ObjectiveTo explore the effect of spinal dural release on the effectiveness of expansive cervical laminoplasty for treating multi-segmental cervical myelopathy with ossification of posterior longitudinal ligament. MethodsA retrospective analysis was made on the clinical data of 32 patients with multi-segmental cervical myelopathy with cervical ossification of posterior longitudinal ligament who underwent expansive cervical laminoplasty and spinal dural release between February 2011 and October 2013 (group A); and 36 patients undergoing simple expansive cervical laminoplasty between January 2010 and January 2011 served as controls (group B). There was no significant difference in gender, age, disease duration, affected segments, combined internal disease, preoperative cervical curvature, Japanese Orthopaedic Association (JOA) score, and visual analogue scale (VAS) score between 2 groups (P>0.05). Postoperative JOA score and improvement rate, VAS score, posterior displacement of the spinal cord, and the change of cervical curvature were compared between 2 groups. ResultsSpinal dural tear occurred in 3 cases (2 cases in group A and 1 case in group B) during operation. Cerebrospinal fluid leakage occurred in 3 cases (2 cases in group A and 1 case in group B) after operation. The patients were followed up 12-46 months (mean, 18.7 months). At last follow-up, the JOA score and VAS score were significantly improved in 2 groups when compared with preoperative scores (P<0.05). JOA score and improvement rate of group A were significantly higher than those of group B (P<0.05), but VAS score of group A was significantly lower than that of group B (P<0.05). At last follow-up, no significant difference in cervical curvature was found between 2 groups (P>0.05); posterior displacement of the spinal cord of group A was significantly larger than that of group B (P<0.05). No reclosed open-door was observed during follow-up. ConclusionFor patients with multi-segmental cervical myelopathy with ossification of posterior longitudinal ligament, full spinal dural release during expansive cervical laminoplasty can increase the posterior displacement of spinal cord, and significantly improve the effectiveness.
Objective To investigate an individualized treatment program of a patient with multilevel cervical spondylotic myelopathy by the method of evidence-based medicine. Methods One patient with multilevel cervical spondylotic myelopathy was admitted into West China Hospital on October 19th, 2015. After evaluating the patient’s condition adequately, we proposed the problem according to the " patient, intervention, control, and outcome” (PICO) principles. Then, we searched and evaluated the systematic reviews, randomized controlled trials (RCTs), cohort studies from Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Medline, Embase, PubMed, OVID ACP Journal Club, CNKI, Wanfang and so on. The search date was from January 1991 to December 2015. And the best evidences from the databases were utilized in clinical practice. Results Twelve studies (five systematic reviews, two RCTs, four cohort studies and one latest guideline) were listed. To patients with multilevel cervical spondylotic myelopathy with ossification of the posterior longitudinal ligament (OPLL), posterior laminoplasty was less traumatic and had less complication. Expansive open-door laminoplasty was better. And the use of mini-plate fixation also reduced the related complications. Conclusions Posterior expansive open-door laminoplasty with mini-plate fixation has less traumatic and complication incidence, which can treat multilevel cervical spondylotic myelopathy effectively. For the best results and avoiding adverse outcomes, the procedure should be preferred in patients with OPLL.
