Surgical Treatment of Multilevel Degenerative Cervical Myelopathy: Open-Door Laminoplasty and Fixation via Unilateral Approach. A Feasibility Study

2021 ◽  
Author(s):  
Gregor Schmeiser ◽  
Janina Isabel Bergmann ◽  
Luca Papavero ◽  
Ralph Kothe
Keyword(s):  
Surgical Treatment ◽  
Cervical Myelopathy ◽  
Screw Fixation ◽  
Lateral Mass ◽  
Open Door ◽  
Lateral Mass Screw ◽  
Unilateral Approach ◽  
The Mean ◽  
Degenerative Cervical Myelopathy

Abstract Objective We compared open-door laminoplasty via a unilateral approach and additional unilateral lateral mass screw fixation (uLP) with laminectomy and bilateral lateral mass screw fixation (LC) in the surgical treatment of multilevel degenerative cervical myelopathy (mDCM). Methods A retrospective cohort analysis of 46 prospectively enrolled patients (23 uLP and 23 LC). The minimum follow-up was 1 year. Neck and arm pains were evaluated with visual analog scales and disability with the Neck Disability Index (NDI). Myelopathy was rated with the modified Japanese Orthopaedic Association (mJOA) score. Cervical sagittal parameters were measured on plain and functional X-ray films with a specific software. The statistical significance was set at p < 0.05. Fusion was defined as <2 degrees of intersegmental motion on flexion/extension radiographs. Results The two groups were similar in age and comorbidities. The mean operation time and the mean hospital stay were shorter in the uLP group (p = 0.015). The intraoperative blood loss did not exceed 200 mL in both groups. At follow-up, the groups showed comparable clinical outcome data. The sagittal profile did not deteriorate in either group. Fusion rates were 67% in the uLP group and 92% in the LC group. No infections occurred in either group. In the LC group, one patient developed a transient C5 palsy. Revision surgery was required for a malpositioned screw (LC) and for one implant failure (uLP). Conclusion Laminoplasty and unilateral fixation via a unilateral approach achieved comparable clinical and radiologic results with laminectomy and bilateral fixation, despite a lower fusion rate. However, the surgical traumatization was less.

Long-term functional outcome of surgical treatment for degenerative cervical myelopathy

2021 ◽  
pp. 1-11
Author(s):  
Mark D. Dijkman ◽  
Martine W. T. van Bilsen ◽  
Michael G. Fehlings ◽  
Ronald H. M. A. Bartels
Keyword(s):  
Surgical Treatment ◽  
Functional Outcome ◽  
Cervical Myelopathy ◽  
Minimal Clinically Important Difference ◽  
Clinically Important Difference ◽  
Surgical Data ◽  
The Mean ◽  
Degenerative Cervical Myelopathy

OBJECTIVE Degenerative cervical myelopathy (DCM) is a major global cause of spinal cord dysfunction. Surgical treatment is considered a safe and effective way to improve functional outcome, although information about long-term functional outcome remains scarce despite increasing longevity. The objective of this study was to describe functional outcome 10 years after surgery for DCM. METHODS A prospective observational cohort study was undertaken in a university-affiliated neurosurgery department. All patients who underwent surgery for DCM between 2008 and 2010 as part of the multicenter Cervical Spondylotic Myelopathy International trial were included. Participants were approached for additional virtual assessment 10 years after surgery. Functional outcome was assessed according to the modified Japanese Orthopaedic Association (mJOA; scores 0–18) score at baseline and 1, 2, and 10 years after surgery. The minimal clinically important difference was defined as 1-, 2-, or 3-point improvement for mild, moderate, and severe myelopathy, respectively. Outcome was considered durable when stabilization or improvement after 2 years was maintained at 10 years. Self-evaluated effect of surgery was assessed using a 4-point Likert-like scale. Demographic, clinical, and surgical data were compared between groups that worsened and improved or remained stable using descriptive statistics. Functional outcome was compared between various time points during follow-up with linear mixed models. RESULTS Of the 42 originally included patients, 37 participated at follow-up (11.9% loss to follow-up, 100% response rate). The mean patient age was 56.1 years, and 42.9% of patients were female. Surgical approaches were anterior (76.2%), posterior (21.4%), or posterior with fusion (2.4%). The mean follow-up was 10.8 years (range 10–12 years). The mean mJOA score increased significantly from 13.1 (SD 2.3) at baseline to 14.2 (SD 3.3) at 10 years (p = 0.01). A minimal clinically important difference was achieved in 54.1%, and stabilization of functional status was maintained in 75.0% in the long term. Patients who worsened were older (median 63 vs 52 years, p < 0.01) and had more comorbidities (70.0% vs 25.9%, p < 0.01). A beneficial effect of surgery was self-reported by 78.3% of patients. CONCLUSIONS Surgical treatment for DCM results in satisfactory improvement of functional outcome that is maintained at 10-year follow-up.

