Open-door cervical laminoplasty with preservation of posterior structures.
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ABSTRACT:
SUBMITTER: Abdullah KG
PROVIDER: S-EPMC3864484 | biostudies-other | 2012 Mar
REPOSITORIES: biostudies-other
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Project description:BACKGROUND:For patients with spinal canal stenosis in the upper cervical spine who undergo C3-7 laminoplasty alone, it remains impossible to achieve full decompression due to its limited range. This study explores the extension of expansive open-door laminoplasty (EODL) to C1 and C2 for the treatment of cervical spinal stenosis of the upper cervical spine and its effects on cervical sagittal parameters. METHODS:A retrospective analysis of 33 patients presenting with symptoms of cervical spondylosis myelopathy (CSM) and ossification in the posterior longitudinal ligament (OPLL) of the upper cervical spine from February 2013 to December 2015 was performed. Furthermore, the changes in the C0-2 Cobb angle, C1-2 Cobb angle, C2-7 Cobb angle, C2-7 SVA, and T1-Slope in lateral X-rays of the cervical spine were measured before, immediately after, and 1 year after the operation. JOA and NDI scores were used to evaluate spinal cord function. RESULTS:The C0-2 and C1-2 Cobb angles did not significantly increase (P?=?0.190 and P?=?0.081), but the C2-7 Cobb angle (P?=?0.001), C2-7 SVA (P?<?0.001), and T1-Slope (P?<?0.001) significantly increased from preoperative to 1?year postoperative. In addition, C2-7 SVA was significantly correlated with the T1-Slope (Pearson?=?0.376, P?<?0.001) and C0-2 Cobb angle (Pearson?=?0.287, P?=?0.004), and the C2-7 SVA was negatively correlated with the C2-7 Cobb angle (Pearson?=?-?0.295, P?<?0.001). The average preoperative and postoperative JOA scores were 8.3?±?1.6 and 14.6?±?1.4 points, respectively, indicating in a postoperative neurological improvement rate of approximately 91.6%. The average preoperative and final follow-up NDI scores were 12.62?±?2.34 and 7.61?±?1.23. CONCLUSIONS:The sagittal parameters of patients who underwent EODL extended to C1 and C2 included loss of cervical curvature, increased cervical anteversion and compensatory posterior extension of the upper cervical spine to maintain visual balance in the field of vision. However, the changes in cervical spine parameters were far less substantial than the alarm thresholds reported in previous studies. We believe that EODL extended to C1 and C2 for the treatment of patients with spinal canal stenosis in the upper cervical spine is a feasible and safe procedure with excellent outcomes.
| S-EPMC7003532 | biostudies-literature
Project description:Study Design Retrospective study. Objectives To analyze lamina hinge fusion failure after plate-only open-door laminoplasty. Methods Thirty-one patients who underwent plate-only open-door laminoplasty (110 levels) for cervical myelopathy and who had serial computed tomography (CT) scans at 6 and 12 months were analyzed. Risk factors for fusion failure at 12 months were analyzed, including age, sex, smoking, presence of diabetes mellitus and ossification of posterior longitudinal ligament, bone mineral density (T-score), preoperative cervical curvature, operated levels, presence of a ventral cortical bony continuity, and reflection angle of the lamina hinge. Clinical outcomes were assessed with neck pain score using visual analog scale, neck disability index, and Japanese Orthopedic Association score. Results Hinge fusion occurred in 84% (26/31) of patients at 12 months. A significant risk factor for fusion failure was the absence of a ventral cortical bony continuity at 6 months (p < 0.01; 100 versus 48%). No lamina with ventral cortical bony continuity at 6 months showed depression at 12 months, but two lamina without continuity showed depression of 2.5 and 2.1 mm, respectively, at 12 months. Clinical outcomes were not different between patients with and without hinge fusion. Conclusion Absence of a ventral cortical bony continuity at 6 months is a risk factor for fusion failure at 12 months. However, bicortically defective laminae usually heal with minimal displacement, although it may take longer than 12 months.
