量均少于对照组,差异有统计学意义(P 0.05)。2组患者末次随访时双手10 s握拳次数、双手握力及JOA评分均较术前改善,差异有统计学意义(P 0.05)。末次随访时,对照组C_(2～7) Cobb角较术前减小、C_(2～7) SVA较术前增大,而试验组无显著改变,2组相比差异有统计学意义(P 0.05)。末次随访时,试验组7例(7/67,10.4%)发生轴性症状,对照组20例(20/63,31.7%)发生轴性症状,试验组轴性症状发生率显著低于对照组,差异有统计学意义(P 0.05)。结论 2种术式治疗CSM中期临床疗效满意。选择性椎板成形术在保证手术疗效的前提下,可缩短手术节段,减少对颈后部肌肉韧带的损伤,降低术后轴性症状的发生率。     

改良颈椎后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病

目的:总结保留颈半棘肌肌止、C3椎板切除、C4～C7“锚定”单开门椎管扩大成形术治疗多节段脊髓型颈椎病的临床效果.方法:2009年1月～2011年10月,共对74例多节段脊髓型颈椎病患者采用保留颈半棘肌肌止、C3椎板切除、“锚定法”固定悬吊C4～C7椎板的单开门椎管扩大成形术治疗,其中57例患者获得随访,男31例,女26例,年龄50～71岁,平均63岁.术前JOA评分4～11分,平均8.5±2.0分,颈椎活动度23°～49°,平均37.4°±10.3°,颈椎曲度指数6.0％～22.0％,平均(13.9±7.4)％.观察患者术中和术后并发症发生情况;术后6个月复查颈椎X线片,测量颈椎曲度指数和颈椎活动度,观察颈椎曲度指数和颈椎活动度变化情况;末次随访时对患者神经功能进行JOA评分,计算神经功能改善率 结果:手术均顺利完成,手术时间50～110min,平均70min.术中出血150～600ml,平均230ml.术中无脊髓损伤、脑脊液漏等并发症发生.术后早期41例患者有颈痛,给予消炎镇痛治疗,术后3周内疼痛消失或明显缓解2例出现切口感染,经抗感染治疗并再次清创后切口延时愈合.9例有明显轴性症状,发生率为15.8％;6例出现C5神经根麻痹,给予甲基强的松龙、营养神经药物等治疗后症状明显缓解.随访6～32个月,平均13个月,术后6个月颈椎曲度指数为4.2％～21.1％,平均(11.3±8.1)％,较术前丢失(2.9±2.4)％;颈椎活动度为18°～46°,平均28.2°±10.8°,平均丢失8.2°±5.1°.患者神经功能均不同程度得到改善,末次随访时JOA评分为10～17分,平均13.8±2.3分,较术前明显提高(P＜0.05),神经功能改善率为29.0％～77.3％,平均(57.0±19.7)％.末次随访均未发现“再关门”现象.结论:保留颈半棘肌肌止、C3椎板切除、“锚定法”固定悬吊C4～C7椎板的单开门椎管扩大成形术可明显改善多节段脊髓型颈椎病患者的神经功能,手术操作简单,临床疗效满意.