Open Door Laminoplasty – Hinge Creation and Fracture Avoidance: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E419-E419
Author(s):  
Jeremy M V Guinn ◽  
Rory Mayer ◽  
Dean Chou
Keyword(s):  
Informed Consent ◽  
Postoperative Pain ◽  
Spinous Process ◽  
Open Door ◽  
Paraspinal Muscles ◽  
Surgical Video ◽  
Spinous Processes ◽  
Single Opening ◽  
Strong Attachment ◽  
Hinge Fracture

Abstract This surgical video demonstrates a technique for an open-door laminoplasty with its associated risks.1-3 The key to maintaining a strong hinge that can be opened without fracture lies in gradual, slow drilling of the hinge followed by sequential, progressively wider opening of the laminoplasty. This is in contradistinction to a single opening maneuver, which “cracks” the hinge and can result in fracture and disconnection of the lamina from the spine. We present our technique of C4-6 right-sided open-door laminoplasty. A C3 laminectomy is performed instead of a laminoplasty in order to prevent any muscular dissection of C2. This not only maintains the strong muscular attachment to C2, but it also helps alleviate postoperative pain since the muscles are maintained.4-6 The top of C7 is drilled to decompress the C6-7 level, and the C7 spinous process, along with its strong attachment to T1, is maintained to prevent kyphosis. The video highlights methods for maintaining key muscular and ligamentous attachments (C2 muscles and C7-T1 ligament) to decrease kyphosis risk, progressive hinge opening to help mitigate the risk of hinge fracture, and methods to help decrease postoperative pain (avoiding laminoplasty of C3, maintaining muscular and ligamentous attachments as stated above, and contouring the spinous processes in a manner that avoids protrusion into the paraspinal muscles). We have received informed consent of this patient to submit this video.

scholarly journals Combining 3D Structured Light Imaging and Spine X-ray Data Improves Visualization of the Spinous Lines in the Scoliotic Spine

2020 ◽  
Vol 11 (1) ◽  
pp. 301
Author(s):  
Sławomir Paśko ◽  
Wojciech Glinkowski
Keyword(s):  
Radiation Exposure ◽  
Surface Topography ◽  
Structured Light ◽  
Spinous Process ◽  
Three Dimensional ◽  
Diagnostic System ◽  
Measurement Tool ◽  
Adequate Treatment ◽  
X Ray ◽  
Spinous Processes

Scoliosis is a three-dimensional trunk and spinal deformity. Patient evaluation is essential for the decision-making process and determines the selection of specific and adequate treatment. The diagnosis requires a radiological evaluation that exposes patients to radiation. This exposure reaches hazardous levels when numerous, repetitive radiographic studies are required for diagnostics, monitoring, and treatment. Technological improvements in radiographic devices have significantly reduced radiation exposure, but the risk for patients remains. Optical three-dimensional surface topography (3D ST) measurement systems that use surface topography (ST) to screen, diagnose, and monitor scoliosis are safer alternatives to radiography. The study aimed to show that the combination of plain X-ray and 3D ST scans allows for an approximate presentation of the vertebral column spinous processes line in space to determine the shape of the spine’s deformity in scoliosis patients. Twelve patients diagnosed with scoliosis, aged 13.1 ± 4.5 years (range: 9 to 20 years) (mean: Cobb angle 17.8°, SD: ±9.5°) were enrolled in the study. Patients were diagnosed using full-spine X-ray and whole torso 3D ST. The novel three-dimensional assessment of the spinous process lines by merging 3D ST and X-ray data in patients with scoliosis was implemented. The method’s expected uncertainty is less than 5 mm, which is better than the norm for a standard measurement tool. The presented accuracy level is considered adequate; the proposed solution is accurate enough to monitor the changes in the shape of scoliosis’s spinous processes line. The proposed method allows for a relatively precise calculation of the spinous process lines based on a three-dimensional point cloud obtained with a four-directional, three-dimensional structured light diagnostic system and a single X-ray image. The method may help reduce patients’ total radiation exposure and avoid one X-ray in the sagittal projection if biplanar radiograms are required for reconstructing the three-dimensional line of the spinous processes line.

