Wang MY, Shah S, Green BA. Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy.
Background
Laminoplasty is a well-recognized technique for decompressing the cervical spine in cases of spondylotic myelopathy and ossification of the posterior longitudinal ligament. This technique, originally popularized in Asia, is becoming more widespread, but to date there have been few reports of clinical series from North American centers.
Methods
Retrospectively we reviewed (1986-2001) 204 cases of open door laminoplasty. All patients presented with symptoms and magnetic resonance imaging (MRI) findings consistent with myelopathy secondary to multisegmental cervical stenosis with spondylosis and underwent decompression from C3 to C7. Improvement in myelopathy was assessed with the Nurick Score.
Results
Average age was 63 years (range 36 to 92). Follow-up averaged 16 months. Postoperatively, Nurick scores improved by 1 point in 78 patients, 2 points in 37 patients, 3 points in 7 patients, and 4 points in 5 patients; 74 patients experienced no improvement, and 3 patients deteriorated by one point. There was no statistical difference in myelopathy outcomes when comparing patients older and younger than 75 years of age. In two patients there was radiographic progression of kyphosis, but in no case was subsequent fusion required. Six patients without neck pain preoperatively developed new intractable neck pain after surgery.
Conclusions
Open door expansile laminoplasty is a safe and effective method for treating cervical spondolytic myelopathy. Laminoplasty is thus an alternative to anterior surgery that can be accomplished quickly with minimal blood loss, minimizing risks in elderly patients. 相似文献
ObjectiveTo describe the surgical technique of cervical transdural discectomy with laminoplasty (CTDL) for the treatment of multi‐segment cervical spinal stenosis (CSS) accompanied with cervical disc herniation (CDH) and investigate its surgical outcomes and complications.MethodsThis was a clinical study. Between 2012 and 2018, 31 patients (13 males and 18 females) with multi‐segment CSS (over two cervical segments) accompanied with huge CDH and underwent CTDL were enrolled in this study. The details of CTDL technique with general anesthesia was described by the authors. The average follow‐up period of patients was 65.03 months (range from 24 to 126 months). Perioperative parameters such as age, sex, operative level, operative time, estimated blood loss, ambulation time, and operative complications were recorded. The results of clinical metrics such as the visual analog scale (VAS) and Japanese Orthopaedic Association (JOA) scores in the preoperative and during the follow‐up period were obtained and used to evaluate clinical outcomes. Radiographic improvement was evaluated by the compression ratio, sagittal maximum spinal cord compression (SMSCC), and cervical range of motion (ROM). The preoperative and postoperative follow‐up parameters (VAS, JOA, Compression ratio, SMSCC, and ROM) were assessed with paired t test. A P‐value <0.05 was considered statistically significant.ResultsIn the study, the mean age of the 31 patients was 55.23 ± 10.97 years. The mean operative time was 192.45 ± 24.17 min (ranging from 150 to 245 min), and intraoperative blood loss was 322.58 ± 129.00 mL (ranging from 150 to 600 mL). The VAS neck pain was improved significantly over the follow‐up period (P < 0.05, respectively). The VAS arm pain improved significantly from 6.26 ± 0.93 preoperatively to 1.74 ± 0.63 at 24 months postoperatively (P < 0.001). There was no significant difference in improvement of VAS arm pain between 24 months postoperatively and final follow‐up (P = 0.180). Compared with preoperative JOA score, JOA score was significantly improved at 24 months postoperatively (14.79 ± 1.84 vs 9.66 ± 2.81, P < 0.001). Meanwhile, there were no statistically significant differences between the final follow‐up and the postoperative JOA scores (15.08 ± 1.71 vs 14.79 ± 1.84, P = 0.051). Postoperative patients showed significantly higher index of compression ratio (58.30 ± 8.51 vs 27.17 ± 3.89, P < 0.001) and lower SMSCC (25.12 ± 5.67 vs 33.66 ± 5.38, P < 0.001). In addition, there was no significant difference between preoperative and postoperative cervical ROM (P = 0.740). One patient observed postoperative symptom of C6 nerve root injury, which was resolved within 24 months after the surgery; meanwhile, the neurological monitoring also reflected the intraoperative stretching of the C6 nerve root. Two cases involved postoperative cerebrospinal fluid (CSF) leakage which may have been related to laceration of dura mater.ConclusionsThis study suggested that CTDL technique could acquire satisfactory surgical outcomes for patients with multi‐segment CSS accompanied with CDH, but the surgical indications of the patients need to be selected strictly. 相似文献
ObjectiveThe authors reviewed their experiences of combined surgery (open door laminoplasty with unilateral screw fixation) for unstable multi-level cervical stenosis, to clarify the situation regarding the surgical approach most appropriate for the treatment of diffuse unstable multi-level cervical stenosis.MethodsFrom January 2011 to January 2012, combined surgery was performed for unstable multi-level cervical stenosis by one surgeon at our institution. The subjects of this study were 6 men of mean age 53.7 years (range, 48-71) with a mean follow-up of 9.3 (range, 3-14) months. All imaging studies showed severe multi-level cervical stenosis with spinal cord signal change, and instability or kyphotic deformity. A retrospective review of clinical, radiological, and surgical data was conducted.ResultsAverage laminoplasty level was 4.8 and the average screw fixation level was 5.0. Japanese Orthopedic Association score improved from an average of 5.2 to 11.2 points. According to Nurick''s grades and Odom''s criteria, symptom improvement was statistically significant. On the other hand, Cobb''s angle changes were not significant. Average operation time was 5.86 hours with an average blood loss of 460 mL. No significant surgical complication was encountered.ConclusionDespite the small cohort and the short follow-up duration, the present study demonstrates that laminoplasty with unilateral screw fixation is a safe and effective treatment for unstable multi-level cervical stenosis. 相似文献