| S-EPMC4303478 | biostudies-other
Project description:Study Design Systematic review. Objective In patients aged 18 years or older, with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament (OPLL), does sparing the C2 muscle attachments and/or C7-preserving cervical laminoplasty lead to reduced postoperative axial pain compared with conventional C3 to C7 laminoplasty? Do these results vary based on early active postoperative cervical motion? Methods A systematic review of the English-language literature was undertaken for articles published between 1970 and August 17, 2012. Electronic databases and reference lists of key articles were searched to identify studies evaluating C2/C3- or C7-preserving cervical laminoplasty for the treatment of cervical spondylotic myelopathy (CSM) or OPLL in adults. Studies involving traumatic onset, cervical fracture, infection, deformity, or neoplasms were excluded, as were noncomparative studies. Two independent reviewers assessed the level of evidence quality using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus. Results We identified 11 articles meeting our inclusion criteria. Only the randomized controlled trial (RCT) showed no significant difference in late axial pain (at 12 months) when C7 spinous muscle preservation was compared with no preservation. However, seven other retrospective cohort studies showed significant pain relief in the preserved group compared with the nonpreserved group. The preservation group included those with preservation of the C7 spinous process and/or attached muscles, the deep extensor muscles, or C2 muscle attachment and/or C3 laminectomy (as opposed to laminoplasty). One study that included preservation of either the C2 or C7 posterior paraspinal muscles found that only preservation of the muscles attached to C2 resulted in reduced postoperative pain. Another study that included preservation of either the C7 spinous process or the deep extensor muscles found that only preservation of C7 resulted in reduced postoperative pain. Conclusion Although there is conflicting data regarding the importance of preserving C7 and/or the semispinalis cervicis muscle attachments to C2, there is enough evidence to suggest that surgeons should make every attempt to preserve these structures whenever possible since there appears to be little downside to doing so, unless it compromises the neurologic decompression.
| S-EPMC3699245 | biostudies-literature
Project description:STUDY DESIGN: Retrospective cohortObjective: To determine if there are differences in important clinical outcomes between patients treated with a "preservation of the unilateral posterior muscular-ligament complex (PMLC) procedure" and a "hinge side anchoring procedure (HSAP)" for the treatment of cervical spondylotic myelopathy (CSM). METHODS: Nine hundred and forty-six patients underwent the above procedures for treatment of CSM between January 2006 and December 2009. Five hundred and fifty-two (58%) subjects met study criteria and 136 were analyzed (76% unavailable for follow-up). One group (70 patients) received a "preservation of unilateral PMLC procedure" and another group (66 patients) received an HSAP. The rate and severity of postoperative axial symptoms were assessed, and the changes of cervical-spine curvature and postoperative decompression were measured. RESULTS: The mean time to follow-up in the preservation of unilateral PMLC group was 6.9 months (range, 6-8 months) and the HSAP group was 6.4 months (6-8 months). The overall rate of any axial symptoms (AS) among all subjects was 35%. No AS was reported in 45.7% of the preservation of unilateral PMLC group and 23.8% of the HSAP group (P = .008). Severe AS was reported in 4.3% and 11.1% of patients per group, respectively (P = .14). Cervical spinal lordosis was improved in the unilateral PMLC group and decreased in the HSAP group. The risk of losing lordosis was more than two times higher in the HSAP group compared with the unilateral PMLC group (70% and 34%, respectively; P < .001). CONCLUSION: Differences were observed between the two groups; however, a high loss to follow-up rate weakens the findings. Cervical expansive laminoplasty with preservation of unilateral PMLC may have the advantage of a lower rate of postoperative AS and maintenance of cervical spinal lordosis compared with the HSAP group.
