Double-door laminoplasty in managing multilevel myelopathy: technique description and literature review

Cervical laminoplasty has become a popular technique for the treatment of cervical myelopathy resulting from multilevel canal stenosis. The goal of this technique is to increase the spinal canal space and to reconstruct the posterior bony arch at the same time. The most common reason for laminoplasty failure is restenosis because of hinge closure. In the present report, the authors describe a variation of the double-door laminoplasty using a specifically tailored plate. The present technique is a modification of the double-door laminoplasty by using a specifically developed plate (Senegas' Plate--by Stryker Technology, Kalamazoo, MI), which allows to fix the two hemilamina in an open and expanded position re-establishing also the posterior canal arch. This procedure was implemented in a series of 22 patients. The device has been successfully implanted in all patients. At a mean follow-up of 21.1 months all patients showed a remarkable neurological improvement documented by serial clinical and radiological investigations. The present study indicates that this specific device effectively preserves the postoperative sagittal cervical canal diameter and provides a rigid construct, and in addition, it is very easy and fast to apply minimizing the risk of iatrogenic injuries, blood loss, and operative time.     

棘突悬吊式颈椎管扩大成形术治疗颈椎管内肿瘤的初步报告

目的介绍棘突悬吊式颈椎管扩大成形肿瘤摘除术,评价其在治疗颈椎管内肿瘤中应用的效果。方法2003年7月～2006年6月,治疗26例颈椎管内肿瘤,其中男14例,女12例;年龄25～57岁,病程3～24个月。四肢肌力～级,四肢肌张力高,腱反射亢进,病理反射阳性,2例出现髌阵挛及踝阵挛。术前MRI检查示肿瘤大小1.5cm×0.8cm～2.8cm×2.0cm,位于C3-6节段,其中C3、4节段8例,C4、5节段9例,C5、6节段9例。术前摄颈椎动力位X线片,测量患者颈椎平均活动范围,前屈30～45°,平均39.3°;后伸32～45°,平均40.5°;左侧屈20～45°,平均25°;右侧屈30～45°,平均36.6°。术后观察症状体征的变化,摄动力位X线片,测量颈椎活动范围,其中15例患者复查MRI及CT。结果术后患者均获随访6～12个月,平均8个月。患者感觉、肌力、肌张力、反射均有不同程度恢复,无并发症及死亡发生,生活全部自理。术后10例出现颈部酸痛,功能锻炼后逐渐缓解。术后7周复查MRI及CT可见棘突与椎板间骨性愈合,未出现“关门”现象,后柱结构基本恢复。术后复查动力位X线片示无颈椎不稳、椎管狭窄,颈椎活动范围：前屈28～43°,平均37.9°;后伸32～44°,平均41°;左侧屈25～45°,平均23°;右侧屈35～45°,平均36.2°。结论棘突悬吊式颈椎管扩大成形术既可充分显露肿瘤,又可在悬吊固定后最大程度保留后柱结构,有效预防术后并发症的发生。     

微型钛板固定颈椎单开门椎管扩大成形术的临床应用

目的:评价微型钛板固定颈椎单开门椎管扩大成形术治疗脊髓型颈椎病的临床疗效。方法:2009年2月至2011年4月,采用单开门颈椎管扩大成形ARCH钛板内固定治疗脊髓型颈椎病,获得完整随访16例(A组),与2007年3月至2009年1月行颈椎单开门椎管成形术治疗的脊髓型颈椎病18例(B组)进行对比分析。分析内容包括手术时间、术中出血量、JOA(17分法)评分改善率、轴性症状的产生及颈椎曲度的变化。结果:手术时间、术中出血量、术后6个月JOA评分改善率A组分别为(122.0±26.8)min、(153.0±46.7)ml、(59.4±11.6)%,B组分别为(119.0±28.6)min、(151.0±50.4)ml、(58.7±12.7)%,两组比较均无统计学意义(P>0.05)。A组术后有明显轴性症状患者为3例(18.75%),B组为6例(33.33%),两组差异有统计学意义(P<0.01);A组术前颈曲角度(17.9±5.2)°与术后的(18.2±4.8)°比较,差异无统计学意义(P>0.05),B组术前颈曲角度(18.1±6.3)°与术后的(16.3±5.9)°比较,差异有统计学意义(P<0.05)。结论:微型钛板固定颈椎单开门椎管扩大成形术能减少术后轴性症状的发生和颈椎曲度的丢失,可提高脊髓型颈椎病的治疗效果。     

Modified K‐line for Making Decisions Regarding the Surgical Approach in Patients with K‐line (‐) OPLL