Objective To explore the practicability and safety of ultrasonic bone curette in the laminoplasty of spinal canal after resection of intraspinal tumors. Methods The clinical data of 17 patients with thoracolumbar intraspinal tumors treated with ultrasonic bone curette after resection of intraspinal tumors between December 2015 and April 2017 were retrospectively analyzed. All patients were male, aged 42-73 years with an average of 57.4 years. The disease duration was 2-47 months with an average of 21.1 months. Among them, there were 4 cases of thoracic intrathoracic tumors (T10 in 1, T12 in 3) and 13 cases of lumbar intrathoracic tumors (L1 in 5, L2 in 4, L3 in 2, and L4 in 2). Postoperative pathological diagnosis showed that 8 cases were schwannoma, 4 cases were meningioma, 2 cases were neurofibroma, 2 cases were dermoid cyst, and 1 case was ependymoma. Spinal nerve function was evaluated preoperatively according to Frankel classification criteria, with 2 cases of grade B, 7 cases of grade C, and 8 cases of grade D. During the operation, the time of single segmental vertebral canal posterior wall incision, the overall operation time, intraoperative blood loss, intraoperative dural injury, and cerebrospinal fluid leakage, spinal cord and nerve root injury were recorded. At 3-6 months after operation, the tumor and bone healing were observed according to MRI and CT three-dimensional reconstruction, and the spinal nerve function was evaluated by Frankel classification. Results The time of ultrasonic osteotomy for the posterior wall of a single segmental vertebral canal was 3.4-5.7 minutes, with an average of 4.1 minutes. The overall operation time was 135-182 minutes, with an average of 157.3 minutes. The intraoperative blood loss was 300-500 mL, with an average of 342.6 mL. There was no accidental dural injury, and cerebrospinal fluid leakage, nerve root injury, or spinal cord injury. The incision healed by first intention after operation. All the 17 patients were followed up 9-18 months, with an average of 12.7 months. MRI examination showed no tumor recurrence, and CT three-dimensional reconstruction showed good bone healing in all patients. During the follow-up, there was no loosening or rupture of the internal fixator and there was no re-compression of the spinal cord. At last follow-up, according to Frankel classification, there were 1 case as grade B, 5 cases as grade C, 7 cases as grade D, and 4 cases as grade E. Conclusion The application of ultrasonic bone curette in laminoplasty of spinal canal after resection of intraspinal tumors can preserve the integrity of the bone ligament structure of posterior column, maintain the volume of vertebral canal, and has high safety, practicability, and good postoperative effectiveness.
Objective To determine the surgical indications for posterior expansive open-door laminoplasty (EOLP) extended to the C1 level. Methods Seventeen patients undergoing C3-7 or C2-7 open-door laminoplasty were included as the case group between September 2005 and January 2010, whose spinal cord injury symptoms were not alleviated or aggravated again because of the cervical stenosis at C1-4 level, and the causes of the surgery itself were eliminated, all of these patients underwent reoperation with decompress upward to C1 level. Fifteen patients with cervical stenosis who underwent C2-7 laminoplasty and C1 laminectomy were selected as the control group. There was no significant difference in gender, age, and disease duration between 2 groups (P gt; 0.05). The pre- and post-operative cervical curvature and spinal cord compression were evaluated according to the patients’ imaging data; the pre- and post-operative neurological recovery situation was evaluated by Japanese Orthopaedic Association (JOA) 17 score and spinal cord function Frankel grade; the neurological recovery rate (according to Hirabayashi et al. method) was used to assess the postoperative neurological recovery situation. Results In the case group, 8 patients underwent primary C3-7 laminoplasty. In 3 of these patients, there was a cervical stenosis at C1, 2 level, and discontinuous cerebrospinal fluid around the spinal cord was observed; 5 of them with a compression mass which diameter was exceed 7.0 mm in the C2-4 segments. The remaining 9 patients in the case group underwent primary C2-7 laminoplasty, and the diameter of the compression mass was exceed 7.0 mm in the C2-4 segments. In all 17 patients of the case group, reoperation was performed with the decompression range extended to the C1 level, and the follow-up time was 35-61 months with an average of 45.6 months. Cervical curvature: there were 11 cases of cervical lordosis, 4 cases of straight spine, and 2 cases of cervical kyphosis before operation; but after operation, 2 cases of cervical lordosis became straight spine and 1 straight case became kyphosis. The postoperative neurological improvement was excellent in 8 cases, good in 7, and fair in 2. In the control group, all the patients had a compression mass which anteroposterior diameter was exceed 7.0 mm in the C2-4 segments before operation. The follow-up time was 30-58 months with an average of 38.7 months. Cervical curvature: there were 13 cases of cervical lordosis and 2 cases of straight spine before operation; but after operation, 1 case of cervical lordosis became straight spine. The postoperative neurological improvement was excellent in 8 cases, good in 6, and fair in 1. No significant difference was found in the JOA score at pre- and post-operation between 2 groups (P gt; 0.05); however, there were significant differences (P lt; 0.05) in the JOA score between at last follow-up and at preoperation. Conclusion The initially surgical indications which can be used as a reference for EOLP extended to C1 are as follows:① Upper cervical (C1, 2) spinal stenosis: C1 posterior arch above the lower edge part of cerebrospinal fluid around the spinal cord signal is not continuous, and the anteroposterior diameter of the spinal canal actual is less than 8.0 mm as judgment standard. ②There is a huge compression at the lower edge of C2-4 vertebrae, and the most prominent part of the diameter is exceed 7.0 mm, which can not be removed through the anterior cervical surgery, or the operation is high-risk.