| S-EPMC3427960 | biostudies-other
Project description:ObjectiveTo investigate and evaluate the biomechanical behaviour of tension-band-reconstruction (TBR) and ordinary titanium plates in open-door laminoplasty by finite element (FE) analysis.MethodsTBR titanium plate and ordinary titanium plate were implanted into a validated finite element model of healthy adult cervical vertebrae. Among them, 5 ordinary titanium plate were used in model A, 2 TBR titanium plates and 3 ordinary titanium plates were used in model B, and 5 TBR titanium plates were used in model C. The same loading conditions was applied identically to all models. Range of motion (ROM) of the vertebral body, stress distribution of the titanium plate and intradiscal pressure (IDP) were compared in flexion, extension, lateral bending and rotation.ResultsThe ROM of model B and C was similar in flexion and extension, and both were smaller than that of model A. The highest von Mises stress in the titanium plate appears is in model C. The IDP in C2/3 was significantly higher than that in other segments in flexion. There was no significant difference in IDP among three models in left lateral bending and left axial rotation.ConclusionApplication of TBR titanium plate in open-door laminoplasty can reduced ROM in flexion, extension and axial rotation of the cervical vertebrae. But the increase of stress in TBR titanium plate could lead to higher risk of adverse events such as titanium plate deformation. Moreover, compared with complete TBR titanium plate, the combination of TBR titanium plate for C3 and C7 with ordinary titanium plate for the other vertebrae largely reduce the stress of the titanium plates by ensuring stability. The proposed FE model (C2-T1) exhibits a great potential in evaluating biomechanical behaviour of TBR titanium plate for open-door laminoplasty.
| S-EPMC9454233 | biostudies-literature
Project description:BackgroundIn treating patients with cervical ossification of the posterior longitudinal ligament (COPLL), a novel surgery technique - anterior controllable antedisplacement and fusion (ACAF) suggested promising clinical benefits in recent exploratory studies.MethodsThis is a multicentre, randomized, open-label, parallel-group, active controlled trial that will compare the clinical benefits of ACAF versus conventional posterior laminoplasty (LAMP) in severe COPLL patients. A total of 164 patients will be enrolled and randomized in a 1:1 ratio to either ACAF or LAMP group. The primary efficacy measure is cervical- Japanese Orthopaedic Association (C-JOA) recovery rate at 12 months post operation, which is to be derived by Hirabayashi's method from JOA data (range, 0 [worst] to 17 [normal condition]). Other important secondary efficacy endpoints include visual analogue scale (VAS) pain score (range, 0 [no pain] to 10 [most severe]), 10-item neck disability index (NDI, a total range of 0 to 50 points, the highest index the worst) and 6-level Nurick disability grade (range, 0 [mild] to 5 [severe]). Safety endpoints including adverse events, perioperative complications, and adverse events of special interest will also be assessed in this study. Full analysis set for baseline and efficacy data analyses according to the intention-to-treat principle will be established as the primary analysis population. Analysis of covariance (ANCOVA) will be used to analyze the C-JOA recovery rate, with random stratification factors (if appropriate) and the treatment group as fixed factors, and the baseline level of C-JOA score as covariate.DiscussionThis study is designed to demonstrate the clinical benefits of ACAF as compared to conventional LAMP in COPLL patients. It will provide clinical evidence that the novel surgery technique - ACAF might be more favorable in treating patients with severe cervical ossification of the posterior longitudinal ligament. (Words: 290).Trial registrationClinicalTrials.gov number, NCT04968028 .