ObjectiveTo investigate whether the modified K‐line can be used to predict the clinical outcome and to determine the surgical approach for K‐line (−) patients with cervical ossification of the posterior longitudinal ligament (OPLL).MethodsA new modified K‐line was defined as the line connecting the midpoints of the spinal cord at C₄ and C₆ on the lateral cervical radiographs. A total of four consecutive patients (three men and one woman) with cervical myelopathy due to OPLL were included in this research. The patients were diagnosed with OPLL with K‐line (−) while they were also classified as modified K‐line (+). Preoperative modified K‐line was used to predict the surgical outcome in K‐line (−) patients with OPLL according to the original K‐line. And a modified laminoplasty with C₃ laminectomy and C_4‐6 bilateral open‐door laminoplasty was adopted to perform on all the patients. The Japanese Orthopaedic Association scores before surgery and at 1‐year follow‐up after surgery were evaluated and the recovery rate was calculated. The visual analogue scale (VAS) scores were also evaluated before surgery and after surgery. Furthermore, cervical plain radiographs in neutral position before surgery and after surgery were obtained to measure C₂–C₇ angles for assessing the cervical sagittal alignment.ResultsThe results showed that good neurological improvement could be achieved in all K‐line (−) patients who underwent C₃ laminectomy with C₄–C₆ bilateral open‐door laminoplasty. The Postoperative JOA scores improved from 13.5 to 16.5, from 11 to 16.5, from 13 to 16, and from 12.5 to 13, respectively. The mean recovery rate was 65.4% in the K‐line (−) patients. And the VAS scores dropped from 3 to 1, 5 to 2, 5 to 3, and 4 to 2, respectively. The JOA and VAS scores showed satisfaction in all patients at the 1‐year follow‐up. Relatively satisfactory and stable cervical sagittal alignment was observed on postoperative lateral radiography in all patients at the 3‐month follow‐up period. There were no postoperative complications associated with this technique found in all the patients.ConclusionsModified K‐line may predict the clinical outcome of this modified laminoplasty and offer guidance regarding the choice of surgical method for K‐line (−) patients with OPLL. Additionally, C₃ laminectomy with C₄–C₆ bilateral open‐door laminoplasty should be recommended for the use in patients with K‐line (−) OPLL, who were also classified as modified K‐line (+). However, further studies with more cases will be required to reveal its generalizability and availability.     

Late-onset spinal deformities in children treated by laminectomy and radiation therapy for malignant tumours

This is a retrospective study of 76 children who had had malignant tumours treated with laminectomy or laminoplasty and/or radiation therapy affecting the spine. Spinal tumours in children are extremely rare. However, their treatment can result in progressive spinal deformity. Radiation therapy affecting the growing spine can lead to asymmetric vertebral growth, causing kyphosis and/or scoliosis. These spinal deformities pose one of the most challenging problems for the spine surgeon. The aim of this article is to describe late-onset post-laminectomy/post-radiation spinal deformities and to evaluate the results of their treatment. Seventy-six children, with a mean age of 4 years and 7 months (range, 2 months to 16 years), underwent surgical removal of malignant tumours, between 1961 and 1995. Sixty-seven of them developed post-laminectomy/post-radiation spinal deformity. Conservative treatment consisted of bracing and corrective plaster casts. In 46 cases the deformity was treated surgically. A distraction plaster cast was used as preoperative preparation in the more severe and rigid curves, with or without neurological impairment. Surgery consisted of combined anterior and posterior fusion in 39 cases and posterior fusion in seven cases. Posterior instrumentation was used in 38 cases. The mean follow-up period was 6 years and 7 months (range, 9 months to 20 years and 2 months). Nine children did not develop deformity following the primary tumour treatment. One of them underwent laminectomy with posterolateral fusion and eight had laminoplasty combined with external immobilisation. Forty-six children developed iatrogenic kyphosis and underwent surgical correction from a mean of 75° pre-correction to a mean of 32°. The mean scoliotic angle correction was 66° preoperatively to 34° postoperatively. At follow-up, the mean correction loss was 7° in the sagittal plane and 5° in the coronal plane. Preoperative distraction plaster cast treatment resulted in a correction of 39% in kyphosis and of 58% in scoliosis, and in a partial or complete recovery of neurological deficits in all but one patient. In severe and rigid curves that develop following treatment of paediatric spinal tumours, preoperative application of a distraction plaster cast can reduce deformity and facilitate surgical correction. Furthermore, in the case of pure bony compression of the spinal cord due to the apical vertebra of the deformity, treatment with the distraction plaster can result in recovery from the neurological impairment. The prevention of post-laminectomy/post-radiation spine deformities is emphasised. Rigid external immobilisation for a period of 4 months in the cervical spine and of 6 months in the thoracic spine is recommended after both laminoplasty and laminectomy with posterolateral fusion.The research was carried out at Saint Vincent de Paul Hospital, Department of Pediatric Orthopaedic Surgery, Paris     

