A New Posterior Extensor Attachment-Point Reconstruction Technique for Cervical Spondylotic Myelopathy Involving C2 Segment: Clinical Outcome and Safety

Abstract Background and Study Aim Cervical spondylotic myelopathy (CSM) is a common degenerative disease that mainly occurs in elder patients, leading to different degrees of neurological dysfunction. Spinal cord involvement is mainly distributed at the C3–C7 segments, but it may also involve up to the C2 level. This study aimed to assess the clinical efficacy and safety of open-door laminoplasty using a new extensor attachment-point reconstruction technique for treating CSM involving the C2 segment. Patients and Methods Fifty-nine patients with CSM involving the C2 segment and undergoing open-door laminoplasty were included in this retrospective study. Based on the titanium plate used in the operation, patients were divided into two groups, a reconstructed titanium plate fixation (RPF) group (n = 28) and a conventional titanium plate fixation (CPF) group (n = 31). Improvements in neurological function, cervical range of motion (ROM), cervical curvature index (CCI), preservation of posterior cervical muscle mass, and axial symptoms were compared between the two groups. Results There were no significant differences in operative time and intraoperative blood loss between the groups (p > 0.05). The Japanese Orthopaedic Association (JOA) score significantly increased in both groups postsurgery (p < 0.05); the neurological recovery rate was similar between the two groups (64.1 ± 13.3% vs. 65.9 ± 14.7%, p > 0.05). There was no significant loss of cervical ROM in either group (p > 0.05). The anteroposterior dural sac diameter at the C2 level was significantly enlarged in both groups (p < 0.05). Alternatively, CCI was significantly reduced in the CRP group (p < 0.05) but unchanged in the RPF group (p > 0.05). The cross-sectional area of the posterior cervical muscles was also significantly reduced in the CPF group (p < 0.05) but maintained in the RPF group (p > 0.05). Finally, axial symptoms were more severe in the CPF group than in the RPF group (p < 0.05). Conclusion Laminoplasty is an effective surgical procedure for CSM involving the C2 segment. The reconstructed titanium plate achieved superior maintenance of cervical curvature and reduced both muscle atrophy and severity of axial symptoms compared with titanium conventional plates.

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Clinical and Radiographic Outcomes of Cervical Open-Door Laminoplasty Withmodified Centerpiece Mini-Plate Fixation and Extensor Attachment Point Reconstruction in Treating Cervical Spondylotic Myelopathy

10.21203/rs.3.rs-242053/v1 ◽

2021 ◽

Author(s):

Fa-jing Liu ◽

Yan-cheng Liu ◽

Ze-pei Zhang ◽

Jun Miao

Keyword(s):

Cervical Spondylotic Myelopathy ◽

Plate Fixation ◽

Open Door ◽

Titanium Plate ◽

Attachment Point ◽

Radiographic Outcomes ◽

Group A ◽

Axial Symptoms ◽

Group B ◽

Mini Plate

Abstract ObjectiveThis retrospective study aimed to investigate the clinical and radiographic outcomes of open-door laminoplasty with modified centerpiece mini-plate fixation and extensor attachment point reconstruction for treating cervical spondylotic myelopathy (CSM).MethodSixty-nine patients with CSM, who underwent C3-7 open-door laminoplasty in our hospital from January 2016 to May 2017, were divided into two groups: group A underwent surgery with a modified centerpiece titanium plate and group B underwent surgery with a conventional centerpiece titanium plate. Changes in cervical spinal angle (CSA), cervical range of motion (ROM), atrophy of posterior cervical muscles, and neurological function (Japanese Orthopaedic Association [JOA] score) and the occurrence of axial symptoms (AS) were compared between the groups.ResultThere were no significant differences in operative time, intra-operative blood loss, lamina open angle, and spinal cord drift distance between the groups. After the surgery, JOA score significantly increased (P < 0.05), neurological recovery rates were similar (62.7% vs. 63.4%), cervical ROM did not significantly change when compared with the preoperative level (P > 0.05) in both groups; CSA and cross-sectional area of the posterior cervical muscles decreased significantly in group B (P < 0.05) but not in group A (P > 0.05), and postoperative AS were significantly more severe in group B than in group A (P < 0.05).ConclusionOpen-door laminoplasty is an effective surgical procedure for CSM. The application of modified centerpiece mini-plate fixation effectively reconstructs the posterior extensor attachment points, which reduces posterior cervical muscle atrophy, maintains cervical curvature, and reduces the occurrence of axial symptoms.

