Relationship between cervical curvature and spinal cord drift distance after laminectomy via lateral mass screw fixation and its effect on clinical efficacy

Abstract Background Laminectomy with lateral mass screw fixation (LCSF) is an effective operation type for the treatment of cervical spondylotic myelopathy (CSM), however, the cervical curvature loss is often observed in some patients after operation. Will the cervical curvature change affect the spinal cord drift distance and the decompression effect? The aim of this study is to investigate the effects of different cervical curvature on spinal cord drift distance and clinical efficacy. Methods A total of 78 cases of CSM patients underwent LCSF were included in this retrospective study. The cervical curvature was measured according to the Bordon method 6 months after the operation, and the patients were divided into two groups. Group A: 42 cases with reduced cervical curvature (0 < the cervical lordosis depth < 7 mm) and group B: 36 cases with normal cervical curvature (7 mm ≤ the cervical lordosis depth ≤ 17 mm). The spinal cord drift distance, laminectomy width, neurological functional recovery, axial symptom (AS) severity and the occurrence of C5 palsy in both groups were observed. Results The cervical lordosis depth was (5.1 ± 1.2) mm in group A and (12.3 ± 2.4) mm in group B (P < 0.05). The laminectomy width was (21.5 ± 2.6) mm in group A and (21.9 ± 2.8) mm in group B (P > 0.05). The spinal cord drift distance was (1.9 ± 0.4) mm in group A and (2.6 ± 0.7) mm in group B, with statistically significant difference between the two groups (P < 0.05). The postoperative JOA scores in both groups were significantly increased (P < 0.05), and there was no significant difference in the neurological recovery rate (61.5% vs 62.7%) between the two groups (P > 0.05). According to the grading standard of AS, the severity of AS in group A was significantly higher than that in group B (P < 0.05). Three cases (7.1%) of C5 palsy occurred in group A and 4 cases (11.1%) occurred in group B (P > 0.05). Conclusion After LCSF, more than half of the patients had cervical curvature loss. The smaller of the cervical curvature was, the shorter distance the spinal cord drifted backward. The loss of cervical curvature was related to the severity of axial symptoms, rather than the improvement of neurological function and C5 palsy.

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Relationship of Change in Cervical Curvature after Laminectomy with Lateral Mass Screw Fixation to Spinal Cord Shift and Clinical Efficacy

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1723807 ◽

2021 ◽

Author(s):

Shu-bing Hou ◽

Xian-ze Sun ◽

Feng-yu Liu ◽

Rui Gong ◽

Zheng-qi Zhao ◽

...

Keyword(s):

Spinal Cord ◽

Clinical Efficacy ◽

Screw Fixation ◽

Japanese Orthopaedic Association ◽

Lateral Mass ◽

Cervical Lordosis ◽

Lateral Mass Screw ◽

C5 Palsy ◽

Group A ◽

Group B

Abstract Background and Study Aims Although laminectomy with lateral mass screw fixation (LCSF) is an effective surgical treatment for cervical spondylotic myelopathy (CSM), loss of cervical curvature may result. This study aimed to investigate the effect of cervical curvature on spinal cord drift distance and clinical efficacy. Patients and Methods We retrospectively analyzed 78 consecutive CSM patients with normal cervical curvature who underwent LCSF. Cervical curvature was measured according to Borden's method 6 months after surgery. Study patients were divided into two groups: group A, reduced cervical curvature (cervical lordosis depth 0–7mm; n = 42); and group B, normal cervical curvature (cervical lordosis depth 7–17mm; n = 36). Spinal cord drift distance, laminectomy width, neurologic functional recovery, axial symptom (AS) severity, and incidence of C5 palsy were measured and compared. Results Cervical lordosis depth was 5.1 ± 1.2 mm in group A and 12.3 ± 2.4 mm in group B (p < 0.05). Laminectomy width was 21.5 ± 2.6 mm in group A and 21.9 ± 2.8 mm in group B (p > 0.05). Spinal cord drift distance was significantly shorter in group A (1.9 ± 0.4 vs. 2.6 ± 0.7 mm; p < 0.05). The Japanese Orthopaedic Association (JOA) score significantly increased after surgery in both groups (p < 0.05). Neurologic recovery rate did not differ between the two groups (61.5 vs. 62.7%; p > 0.05). AS severity was significantly higher in group A (p < 0.05). C5 palsy occurred in three group A patients (7.1%) and four group B patients (11.1%), but the difference was not significant (p > 0.05). Conclusion After LCSF, 53.8% of the patients developed loss of cervical curvature. A smaller cervical curvature resulted in a shorter spinal cord drift distance. Loss of cervical curvature was related to AS severity but not improvement of neurologic function or incidence of C5 palsy.