scholarly journals MINIMALLY INVASIVE SINGLE-DOOR PLATE LAMINOPLASTY WITH LATERAL MASS SCREW FIXATION FOR THE UNSTABLE SEGMENT. REPORT OF TWO CASES WITH LONG FOLLOW-UP

2017 ◽  
Vol 16 (3) ◽  
pp. 236-239 ◽  
Author(s):  
SERGIO SORIANO-SOLÍS ◽  
JAVIER QUILLO-OLVERA ◽  
MANUEL RODRÍGUEZ-GARCÍA ◽  
HÉCTOR ANTONIO SORIANO SOLÍS ◽  
JOSÉ-ANTONIO SORIANO-SÁNCHEZ
Keyword(s):  
Minimally Invasive ◽  
Cervical Spondylotic Myelopathy ◽  
Screw Fixation ◽  
Short Form ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Sf 36 ◽  
Flexion Extension ◽  
Multilevel Cervical Spondylotic Myelopathy

ABSTRACT Objective: To report two cases of multilevel cervical spondylotic myelopathy with monosegmental instability, in which we performed a minimally invasive microsurgical transmuscular approach with tubular retractors to create a single-door plate laminoplasty combined with fixation of the unstable segment with lateral mass screws. Methods: The surgical procedures were performed by the senior author. In both patients, the follow-up was performed using the Oswestry Disability Index (ODI), the Visual Analogue Scale for neck and radicular pain (radVAS, neckVAS), the Neck Disability Index (NDI) and the Short Form 36 (SF-36), in the preoperative (preop) and postoperative (postop) periods, and at 1, 3, 6, 12, 18 and 24 months. A radiological evaluation also was performed, which included AP, lateral and flexion-extension films at 6, 12 and 24 months and CT-scan at 12 months. Results: Case 1 - preop ODI: 40%, 24 months postop ODI: 4%; preop radVAS: 7, 24 months radVAS: 0; preop neckVAS: 8, postop 24 months neckVAS: 0; preopNDI: 43%, 24 months PostopNDI: 8%; SF-36 - preop Physical Functioning (PF): 40, preop Vitality (VT): 40, preop Emotional role functioning (RE): 33.3, Bodily pain (BP): 51, General Health (GH): 57, Social Functioning (SF): 75; postop PF: 95, VT: 95, RE: 100, BP: 74, GH: 87, SF: 100. Case 2 - preopODI: 46%, 24 months postopODI: 10%; preop radVAS: 7, 24m radVAS: 0; preop neckVAS: 9, postop 24 months neckVAS: 0; preopNDI: 56%, 24 months PostopNDI: 15%; SF-36 - preop PF: 39, VT: 45, RE: 33.3, BP: 50, GH: 49, SF: 70; postop PF: 90, VT: 100, RE: 100, BP: 82, GH: 87, SF: 100. No complications, cervical instability or signs of failed surgery were found trough and at final follow-up at 24 months. We found significant clinical improvement in both patients. Conclusions: Minimally invasive cervical laminoplasty combined with lateral mass screw fixation for the unstable segment is a useful technique in cases with multilevel cervical spondylotic myelopathy associated with monosegmental instability. Additional comparative studies are needed to establish its efficacy.