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A Modified Open-Door Laminoplasty with Reconstruction of the Cervical Posterior Ligamental Complex to Decrease Axial Pain in Cervical Spondylotic Myelopathy

10.21203/rs.3.rs-1069511/v1 ◽

2021 ◽

Author(s):

Yayun Zhang ◽

Liangxi Chen ◽

Hao Li ◽

Xianlei Gao ◽

Hongwei Zhao ◽

...

Keyword(s):

Cervical Spondylotic Myelopathy ◽

Statistical Significance ◽

Operation Time ◽

Open Door ◽

Post Surgery ◽

Curvature Index ◽

Group A ◽

Axial Symptoms ◽

Axial Pain ◽

Group B

Abstract Background:Cervical spondylotic myelopathy patients with multiple segments are usually treated with the posterior approach. But expansive open laminoplasty (ELAP) often results in heavy, rigid, and acid bilges feelings in the neck, shoulder, and back, collectively known as axial symptoms. Objective: To evaluate the effect of modified posterior cervical ligament complex reconstruction and single-door laminoplasty with titanium plate fixation on postoperative axial symptoms in patients. Methods: A retrospective analysis conducted from June 2016 to March 2018 collected more than 132 cases of cervical spondylotic myelopathy at our institute. Group A includes 74 patients and Group B includes 58 patients who use different surgery method. Gender, age, operation time, intraoperative blood loss, post-operative drainage volume, and follow-up time, Visual analogue scoring (VAS), cervical curvature index (CCI) and the cross-sectional area of the posterior cervical muscles of the two groups were recorded. Results: There was statistical significance in the incidence of axial pain 3 months after surgery (P =0.001), 6 months after surgery (P =0.006), and 1 year after surgery (P =0.015). And the VAS score was decreased in group A 1 week (P <0.0001), 1 ,3 month(P=0.0001), 6 months(P=0.0076), and 1 year(P=0.0085) post-surgery compared to group B. Also the CCI and the posterior cervical muscle area between groups A and B (P < 0.0001).Conclusion: Modified single open-door laminoplasty could relieve cervical axial pain in patients with cervical spondylotic myelopathy.

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Comparison of anchor screw fixation versus mini-plate fixation in unilateral expansive open-door laminoplasty for the treatment of multi-level cervical spondylotic myelopathy

Medicine ◽

10.1097/md.0000000000013534 ◽

2018 ◽

Vol 97 (49) ◽

pp. e13534 ◽

Cited By ~ 2

Author(s):

Xiang Lin ◽

Kaiwei Chen ◽

Haijun Tang ◽

Xianying Huang ◽

Changwu Wei ◽

...

Keyword(s):

Cervical Spondylotic Myelopathy ◽

Screw Fixation ◽

Plate Fixation ◽

Open Door ◽

Multi Level ◽

Mini Plate

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Comparative Study of Imaging Parameters between a New Cervical Full Lamina Back Shift Spinal Canal Enlargement Technique and Single Open-door Laminoplasty for Multisegment Cervical Spondylotic Myelopathy

10.21203/rs.3.rs-93191/v1 ◽

2020 ◽

Author(s):

Xiaonan Wang ◽

Yibo Zhao ◽

Xiangdong Lu ◽

Xiaofeng Zhao ◽

Detai Qi ◽

...