颈椎后-前路联合手术治疗高危颈椎病临床观察

目的 观察高危颈椎病的诊断及其颈椎后．前路手术治疗高危颈椎病的疗效。方法 对42例符合拟定的高危颈椎病患者行后-前路颈椎手术治疗,2例轻微外伤后不全瘫的高危颈椎病患者均行Ⅰ期后．前路联合手术,余40例患者中分期行后．前路颈椎手术10例,Ⅰ期手术30例。后路采用“双开门”椎管成形减压术,前方植骨均为自体三面皮质髂骨,均加颈椎前自锁钛板固定。以手术前后的JOA评分评价手术疗效。结果 全部患者获得随访,随访时间6～30月,无伤口感染,未见颈椎内固定及植骨块松脱,术后4月X线复查示前方植骨块与椎体融合。依照JOA评分法,42例患者平均J2．5分。手术前平均评分、神经功能均改善,优11例,良18例,好转10例,无效3例。手术有效率为92％（39／42）,优良率为61％（29／42）。结论 颈椎病的MRI矢状面可见节段性的脊髓前后受压,脊髓的形状变成月牙形甚至线形;横截面脊髓面积减少50％以上的影像学特征加病史、临床症状、体征中任一项即可以确诊为高危颈椎病。颈椎后前路手术治疗高危颈椎病使颈脊髓得到直接的较充分的减压,降低了前方手术操作引起脊髓损伤的风险,为脊髓形状的复原、血供的改善及其功能的恢复提供了有利条件。     

伊藤法"单开门"颈椎椎管扩大椎板成形术的并发症及其原因分析

目的探讨伊藤法"单开门"颈椎椎管扩大椎板成形术并发症的发生率及其原因.方法对1983年2月～1992年3月行伊藤法"单开门"颈椎椎管扩大椎板成形术的87例患者的临床资料进行回顾性分析,通过查阅病历及门诊随访,确定其手术并发症.采用临床观察、影像学评价及统计学方法分析其原因.结果随访2～14年,平均5.3年.39例(45%)患者出现轴性症状,4例(4.6%)出现神经根麻痹,颈部旋转受限48例(55.2%),过伸受限33例(37.9%),屈曲受限17例(18.3%),侧屈受限17例(18.3%).颈椎曲度术前平均14.8°,术后平均4.9°,平均减少9.9°.结论伊藤法"单开门"颈椎椎管扩大椎板成形术后轴性症状较多见,术后颈椎前凸减小,尤其是颈椎后凸可能是产生轴性症状的原因之一.     

CenterpieceTM微型钢板在颈椎单开门椎管扩大成形术中的应用-附14例报告

目的　评价应用CenterpieceTM微型钢板固定单开门椎管扩大成形术的疗效。 方法　采用改良单开门手术,C3、C5、C7椎板开门侧行CenterpieceTM微型钢板固定椎管扩大成形术治疗14例脊髓型颈椎病患者。 结果　随访6个月～2年,平均13.6个月。JOA评分由术前的(11.1±0.78)分提升为　(15.3±1.12)分（P<0.05）,术后复查CT及MRI提示椎管显著扩大、脊髓减压,随访期间无一例发生内固定物松脱、门轴侧椎板内陷及再“关门”现象,术后2个月时仅有2例存在颈部轻微疼痛、僵硬感,术后半年复查症状消失。 结论 CenterpieceTM微型钢板固定单开门椎管扩大成形术治疗是治疗脊髓型颈椎病安全有效的术式,门轴固定牢固,能显著减少再关门现象及轴性症状。     

脊髓型颈椎病前、后路手术临床疗效的对比研究

目的探讨脊髓型颈椎病前、后路手术的临床疗效。方法对86例脊髓型颈椎病患者分前路减压植骨内固定40例和后路单开门椎管成形术46例,比较两种手术方式对单节段、两节段、三节段、四节段压迫的改善率。结果随访20—73个月,平均43个月,两种减压术后JOA评分改善率在单节段压迫者差异有统计学意义（P〈0．05）,在两节段、三节段压迫者差异无统计学意义（P〉0．05）,在四节段压迫者差异有统计学意义（P〈0．05）。结论脊髓型颈椎病单节段压迫者,前路手术效果好,对于两个或三个节段压迫者,前、后路手术的疗效相同,对于四个节段的压迫,后路手术效果好。     

单开门颈椎椎管扩大成形术治疗颈椎椎管狭窄症的临床观察

目的探讨对于颈椎椎管狭窄症患者应用单开门颈椎椎管扩大成形术进行治疗的效果。方法回顾性分析34例颈椎椎管狭窄症患者的临床资料,均行单开门椎管扩大成形术,观察疗效及JOA17分评分。结果所有患者均有效随访,术后优11例,良17例,优良为82%。术前JOA17评分平均为5.34,术后评分平均为10.27。结论对于颈椎椎管狭窄症的患者采用单开门椎管扩大成形术治疗疗效确切,安全性高,值得在临床上推广使用。