Objective To evaluate the effectiveness of microplate fixation in open-door cervical expansive laminoplasty (ELP) by comparing with anchor fixation. Methods Between January 2005 and October 2008, 35 patients with multi-segment cervical spondylotic myelopathy were treated. Of them, 15 patients underwent ELP by microplate fixation (microplate group) and 20 patients underwent ELP by anchor fixation (anchor group). In microplate group, there were 10 malesand 5 females with the age of (51.2 ± 11.5) years; the disease duration ranged from 6 to 60 months (mean, 14 months); and the preoperative Japanese Orthopoaedic Association (JOA) score was 7.7 ± 2.5. In anchor group, there were 13 males and 7 females with the age of (50.7 ± 10.8) years; the disease duration ranged from 3 to 58 months (mean, 17 months); and the preoperative JOA score was 7.8 ± 2.9. There was no significant difference in the general data, such as gender, age, and JOA score between 2 groups (P gt; 0.05). Results All incisions healed by first intention. Thirty-five cases were followed up 24-68 months (mean, 32 months). The operation time was (113 ± 24) minutes in anchor group and (111 ± 27) minutes in microplate group, showing no significant difference (t=0.231 3, P=0.818 5). The rate of spinal canal expansion in microplate group (60% ± 24%) was significantly higher than that in anchor group (40% ± 18%) (t=2.820, P=0.008). The JOA scores of 2 groups at 3 months and 24 months after operation were significantly higher than the preoperative scores (P lt; 0.01). There was no significant difference in JOA score between 2 groups at 3 months after operation (t=1.620 5, P=0.114 6), but the JOA score of microplate group was significantly higher than that of anchor group at 24 months after operation (t=3.454 3, P=0.001 5). X-ray film, MRI, and CT scan at 3-6 months after operation displayed that door spindle reached bony fusion. There was no occurrence of ‘‘re-close of door’’ in 2 groups. The rate of compl ication in microplate group (13.3%, 2/15) was significantly lower than that in anchor group (25.0%, 5/20) (χ2=7.160 0, P=0.008 6). Conclusion ELP by microplate fixation can achieve the stabil ity quickly after operation, which can help patients to do functional exercises early, and has satisfactory effectiveness and less complications.
ObjectiveTo investigate the risk factors of axial symptoms after single door laminoplasty for cervical myelopathy. MethodsA retrospective analysis was made on the clinical data of 102 patients with cervical myelopathy who underwent single door laminoplasty and were accorded with selective standard between February 2009 and October 2011. There were 59 males and 43 females, aged 35 to 72 years (mean, 58 years). The disease duration was 1-70 months (mean, 18 months). The operated segments included C3-7 in 58 cases, C3-6 in 23 cases, C4-7 in 15 cases, and C3-5 in 6 cases. The visual analogue scale (VAS) was used to determine whether the patient had axial symptoms (group A) or not (group B). The logistic regression analysis was used to analyze the risk factors of postoperative axial symptoms by assessing the following indexes:preoperative VAS score, preoperative Japanese Orthopaedic Association (JOA) score, gender, age, disease duration, operated segment, operation time, intraoperative blood loss, wearing collar time, preoperative encroachment rate of anterior spinal canal, preoperative cervical curvature, and preoperative cervical range of motion. ResultsA total of 102 cases were followed up 18-26 months (mean, 24 months). And no postoperative spinal cord injury, cerebrospinal fluid leakage, or infection occurred. Of 102 cases, 50 had axial symptoms (group A) and 52 had no axial symptoms (group B). There were significant differences in age, wearing collar time, preoperative cervical range of motion, preoperative cervical curvature, and preoperative encroachment rate of anterior spinal canal between 2 groups (P<0.05), but no significant difference was found in preoperative JOA score and VAS score, blood loss, gender, disease duration, operated segment, and operation time (P>0.05). The logistic regression analysis showed that the increased preoperative encroachment rate of anterior spinal canal, reduced preoperative cervical curvature, and preoperative cervical range of motion loss were the risk factors for cervical axial symptoms. ConclusionAge, wearing collar time, preoperative cervical range of motion, preoperative encroachment rate of anterior spinal canal, and preoperative cervical curvature are relevant factors of axial symptoms; increased preoperative encroachment rate of anterior spinal canal, reduced preoperative cervical curvature, and preoperative cervical range of motion loss are risk factors for cervical axial symptoms.