Keyword(s):

Internal Fixation ◽

Spinal Canal ◽

Cervical Spondylotic Myelopathy ◽

Sectional Area ◽

Open Door ◽

Mr Images ◽

Titanium Plate ◽

Cross Sectional ◽

Imaging Parameters ◽

Canal Enlargement

Abstract Purpose To provide imaging evidence of the feasibility and clinical efficacy of a new full lamina back shift spinal canal enlargement technique by comparing its imaging parameters to those of single open-door miniature titanium plate internal fixation.Methods A retrospective analysis was conducted on 64 patients with multisegment cervical spondylotic myelopathy caused by cervical stenosis. Of these, 32 underwent the new full lamina back shift spinal canal enlargement technique (observation group), and 32 underwent single open-door miniature titanium plate internal fixation (control group). The CT data of both groups were imported into Mimics 17.0 software to measure the median sagittal diameter and cross-sectional area of the spinal canal. Photoshop CS5 was employed to measure the drift distance of the spinal cord on MR images to perform a comparative study of the imaging parameters from the two groups.Results The T2-weighted MR images in both groups showed continuous recovery of the cerebrospinal fluid signal in the C3–C7 range. The new full lamina back shift spinal canal enlargement technique was significantly superior to single open-door miniature titanium plate internal fixation with respect to the spinal canal cross-sectional area and the median sagittal diameter (P<0.05). No significant difference was detected in the drift distance of the spinal cord between the two groups (P>0.05).Conclusion The new full lamina back shift spinal canal enlargement technique achieved a thorough spinal canal decompression effect on imaging while ensuring a reasonable spinal drift distance and few surgical complications. The clinical curative effect of the new technique was precise.

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Comparative Five-Year Surgical Outcomes of Open-Door versus French-Door Laminoplasty in Multilevel Cervical Spondylotic Myelopathy

BioMed Research International ◽

10.1155/2020/8853733 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Guoliang Chen ◽

Xizhe Liu ◽

Ensi Zhao ◽

Ningning Chen ◽

Fuxin Wei ◽

...

Keyword(s):

Postoperative Complications ◽

Cobb Angle ◽

Surgical Outcomes ◽

Cervical Spondylotic Myelopathy ◽

Loss Rate ◽

Japanese Orthopaedic Association ◽

Medical Costs ◽

Open Door ◽

Multilevel Cervical Spondylotic Myelopathy

Objective. To compare the five-year surgical outcomes between Open-Door laminoplasty (ODL) and French-Door laminoplasty (FDL) in the management of multilevel cervical spondylotic myelopathy (MCSM). Methods. Sixty patients with MCSM, who were operated by ODL or FDL, were included in this study and followed up for at least 5 years. The average follow-up period was 69.2 ± 3.2 months. The modified Japanese Orthopaedic Association (mJOA) score and radiological assessments including the Cobb angle and cervical range of motion (ROM) were evaluated and compared before surgery and at the final follow-up. The incidence of postoperative complications and medical costs were also compared. Results. Both ODL and FDL groups achieved significant improvements of the mJOA score in postoperative 5 years; the average recovery rate (RR) of the mJOA score in the ODL and FDL groups was 72.14 ± 6.97 % and 69.53 ± 7.51 % , respectively. No statistically significant differences regarding the pre- and postoperative mJOA score, the RR of the mJOA score, the loss and the loss rate of the Cobb angle, and the incidence of postoperative complications existed between ODL and FDL. The mean loss and the loss rate of cervical ROM in the FDL group ( 18.70 ± 8.91 ° , 41.08 ± 11.17 % ) were significantly higher than those of the ODL group ( 13.81 ± 8.62 ° , 31.47 ± 12.43 % ) ( P < 0.05 ). FDL reduced medical costs more greatly than ODL ( 33014.37 ± 3424.12 China Yuan versus 82096.62 ± 7093.07 China Yuan, P < 0.001 ). Conclusions. Both ODL and FDL are effective for MCSM. The 5-year neurological results are similar between the two groups. ODL trends to be superior to FDL in postoperative preservation of cervical ROM while FDL reduced medical costs more greatly.

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The Anatomical and Biomechanical Superiority of Novel Posterior En Bloc Elevation Cervical Laminoplasty

Surgical Innovation ◽

10.1177/1553350620984650 ◽

2021 ◽

pp. 155335062098465

Author(s):

Dong-Lai Wang ◽

Guo-Qing Zhu ◽

An-Quan Huang ◽

Hong Zhang ◽

Chuan Feng ◽

...