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Lateral Mass Screw Fixation Techniques for the Lower Cervical Spine

Internal Fixation of the Spine ◽

10.1007/978-981-16-1562-7_3 ◽

2021 ◽

pp. 29-37

Author(s):

Lei Shi ◽

Yabo Yan ◽

Wei Lei

Keyword(s):

Cervical Spine ◽

Screw Fixation ◽

Lateral Mass ◽

Lower Cervical Spine ◽

Lateral Mass Screw ◽

Fixation Techniques

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The Surgical Treatment of the Cervical Myelopathy with Laminectomy and Posterior Fusion by using Lateral Mass Screw Fixation

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2009.44.1.123 ◽

2009 ◽

Vol 44 (1) ◽

pp. 123

Author(s):

Kyung-Soo Suk ◽

Ki-Tack Kim ◽

Jung-Hee Lee ◽

Sang-Hun Lee ◽

Jin-Soo Kim ◽

...

Keyword(s):

Surgical Treatment ◽

Cervical Myelopathy ◽

Screw Fixation ◽

Posterior Fusion ◽

Lateral Mass ◽

Lateral Mass Screw

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C2 Nerve Root Transection During C1 Lateral Mass Screw Fixation

Neurosurgery ◽

10.1227/neu.0000000000000306 ◽

2014 ◽

Vol 74 (5) ◽

pp. 475-481 ◽

Cited By ~ 16

Author(s):

Michael C. Dewan ◽

Saniya S. Godil ◽

Stephen K. Mendenhall ◽

Clinton J. Devin ◽

Matthew J. McGirt

Keyword(s):

Nerve Root ◽

Screw Fixation ◽

Neck Disability Index ◽

Occipital Neuralgia ◽

Lateral Mass ◽

Negative Consequences ◽

Lateral Mass Screw ◽

Patient Reported ◽

C2 Nerve Root ◽

C1 Lateral Mass Screw

Abstract BACKGROUND: Sectioning of the C2 nerve root allows for direct visualization of the C1-2 joint and may facilitate arthrodesis. OBJECTIVE: To determine the clinical and functional consequences of C2 nerve root sectioning during placement of C1 lateral mass screws. METHODS: All patients undergoing C1 lateral mass screw fixation were included in this prospective study. A standard questionnaire was used to determine the severity of occipital numbness/pain and its effect on quality of life (QOL). Domains of the neck disability index were used to assess the disability related to C2 symptoms. RESULTS: A total of 28 patients were included (C2 transection, 8; C2 preservation, 20). A trend of decreased blood loss and length of surgery was observed in the C2 transection cohort. Occipital numbness was reported by 4 (50.0%) patients after C2 transection. Occipital neuralgia was reported by 7 (35.0%) patients with C2 preservation. None of the patients with numbness after C2 transection reported being “bothered” by it. All patients with occipital neuralgia after C2 sparing reported being “bothered” by it, and 57.1% reported a moderate to severe effect on QOL. The use of medication was reported by 5 (71.4%) patients with neuralgia vs none with numbness. Mean disability was significantly higher with neuralgia vs numbness (P = .016). CONCLUSION: C2 nerve root transection is associated with increased occipital numbness but this has no effect on patient-reported outcomes and QOL. C2 nerve root preservation can be associated with occipital neuralgia, which has a negative impact on patient disability and QOL. C2 nerve root transection has no negative consequences during C1-2 stabilization.

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