| S-EPMC8425037 | biostudies-literature
Project description:ObjectiveAlthough the lamina open angle of making hinges is closely related to the outcomes of French-door laminoplasty (FDL) for treatment of cervical spondylosis, there have been no methods to predict the lamina open angle preoperatively as yet. The aim of this study was to investigate the accuracy of predicting the laminal open angle using our newly designed sharp rongeur, and to compare the postoperative outcomes and complications between the methods of making hinges using the newly designed sharp rongeur and the traditional high-speed micro-drill during the FDL.MethodsThis was a single-center retrospective study. Following the approval of the institutional ethics committee, a total of 39 patients (Male: 28; Female: 11) diagnosed with cervical spondylos who underwent FDL in our institution between January 2018 and May 2019 were enrolled. Patients were divided into two groups based on the method of making hinges (sharp rongeur: 22 cases; high-speed micro-drill: 17 cases). The average age at surgery was 59.1 years (range: 16-85 years). The radiological parameters, clinical outcomes, modified Japanese Orthopaedic Association (mJOA) scale score, and the recovery rate of mJOA were recorded and compared between the groups, respectively. The radiological parameters and clinical measurements at pre- and post-operation stages were compared using the paired-sample t-test, the Wilcoxon signed-rank test, and the Friedman's test, and variables in the two groups were analyzed using an unpaired Student's t-test or a Mann-Whitney U test.ResultsThe average follow-up period was 20.4 months (range: 14.0-25.9 months), the postoperative open angle was 60.13° ± 3.69° in the rongeur group with 22.78° ± 4.34° of angular enlargement, which was significantly lower than that of 68.96° ± 1.00° in the micro-drill group with 32.75° ± 4.22° of angular enlargement (U = 19.000, p < 0.001). The rongeur group showed a higher fusion rate (34.1% vs 14.7%, χ2 = 11.340, p = 0.001), and a lower fracture rate of the lamina (7.8% vs 25.5%, χ2 = 14.185, p < 0.001) at 1-month post-surgery, compared to the micro-drill group. There were no significant differences in the clinical outcomes and postoperative complications between the two groups (p > 0.05), except in the recovery rate of mJOA scores (0.836 ± 0.138 vs 0.724 ± 0.180, U = 115.000, p = 0.042) and neck disability index (NDI) at the final follow-up (7.55 ± 10.65 vs 14.71 ± 8.72, U = 94.000, p = 0.008).ConclusionsThe special sharp rongeur with a tip angle of 20° could be a preferred method to make hinges during FDL, which can predict the laminal open angle accurately and enlarge it to about 23°, thus reducing the fracture rate and accelerating the bony fusion of hinges compared with the outcomes of the traditional micro-drill method.
| S-EPMC9732589 | biostudies-literature
Project description:Study Design Systematic review. Study Rationale Numerous cervical laminoplasty techniques have been described but there are few studies that have compared these to determine the superiority of one over another. Clinical Questions The clinical questions include key question (KQ)1: In adults with cervical myelopathy from ossification of the posterior longitudinal ligament (OPLL) or spondylosis, what is the comparative effectiveness of open door cervical laminoplasty versus French door cervical laminoplasty? KQ2: In adults with cervical myelopathy from OPLL or spondylosis, are postoperative complications, including pain and infection, different for the use of miniplates versus the use of no plates following laminoplasty? KQ3: Do these results vary based on early active postoperative cervical motion? Materials and Methods A systematic review of the English-language literature was undertaken for articles published between 1970 and March 11, 2013. Electronic databases and reference lists of key articles were searched to identify studies evaluating (1) open door cervical laminoplasty and French door cervical laminoplasty and (2) the use of miniplates or no plates in cervical laminoplasty for the treatment of cervical spondylotic myelopathy or OPLL in adults. Studies involving traumatic onset, cervical fracture, infection, deformity, or neoplasms were excluded, as were noncomparative studies. Two independent reviewers (A.L.R., J.R.D.) assessed the level of evidence quality using the Grades of Recommendations Assessment, Development and Evaluation system, and disagreements were resolved by consensus. Results We identified three studies (one of class of evidence [CoE] II and two of CoE III) meeting our inclusion criteria comparing open door cervical laminoplasty with French door laminoplasty and two studies (one CoE II and one CoE III) comparing the use of miniplates with no plates. Data from one randomized controlled trial (RCT) and two retrospective cohort studies suggest no difference between treatment groups regarding improvement in myelopathy. One RCT reported significant improvement in axial pain and significantly higher short-form 36 scores in the French door laminoplasty treatment group. Overall, complications appear to be higher in the open door group than the French door group, although complete reporting of complications was poor in all studies. Overall, data from one RCT and one retrospective cohort study suggest that the incidence of complications (including reoperation, radiculopathy, and infection) is higher in the no plate treatment group compared with the miniplate group. One RCT reported greater pain as measured by the visual analog scale score in the no plate treatment group. There was no evidence available to assess the effect of early cervical motion for open door cervical laminoplasty compared with French door laminoplasty. Both studies comparing the use of miniplates and no plates reported early postoperative motion. Evidence from one RCT suggests that earlier postoperative cervical motion might reduce pain. Conclusion Data from three comparative studies are not sufficient to support the superiority of open door cervical laminoplasty or French door cervical laminoplasty. Data from two comparative studies are not sufficient to support the superiority of the use of miniplates or no plates following cervical laminoplasty. The overall strength of evidence to support any conclusions is low or insufficient. Thus, the debate continues while opportunity exists for the spine surgery community to resolve these issues with appropriately designed clinical studies.