ObjectiveTo investigate the effect of modified lateral mass screws implantation strategy on axial symptoms in cervical expansive open-door laminoplasty. MethodsA clinical data of 166 patients, who underwent cervical expansive open-door laminoplasty between August 2011 and July 2016 and met the selection criteria, was retrospective analyzed. Among them, 81 patients were admitted before August 2014 using the traditional mini-plate placement and lateral mass screws implantation strategy (control group), and 85 patients were admitted after August 2014 using modified lateral mass screws implantation strategy (modified group). There was no significant difference in the gender composition, age, clinical diagnosis, disease duration, diseased segment, and preoperative Japanese Orthopaedic Association (JOA) score, pain visual analogue scale (VAS) score, Neck Disability Index (NDI), cervical curvature and range of motion, spinal canal diameter and cross-sectional areas, and Pavlov’s value between the two groups (P>0.05). The operation time, intraoperative blood loss, the number of facet joints penetrated by lateral mass screws, effectiveness evaluation indexes (JOA score and improvement rate, VAS score, NDI), imaging evaluation indexes (cervical curvature and range of motion, spinal canal diameter and cross-sectional areas, Pavlov’s value, and lamina open angle), and complications were recorded and compared between the two groups.ResultsThe modified group had shorter operation time and lower intraoperative blood loss than the control group (P<0.05). There were 121 (29.9%, 121/405) and 10 (2.4%, 10/417) facet joints penetrated by lateral mass screws in control and modified groups, respectively; and the difference in incidence was significant (χ2=115.797, P=0.000). Eighteen patients in control group had 3 or more facet joints penetrated while no patients in modified group suffered 3 or more facet joint penetrated. The difference between the two groups was significant (P=0.000). All patients were followed up, the follow-up time was (28.7±4.9) months in modified group and (42.4±10.7) months in control group, showing significant difference (t=10.718, P=0.000). The JOA score, VAS score, and NDI at last follow-up of the two groups were significantly improved compared with preoperative (P<0.05); there was no significant difference in JOA score and improvement rate and VAS score between the two groups (P>0.05), but the NDI was significantly lower in modified group than in control group (P<0.05). There were significant differences in cervical curvature and range of motion, spinal canal diameter, Pavlov’s value, and cross-sectional areas at last follow-up when compared with those before operation in both groups (P<0.05). There was no significant difference in the above indicators and lamina open angle between the two groups (P>0.05). The modified group has a relative lower axial symptom rate (23/85, 27.1%) than the control group (27/81, 33.3%), but the difference was not significant (Z=−1.446, P=0.148). There was no significant differences between the two groups in the incidences of C5 nerve root palsy, cerebrospinal fluid leakage, wound infection, and lung or urinary tract infection (P>0.05). ConclusionIn the cervical expansive open-door laminoplasty, the modified lateral mass screws implantation strategy can effectively reduce the risk of lateral mass screw penetrated to the cervical facet joints, and thus has a positive significance in avoiding the axial symptoms caused by facet joint destruction.