Atlantoaxial stabilization with the use of C1–3 lateral mass screw fixation

2006 ◽  
Vol 5 (2) ◽  
pp. 172-177 ◽  
Author(s):  
Eric M. Horn ◽  
Jonathan S. Hott ◽  
Randall W. Porter ◽  
Nicholas Theodore ◽  
Stephen M. Papadopoulos ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Intraoperative Complications ◽  
Atlantoaxial Instability ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Transarticular Screw ◽  
Transarticular Screw Fixation ◽  
Cervical Orthosis ◽  
Atlantoaxial Stabilization

✓ Atlantoaxial stabilization has evolved from simple posterior wiring to transarticular screw fixation. In some patients, however, the course of the vertebral artery (VA) through the axis varies, and therefore transarticular screw placement is not always feasible. For these patients, the authors have developed a novel method of atlantoaxial stabilization that does not require axial screws. In this paper, they describe the use of this technique in the first 10 cases. Ten consecutive patients underwent the combined C1–3 lateral mass–sublaminar axis cable fixation technique. The mean age of the patients was 62.6 years (range 23–84 years). There were six men and four women. Eight patients were treated after traumatic atlantoaxial instability developed (four had remote trauma and previous nonunion), whereas in the other two atlantoaxial instability was caused by arthritic degeneration. All had VA anatomy unsuitable to traditional transarticular screw fixation. There were no intraoperative complications in any of the patients. Postoperative computed tomography studies demonstrated excellent screw positioning in each patient. Nine patients were treated postoperatively with the aid of a rigid cervical orthosis. The remaining patient was treated using a halo fixation device. One patient died of respiratory failure 2 months after surgery. Follow-up data (mean follow-up duration 13.1 months) were available for seven of the remaining nine patients and demonstrated a stable construct with fusion in each patient. The authors present an effective alternative method in which C1–3 lateral mass screw fixation is used to treat patients with unfavorable anatomy for atlantoaxial transarticular screw fixation. In this series of 10 patients, the method was a safe and effective way to provide stabilization in these anatomically difficult patients.

Minimally Invasive Lateral Mass Screw Fixation in the Cervical Spine: Initial Clinical Experience with Long-term Follow-up

Neurosurgery ◽  
2006 ◽  
Vol 58 (5) ◽  
pp. 907-912 ◽  
Author(s):  
Michael Y. Wang ◽  
Allan D.O. Levi
Keyword(s):  
Cervical Spine ◽  
Minimally Invasive ◽  
Screw Fixation ◽  
Ct Scans ◽  
Lateral Mass ◽  
Minimal Access ◽  
Lateral Mass Screw ◽  
Subaxial Cervical Spine ◽  
Lateral Mass Screws

Abstract OBJECTIVE: Lateral mass screw fixation of the subaxial cervical spine has been a major advancement for spinal surgeons. This technique provides excellent three-dimensional fixation from C3 to C7. However, exposure of the dorsal spinal musculature can produce significant postoperative neck pain. The incorporation of a minimal access approach using tubular dilator retractors can potentially overcome the drawbacks associated with the extensive muscle stripping needed for traditional surgical exposures. METHODS: A retrospective analysis was performed on the first 18 patients treated using lateral mass screws placed in a minimally invasive fashion. All patients, except 2 who were lost to follow-up, had a 2-year minimum clinical follow-up. All patients had a computed tomography (CT) scan in the immediate postoperative period to check the positioning of implanted hardware. Operative time, blood loss, and complications were ascertained. Fusion was assessed radiographically with dynamic radiographs and CT scans. RESULTS: Sixteen of the 18 patients underwent successful screw placement. Two patients had the minimal access procedure converted to an open surgery because radiographic visualization was not adequate in the lower cervical spine. Six cases involved unilateral instrumentation and 10 had bilateral screws. A total of 39 levels were instrumented. There were no intraoperative complications, and follow-up CT scans demonstrated no bony violations except in cases where bicortical purchase was achieved. All patients achieved bony fusion. CONCLUSION: A minimally invasive approach using tubular dilator retractors can be a safe and effective means for placing lateral mass screws in the subaxial cervical spine. Up to two levels can be treated in this manner. This approach preserves the integrity of the muscles and ligaments that maintain the posterior tension band of the cervical spine but requires adequate intraoperative imaging.