| S-EPMC3836957 | biostudies-literature
Project description:This article reviews cervical laminoplasty. The origin of cervical laminoplasty dates back to cervical laminectomy performed in Japan ~50 years ago. To overcome poor surgical outcomes of cervical laminectomy, many Japanese orthopedic spine surgeons devoted their lives to developing better posterior decompression procedures for the cervical spine. Thanks to the development of a high-speed surgical burr, posterior decompression procedures for the cervical spine showed vast improvement from the 1970s to the 1980s, and the original form of cervical laminoplasty was determined. Since around 2000, surgeons performing cervical laminoplasty have been adopting less invasive procedures for the posterior cervical muscle structures so as to minimize postoperative axial neck pain and obtain better functional outcomes of the cervical spine. This article covers the history of cervical laminoplasty, surgical procedures, the benefits and limitation of this procedure, and surgery-related complications.
| S-EPMC3864408 | biostudies-other
Project description:BackgroundPostoperative C5 palsy is a common complication of laminoplasty for cervical ossification of the posterior longitudinal ligament (C-OPLL), although there are several hypotheses regarding its etiology, the exact pathomechanism for this undesirable event remain unclear. The aim of this study was to review clinical and imaging findings in patients with C5 palsy and to propose potential risk factors for this complication.MethodsA total of 220 consecutive patients who had undergone posterior spinal process-splitting laminoplasty (pSPSL) for C-OPLL between January 2018 and December 2019 were included in this study. Postoperative C5 palsy was defined as deltoid muscle weakness of a grade ≤3 in manual muscle test (MMT). These patients were divided into two groups based on the postoperative development of C5 palsy: patients with C5 palsy (group A) and those without C5 palsy (group B). The clinical and imaging covariates evaluated were age, sex, OPLL type, K-line, foraminal stenosis, gutter malposition, and preoperative spinal cord signal change. Logistic regression was used to analyze the independent risk factors for C5 palsy.ResultsIn total, 211 patients (18 in group A and 193 in group B) were enrolled in this study, and the incidence of C5 palsy was 8.53%. Sixteen patients had a MMT of grade 3 and two had an MMT of grade ≤2. During the follow-up period (mean duration: 25.10±6.67 months), the MMT grade rose to 5 in 16 patients, 4 in one patient, and 3 in one patient. Multivariate analysis revealed that malposition of the bony gutter [odds ratio (OR) 11.073, 95% confidence interval (CI): 3.411, 35.948; P<0.001] and C4/5 intervertebral foramen stenosis (OR 8.455, 95% CI: 2.559, 27.936; P<0.001) were independent risk factors for C5 palsy.ConclusionsThe incidence of C5 palsy was 8.53% among patients undergoing pSPSL for C-OPLL. Gutter malposition and C4/5 intervertebral foramen stenosis were identified as risk factors for this complication.
| S-EPMC9263768 | biostudies-literature