ObjectiveTo evaluate the effectiveness of modified recapping laminoplasty preserving the continuity of supraspinous ligament in the treatment of intraspinal benign tumors in upper cervical vertebrae and its influence on the stability of the cervical vertebrae. MethodsThe clinical data of 13 patients with intraspinal benign tumors in upper cervical vertebrae treated between January 2012 and January 2021 were retrospectively analyzed. There were 5 males and 8 females, the age ranged from 21 to 78 years, with an average of 47.3 years. The disease duration ranged from 6 to 53 months, with an average of 32.5 months. The tumors located between C1 and C2. Postoperative pathology showed 6 cases of schwannoma, 3 cases of meningioma, 1 case of gangliocytoma, 2 cases of neurofibroma, and 1 case of hemangioblastoma. During operation the continuity of the supraspinal ligament were retained, the lamina ligament complex was lifted to expose the spinal canal via the approach of the outer edge of the bilateral lamina, and the lamina was fixed after the resection of the intraspinal tumors. Before and after operation, the atlantodental interval (ADI) was measured on three-dimensional CT; the effectiveness was evaluated by Japanese Orthopaedic Association (JOA) score, the neck dysfunction index (NDI) was used to evaluate the cervical function, and the total rotation of the cervical spine was recorded. Results The operation time was 117-226 minutes (mean, 127.3 minutes); the intraoperative blood loss was 190-890 mL (mean, 227.8 mL). The tumors were completely removed in all patients. There was no vertebral artery injury, aggravation of neurological dysfunction, epidural hematoma, infection, or other related complications. Two patients occurred cerebrospinal fluid leakage after operation, which were healed through electrolyte supplement and local pressure treatment of incision. All the patients were followed up 14-37 months, with an average of 16.9 months. Imaging examination showed no recurrence of tumor, displacement of vertebral lamina, loosening and displacement of internal fixator, and secondary reduction of vertebral canal volume. At last follow-up, JOA score significantly improved when compared with preoperative scores (P<0.05). Among them, 8 cases were excellent, 3 cases were good, and 2 cases were medium, with an excellent and good rate was 84.6%. There was no significant difference in ADI, total rotation of the cervical spine, and NDI between pre- and post-operation (P>0.05). ConclusionThe treatment of intraspinal benign tumors in upper cervical vertebrae with modified recapping laminoplasty preserving the continuity of the supraspinous ligament can restore the normal anatomical structure of the spinal canal and maintain the stability of the cervical spine.
Objective To evaluate the reliability and the advantageof canal laminoplasty with laminoplasty over laminectomy for treatment of lumbar spinal stenosis.Methods From June 2000 to September 2004, the titanium miniplate fixation technique was applied to re-implantation of the vertebral lamina in the lumbar spine. The vertebral lamina was made with a specially made osteotome and a special technique in 18 patients with lumbar spinal stenosis. Results The patients were followed up for 1 yr and 8 mon on average (range, 3 mon4 yr and 3 mon) and were observed to have a bony fusion of the re-implanted lamina 3-9 months postoperatively. There was no nonunion, displacement of the re-implanted lamina, overgrowth of the anterior bone edge of osteotomy, recompression of the nerves or instability of the lumbar spine. Conclusion The result demonstrates that canal laminoplasty with the titanium miniplate re-implantation of the vertebral lamina in lumbar spine can restore the normal anatomy, keep stability of the spine, and avoid adhesion and scar in the canal.
ObjectiveTo evaluate the effectiveness of cervical single open-door laminoplasty with the unilateral C4,5 foraminotomy for cervical myelopathy in preventing postoperative C5 palsy. MethodsBetween January 2008 and June 2012, 200 consecutive patients with cervical myelopathy and unilateral C4,5 foraminal stenosis were treated, and the clinical data were retrospectively analyzed. Of them, 89 patients underwent cervical single open-door laminoplasty combined with unilateral C4,5 foraminotomy (group A), and 111 patients underwent simple cervical single open-door laminoplasty (group B). There was no significant difference in gender, age, disease duration, segmental lesions, and diagnosis distribution between 2 groups (P>0.05). The operation time, intraoperative bleeding volume, and the incidence of C5 palsy were recorded. The Japanese Orthopaedic Association (JOA) score before and after operation was used for neurological assessment, and the JOA recovery rate was calculated. ResultsThe operation time was (122±29) minutes and the intraoperative bleeding volume was (165±50) mL in group A, which were significantly higher than those in group B[(109±31) minutes and (145±32) mL] (t=3.033, P=0.010;t=3.429, P=0.003). All patients were followed up; the follow-up time was 3-48 months (mean, 25 months) in group A, and was 4-50 months (mean, 27 months) in group B. C5 palsy occurred in 1 patient of group A (1.12%), and in 9 patients of group B (8.11%), showing significant difference between 2 groups (χ2=3.709, P=0.045). The JOA score was significantly improved at 2 weeks and last follow-up after operation when compared with preoperative JOA scores in 2 groups (P<0.05), but no significant was found between at 2 weeks and at last follow-up (P>0.05) in each group. Between group A and group B, no significant difference was found in JOA score and the recovery rate (P>0.05). During follow-up, no persistent axial pain for a long time and obvious spinal instability occurred in 2 groups. ConclusionCervical single open-door laminoplasty with unilateral C4,5 foraminotomy can reduce the incidence of the C5 palsy for patients with cervical myelopathy combined with unilateral C4,5 foraminal stenosis.