En bloc laminoplasty without dissection of paraspinal muscles

2005 ◽  
Vol 3 (1) ◽  
pp. 29-33 ◽  
Author(s):  
Noboru Hosono ◽  
Hironobu Sakaura ◽  
Yoshihiro Mukai ◽  
Takahiro Ishii ◽  
Hideki Yoshikawa
Keyword(s):  
Ct Scanning ◽  
Cord Compression ◽  
Neck Muscle ◽  
Open Door ◽  
En Bloc ◽  
Cross Sectional ◽  
Content Type ◽  
Spinous Processes ◽  
Significant Difference ◽  
Fine Print

Object. Although conducting cervical laminoplasty in patients with multisegmental cord compression provides good neurological results, it is not without shortcomings, including C-5 palsy, axial neck pain, and undesirable radiologically detectable changes. Postoperative kyphosis and segmental instability can cause neurological problems and are believed mainly to result from neck muscle disruption. The authors developed a new laminoplasty technique, with the aim of preserving optimal muscle function. Methods. The present technique is a modification of unilateral open-door laminoplasty. By using an ultrasonic osteotome in small gaps of muscle bellies, a gutter is made without disrupting muscles, spinous processes, or their connections on the hinged side. Ceramic spacers are then positioned between elevated laminae and lateral masses at C-3, C-5, and C-7 on the opened side, which is exposed in a conventional manner. This new procedure was used to treat 37 consecutive patients with compression myelopathy. Postoperative computerized tomography (CT) scanning revealed a significant difference in a cross-sectional area of muscles between the hinged and opened side. The mean follow-up period was 40.2 months (range 24–54 months). Changes in alignment were observed in only one patient, and vertebral slippage developed in two. Performed at regular intervals, CT scanning demonstrated that the elevated laminae remained in situ throughout the study period. Conclusions. In using the present unilateral open-door laminoplasty technique, deep extensor muscles are left intact along with their junctions to spinous processes on the hinged side. Radiologically documented changes were minimal because the preserved muscles functioned normally immediately after the operation.

scholarly journals Laminectomy versus open-door laminoplasty for cervical spondylotic myelopathy: A clinical outcome analysis

2020 ◽  
Vol 11 ◽  
pp. 73 ◽  
Author(s):  
Mauro Dobran ◽  
Fabrizio Mancini ◽  
Riccardo Paracino ◽  
Simona Lattanzi ◽  
Lucia di Somma ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Clinical Outcome ◽  
Cervical Spondylotic Myelopathy ◽  
Outcome Analysis ◽  
Complication Rates ◽  
Open Door ◽  
Analog Scale ◽  
Geriatric Population ◽  
Decompressive Laminectomy ◽  
Japanese Orthopedic Association

Background: Cervical spondylotic myelopathy (CSM) is one of the most common diseases in the geriatric population. Decompressive laminectomy or laminoplasty is the predominant surgical procedure of choice, but there remains debate as to which procedure is optimal for managing CSM. Methods: Here, we retrospectively analyzed 64 patients with CSM undergoing laminectomy (39 patients) versus laminoplasty (25 patients). The data were collected included respective Japanese orthopedic association (JOA) scores, Nurick grades, and Visual analog scale (VAS) values preoperatively versus 12 months postoperatively. Results: The JOA score after 1 month improved in both groups utilizing laminectomy or laminoplasty. However, at 12 postoperative months, the JOA scores and Nurick grades showed greater improvement following laminoplasty, despite no differences in postoperative pain and complication rates. Conclusion: Patients with cervical spondylotic myelopathy undergoing laminoplasty (25 patients) showed better 12-month postoperative outcomes (JOA scores and Nurick grades) versus those having laminectomies (39 patients).

Technique for C-1, C-2, and C-3 Fixation in Cases of Odontoid Fracture

Neurosurgery ◽  
1981 ◽  
Vol 8 (3) ◽  
pp. 374-377 ◽  
Author(s):  
Eric Six ◽  
David L. Kelly
Keyword(s):  
Methyl Methacrylate ◽  
Spinous Process ◽  
Kirschner Wire ◽  
Odontoid Fracture ◽  
Reinforcing Bars ◽  
Odontoid Fractures ◽  
Spinous Processes

Abstract A technique for fixation of C-1, C-2, and C-3 for odontoid fractures is described. Fixation wires between the laminae of the atlas and the spinous process of the axis maintain the atlantoaxial alignment. Kirschner wire pins through the spinous processes of C-2 and C-3 act as reinforcing bars for a methyl methacrylate fusion. (Neurosurgery 8:374-377, 1981)

Clinical and radiographic outcomes following hinge fracture during open-door cervical laminoplasty

2017 ◽  
Vol 43 ◽  
pp. 72-76 ◽  
Author(s):  
Dong-Ho Lee ◽  
Hyoungmin Kim ◽  
Choon Sung Lee ◽  
Chang-Ju Hwang ◽  
Jae-Hwan Cho ◽  
...  
Keyword(s):  
Cervical Laminoplasty ◽  
Open Door ◽  
Radiographic Outcomes ◽  
Hinge Fracture