Causes, Patterns, and Outcomes of Nontraumatic Spinal Cord Injury

2021 ◽  
pp. 9
Author(s):  
Mutlaq AlMutlaq
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Stenosis ◽  
Cervical Myelopathy ◽  
Thoracic Injuries ◽  
Cord Injury ◽  
Asia Score ◽  
The Mean ◽  
Degenerative Cervical Myelopathy

Introduction: Nontraumatic spinal cord injury (NTSCI), refers to damage to the spinal cord resulting from a cause other than trauma. It is a condition with immense functional implications for individuals involved. The incidence of NTSCI is difficult to estimate due to its heterogeneous cluster of a wide spectrum etiologies with varying pathophysiology. The most described NTSCI causes are degenerative diseases and spinal stenosis, tumors, and inflammatory conditions. In order to avoid delay in diagnosis and time-critical treatment, knowledge of each is important. We aim to fill the gap of knowledge by assessing the causes, patterns, and outcomes of NTSCI. Methodology: This retrospective cohort study included all patients who had an NTSCI between 2016 and 2020. In addition, patients aged >18 years and treated surgically were included. Demographic and clinical data were collected. Pre- and postoperative American Spinal Injury Association (ASIA) impairment scales and last follow-up outcomes were assessed. Result: A total of 124 patients were included. The mean age of our population was 62.8 years with an average BMI of 31; 8% of them were smokers. Upon admission, back pain (45%), numbness (43%), and inability to walk (18%) were the highest recorded clinical presentations. Spinal stenosis (45%) followed by degenerative cervical myelopathy (27%) were the most observed pathologies. Lumbar injuries accounted for 45% whereas cervical injuries accounted for 41% and thoracic injuries for 14%. The average length of stay period was 23.2 days, with 48% of patients transferred to inpatient rehabilitation, and the mean follow-up duration was 15 months. Conclusion: In summary, after assessing the causes, patterns, and outcomes of NTSCI, our study showed that comorbidities were observed in 85% of patients. Spinal stenosis and degenerative cervical myelopathy were the most common etiologies. Patients who presented with urinary incontinence and/or bowel incontinence upon admission had a significantly worse ASIA score at last follow-up. Degenerative pathologies recorded a worse ASIA score, and thoracic injuries recorded the worst ASIA score improvement compared to cervical and lumbar injuries. In total, 57% of the patients showed full recovery at the last follow-up.

scholarly journals Clinical and Radiological Evaluation of Cervical Spondylotic Myelopathy Operated With Posterior Decompression and Lateral Mass Fixation- a Retrospective Review with Minimum Two Years Follow-Up

2021 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Clinical Outcome ◽  
Neck Pain ◽  
Cervical Spondylotic Myelopathy ◽  
Screw Fixation ◽  
Lateral Mass ◽  
Cervical Lordosis ◽  
Lateral Mass Screw ◽  
C5 Palsy ◽  
Radiological Parameters

