Multivariate Analysis of Factors Associated With Axial Symptoms in Unilateral Expansive Open-Door Cervical Laminoplasty With Miniplate Fixation

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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Multivariate analysis of factors associated with spinal cord area in single-door cervical laminoplasty with miniplate fixation

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04773-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ke-rui Zhang ◽

Yi Yang ◽

Hao Liu ◽

Bei-yu Wang ◽

Chen Ding ◽

...

Keyword(s):

Spinal Cord ◽

Multivariate Analysis ◽

Spinal Canal ◽

Preoperative Diagnosis ◽

Cervical Spinal Cord ◽

Cervical Laminoplasty ◽

Factors Associated ◽

Canal Area ◽

Curvature Index ◽

Before And After

Abstract Objectives To explore the factors associated with the increased spinal cord area in single-door cervical laminoplasty (SDCL) with miniplate fixation. Methods A retrospective study enrolled 83 patients underwent SDCL with miniplate fixation and the patient characteristics such as age, gender, tobacco use, alcohol use, diabetes mellitus, hypertension, diagnosis, operative level, etc., were obtained. The opening angle, door shaft position and spinal canal area of the patients were measured after surgery. The sagittal canal diameter (SCD), the C2–7 Cobb angle, the cervical curvature index (CCI), the range of motion (ROM) and the spinal canal area were measured before and after operation. The increased cervical spinal cord area was also measured before and after surgery, and the correlation between the above indicators and the increased cervical spinal cord area was studied through Pearson’s correlation analysis and multivariate logistic regression analysis. Results There were 34 patients in small spinal cord area increment group (SAI group), 29 patients in middle spinal cord area increment group (MAI group) and 20 patients in large spinal cord area increment group (LAI group). The preoperative diagnosis(P = 0.001), door shaft position (P = 0.008), preoperative spinal canal area (P = 0.004) and postoperative spinal canal area (P = 0.015) were significant different among the 3 groups. The multivariate analysis showed that the preoperative diagnosis (OR = 2.076, P = 0.035), door shaft position (OR = 3.425, P = 0.020) and preoperative spinal canal area (OR = 10.217, P = 0.009) were related to increased spinal cord area. Conclusions The preoperative diagnosis, door shaft position and preoperative spinal canal area might be associated with increased spinal cord area after cervical laminoplasty with miniplate fixation. Preoperative symptoms are mostly caused by compression of the spinal cord, so spinal cord area enlargement can bring a better recovery in patients alongside long-term. Spine surgeons should pay more attention to the accuracy of the preoperative diagnosis, the preoperative measurement of spinal canal area and the door shaft position during the operation.

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Multivariate Analysis of the Risk Factors Associated with Complications and Mortality after and Emergency Operation for Obstructive, Perforated Colorectal Cancer

Journal of the Korean Society of Coloproctology ◽

10.3393/jksc.2009.25.3.165 ◽

2009 ◽

Vol 25 (3) ◽

pp. 165 ◽

Cited By ~ 4

Author(s):

Dong Baek Kang ◽

Chang Yeol Shin ◽

Jeong Kyun Lee ◽

Won Cheol Park

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Multivariate Analysis ◽

Emergency Operation ◽

Factors Associated ◽

Perforated Colorectal Cancer ◽

Complications And Mortality

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

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1719102 ◽

2020 ◽

Author(s):

Hai-Yun Yang ◽

Yun-Ge Zhang ◽

Dong Zhao ◽

Gui-Ming Sun ◽

Yi Ma ◽

...

Keyword(s):

Cervical Spondylotic Myelopathy ◽

Plate Fixation ◽

Japanese Orthopaedic Association ◽

Neurological Dysfunction ◽

Reconstruction Technique ◽

Open Door ◽

Titanium Plate ◽

Attachment Point ◽

Curvature Index ◽

Axial Symptoms

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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Axial Symptoms After Cervical Laminoplasty With C3 Laminectomy Compared With Conventional C3–C7 Laminoplasty

Spine ◽

10.1097/01.brs.0000186332.66490.ba ◽

2005 ◽

Vol 30 (22) ◽

pp. 2544-2549 ◽

Cited By ~ 99

Author(s):

Kazunari Takeuchi ◽

Toru Yokoyama ◽

Shuichi Aburakawa ◽

Akira Saito ◽

Takuya Numasawa ◽

...

Keyword(s):

Cervical Laminoplasty ◽

Axial Symptoms

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OPEN-DOOR EXPANSILE CERVICAL LAMINOPLASTY

Neurosurgery ◽

10.1227/01.neu.0000215353.94448.16 ◽

2007 ◽

Vol 60 (suppl_1) ◽

pp. S1-154-S1-159 ◽

Cited By ~ 5

Author(s):

Elizabeth Vitarbo ◽

Rishi N. Sheth ◽

Allan D. Levi

Keyword(s):

Surgical Technique ◽

Spinal Stenosis ◽

Cervical Myelopathy ◽

Outcome Data ◽

Cervical Laminoplasty ◽

Open Door ◽

Cervical Spinal Stenosis ◽

Current Article

Abstract OPEN-DOOR EXPANSILE laminoplasty is a practical surgical technique for the treatment of cervical myelopathy secondary to cervical spinal stenosis. Laminoplasty procedures were first described in the late 1970s and have undergone numerous modifications. The current article reviews the indications, techniques, and outcome data for cervical laminoplasty. Complications of laminoplasty and comparison to laminectomy outcomes are also discussed.

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