Comparison of fusion assessment techniques: computer-assisted versus manual measurements

2008 ◽  
Vol 8 (6) ◽  
pp. 544-547 ◽  
Author(s):  
Daniel R. Fassett ◽  
Ronald I. Apfelbaum ◽  
John A. Hipp
Keyword(s):  
Measurement Technique ◽  
Spinous Process ◽  
Angular Motion ◽  
Computer Assisted ◽  
Data Sets ◽  
Manual Measurement ◽  
Spinous Processes ◽  
Assessment Techniques ◽  
Limited Motion

Object Fusion assessment after cervical arthrodesis can be subjective. Measures such as bridging bone quantification or extent of (limited) motion on dynamic studies are common but difficult to interpret and fraught with biases. We compared manual measurement and computer-assisted techniques in assessing fusion after anterior cervical discectomy and fusion (ACDF). Methods One hundred patients who underwent ACDF (512 intervertebral levels) were randomly selected for this radiographic review (follow-up 3–36 months). Two assessment techniques were performed by different observers, with each blinded to the results of the other. The manual spinous process displacement measurement technique was used to calculate motion between the spinous processes under magnification on a digital imaging workstation. Computer-assisted measurements of intervertebral angular motion were made using Quantitative Motion Analysis (QMA) software. Fusion criteria were arbitrarily set at 1 mm of motion for the manual technique and 1.5° of angular motion for the QMA technique. Results The manual measurement technique revealed fusion in 61.7% (316 of 512) of the interspaces assessed, and QMA revealed fusion in 64.3% (329 of 512). These two assessment techniques agreed in 87.5% of cases, with a correlation coefficient of 0.68 between the two data sets. In cases in which the two techniques did not agree, QMA revealed fusion and the manual measurement revealed nonfusion in 64% of the disagreements; 98% of the disagreements occurred when motion was < 2 mm or 2°. Conclusions Although osseous fusion after arthrodesis remains difficult to assess, new computer-assisted techniques may remove the subjectivity generally associated with assessing fusion.

Delayed hinge fracture after plate-augmented, cervical open-door laminoplasty and its clinical significance

2014 ◽  
Vol 14 (7) ◽  
pp. 1205-1213 ◽  
Author(s):  
Youn-Kwan Park ◽  
Do-Yeol Lee ◽  
Junseok W. Hur ◽  
Hong-Joo Moon
Keyword(s):  
Clinical Significance ◽  
Open Door ◽  
Hinge Fracture

CERVICAL SPINOLAMINOPLASTY WITH NEWLY DESIGNED TITANIUM MINI-PLATES

2016 ◽  
Vol 16 (04) ◽  
pp. 1650050
Author(s):  
CAN YALDIZ ◽  
TOLGA TOLUNAY ◽  
ARSLAN KAĞAN ARSLAN ◽  
ONUR YAMAN ◽  
TEYFIK DEMIR
Keyword(s):  
Conventional Method ◽  
Cervical Vertebrae ◽  
Spinous Process ◽  
Fixation Method ◽  
Open Door ◽  
Compression Tests ◽  
New Construction ◽  
Construction Model ◽  
Mini Plate ◽  
Ultra High Molecular Weight

One of the complication of cervical laminoplasty is the restenosis of the opened laminae. Weakness of the screws placed on laminae may cause restenosis. Here, we describe a new technic ‘spinolaminoplasty (Turkish Open-door laminoplasty)’ with newly designed titanium mini plate that placed one side to lateral mass, and the other on spinous process to keep the laminae opened. Two different fixation materials were used for axial compression tests. One was Ultra high molecular weight polyethylene block with cervical vertebrae geometry and fresh ovine cervical vertebrae. In the first group, mini plates were fixed on laminae as in the conventional method described by Hirabayashi. In the second group, mini plates were fixed on spinous process to perform spinolaminoplasty with single and double screws. New fixation method with double screw provides 26% higher stiffness than the closest group, namely new fixation on polyethylene block. And new fixation method with double screw was exhibited significantly higher ([Formula: see text]) performance between the Ovine groups. As in the spinolaminoplasty technic fixing the mini plates to spinous process with longer screws instead of laminae, strengthens the system compared to the conventional method. This proves that rigidity of new construction model is more stable than the conventional method. Tight fixed laminae may prevent restenosis. Also applying the screw through spinous process instead of laminae may prevent the possible cord injuries.

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