Keyword(s):

Biomechanical Testing ◽

Cervical Laminoplasty ◽

Open Door ◽

Lateral Bending ◽

En Bloc ◽

Cross Sectional ◽

Expansion Pattern ◽

Intact Condition ◽

Axial Symptoms ◽

The Common

Objectives. In this study, we performed a novel type of posterior en bloc elevation cervical laminoplasty (PEEL) to keep the integrity of the posterior structure, aiming to reduce axial symptoms complicated by a conventional cervical laminoplasty procedure. Methods. Twelve human cervical cadaveric spines (C2-T1) were sequentially tested in the following order: intact condition, open-door laminoplasty (ODL) through bilateral intermuscular approach (mini-invasive ODL), PEEL, and laminectomy (LN). After bilateral transecting at the junction of lamina and lateral mass through the tubular retraction system, the PEEL procedure symmetrically elevated all the posterior structure which was further stabilized with bone grafts and titanium plates. Computed tomography (CT) scan and biomechanical testing were performed after each condition. Results. Both mini-invasive ODL and PEEL procedures were accomplished with 2 small incisions on each side. Two types of laminoplasties could enlarge the spinal canal significantly both in cross-sectional area and anteroposterior diameter comparing with intact condition. The PEEL procedure demonstrated a significantly higher enlargement rate on a canal area and a symmetrical expansion pattern. Compared with intact condition, mini-invasive ODL performed from C3-C7 demonstrated significantly decreased motion in all testing directions except the flexion range of motion (ROM); the PEEL procedure showed mild and insignificant decrease on ROM in all directions. Laminectomy resulted in a statistically significant increase in all directions except the lateral bending ROM. Conclusions. Posterior en bloc elevation cervical laminoplasty can enlarge the canal more effectively and preserve better ROM after operation than the ODL procedure. Although technically challenging, the PEEL procedure probably would decrease the common complications associated with ODL laminoplasty.

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A Clinicoradiological Assessment following Surgical Intervention in Patients of Cervical Spondylotic Myelopathy: An Institutional Experience

Indian Journal of Neurosurgery ◽

10.1055/s-0041-1726607 ◽

2021 ◽

Author(s):

Maneet Gill ◽

Vikas Maheshwari ◽

Arun Kumar Yadav ◽

Rushikesh Gadhavi

Keyword(s):

Cervical Spondylotic Myelopathy ◽

Anterior Approach ◽

Posterior Approach ◽

Surgical Intervention ◽

Japanese Orthopaedic Association ◽

Surgical Decompression ◽

Functional Improvement ◽

Male Predominance ◽

Canal Diameter ◽

Posterior Group

Abstract Introduction To critically analyze the functional and radiological improvement in patients of cervical spondylotic myelopathy (CSM) who underwent surgical decompression by an anterior or posterior approach. Materials and Methods A retrospective study was conducted in a tertiary-level Armed Forces Hospital from June 2015 to December 2019. Preoperative assessment included a thorough clinical examination and functional and radiological assessment. The surgical decompression was done by an anterior or a posterior approach with instrumented fusion. Anterior approach was taken for single or two-level involvement and posterior approach for three or more cervical levels. The pre and postoperative neurological outcome was assessed by Nurick and modified Japanese Orthopaedic Association (mJOA) score along with measurement of canal diameter and cross-sectional area. Results A total of 120 patients of CSM who underwent surgical decompression were analyzed. Both the groups were comparable and had male predominance. A total of 59 patients underwent surgical decompression by an anterior approach and the remaining 61 patients by the posterior approach. Out of the 59 patients operated by the anterior approach, 30 (50.85%) underwent anterior cervical discectomy and fusion (ACDF); remaining 29 (49.15%) underwent anterior cervical corpectomy and fusion (ACCF). In the posterior group (n = 61), 26 (42.6%) patients underwent laminoplasty and the remaining 35 (57.4%) underwent laminectomy with or without instrument fusion. Sixteen patients out of these underwent lateral mass fixation and the remaining 19 underwent laminectomy. There was functional improvement (mJOA and Nurick grade) and radiological improvement in both subgroups, which were statistically significant (p < 0.0001). Conclusion A prompt surgical intervention in moderate-to-severe cases of CSM either by the anterior or the posterior approach is essential for good outcome.

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