Objective: There is controversy in surgical management of cervical spondylotic myelopathy (CSM); a few group encourage only laminectomy or laminoplasty while the others emphasize on lateral mass fixation along with laminectomy. Cervical lordosis is an important factor for maintaining posture neck and preventing postoperative axial neck pain. Literature has reported that cervical lordosis less than -20 degrees is often responsible for neck pain. The purpose of this study was to evaluate clinical outcome and radiological parameters after posterior cervical laminectomy and fixation in CSM. Material and Methods: This retrospective study included 37 patients operated with posterior cervical decompression and lateral mass screw fixation with minimum two-year follow-up. All patients were operated for CSM. All were operated by a single surgeon and followed up at six weeks, twelve weeks, six months, one year and yearly afterwards. Clinical outcome and radiological parameters were analyzed for clinical improvement [European Myelopathy Score (EMS)] and cervical lordotic angle. Results: Average age 68±8.3 years. The cervical lordotic angle of -23.02±4.19 degrees was maintained in patients operated with lateral mass screw fixations along with laminectomy at final follow-up. The EMS and VAS score showed significant improvement postoperatively from 15.7 to 13.6 (p<0.05) and 8.1 to 1.5 (p<0.05), respectively. Three patients had postoperative C5 palsy that recovered completely within three months. Two patients expired within a few months after surgery due to acute myocardial infarction and respiratory arrest, respectively. There were three patients who had postoperative C5 palsy, which recovered completely within three months postoperatively. There was no permanent postoperative neurological deficit noticed in the series. Conclusion: Posterior cervical lateral mass screw fixation for CSM gives satisfactory clinical outcome and maintains cervical lordosis. Lateral mass fixation with

Transverse Lag Screw Fixation in Midline Mandibulotomy

2000 ◽  
Vol 109 (3) ◽  
pp. 334-339 ◽  
Author(s):  
Joseph M. Serletti ◽  
John U. Coniglio ◽  
Salvatore J. Pacella ◽  
John D. Norante
Keyword(s):  
Reliable Method ◽  
Screw Fixation ◽  
Postoperative Radiotherapy ◽  
Major Complication ◽  
Recurrent Tumor ◽  
Minor Complication ◽  
Anterior Cortex ◽  
Lag Screw ◽  
The Mean

Vertical midline mandibulotomy has provided a relatively simple and efficient means of obtaining access to intraoral tumors that are too large or too posterior to be removed transorally. Midline mandibulotomy has had the advantage of nerve and muscle preservation and places the osteotomy outside the typical field of radiotherapy, in contrast to lateral and paramedian osteotomies. Plate and screw fixation has been the usual means of osteosynthesis for these mandibulotomies; however, plate contouring over the symphyseal surface has been a time-consuming process. Unless the plate was contoured exactly, mandibular malalignment and malocclusion in dentulous patients has occurred. Use of parallel transverse lag screws has become a popular method of osteosynthesis for parasymphyseal fractures, and we have extended their use for mandibulotomy fixation. This paper reports our clinical experience with transverse lag screw fixation of midline mandibulotomies in 9 patients from 1994 to 1997. There were 7 men and 2 women with a mean age of 56 (range 35 to 71 years). The pathological diagnosis in all patients was squamous cell carcinoma; 8 cases were primary, and 1 patient presented with recurrent tumor. No tumors involved the mandibular periosteum. One patient had had previous radiotherapy, and 3 patients underwent postoperative radiotherapy. The mean follow-up has been 17 months (range 9 to 27). There was 1 minor complication and 1 major complication related to our technique. The major complication was a delayed nonunion of the mandibulotomy. This occurred because the 2 parallel screws were placed too close to one another, and this placement resulted in a delayed sagittal fracture of the anterior cortex and subsequent nonunion. Transverse lag screw fixation has not affected occlusion in our dentulous patients. Speech and diet were normal in the majority of our patients. Transverse lag screw fixation of the midline mandibulotomy has been a relatively safe, rapid, and reliable method for tumor access and postextirpation mandibular stabilization and has significant advantages over other current methods of mandibulotomy and fixation.

Sign in / Sign up

Export Citation Format

Share Document