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

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.

scholarly journals Cervical curvature changes following laminectomy with lateral mass screw fixation: Does it relate with spinal cord shift and clinical efficacy

2020 ◽  
Author(s):  
Shu-bing Hou ◽  
Xian-ze Sun ◽  
Feng-yu Liu ◽  
Rui Gong ◽  
Zheng-qi Zhao ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Clinical Efficacy ◽  
Screw Fixation ◽  
Lateral Mass ◽  
Cervical Lordosis ◽  
Lateral Mass Screw ◽  
C5 Palsy ◽  
Significant Difference ◽  
Group A ◽  
Group B

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.

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

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.

scholarly journals Effect of sub-axial cervical lateral mass screw fixation on functional outcome in patients with cervical spondylotic myelopathy

2019 ◽  
Vol 14 (1) ◽  
pp. 140
Author(s):  
AliRabee Kamel Hamdan ◽  
RadwanNouby Mahmoud ◽  
MomenMohammed Al Mamoun ◽  
EslamEl Sayed El Khateeb
Keyword(s):  
Functional Outcome ◽  
Cervical Spondylotic Myelopathy ◽  
Screw Fixation ◽  
Lateral Mass ◽  
Lateral Mass Screw

scholarly journals Sagittal Alignment After Laminectomy Without Fusion as Treatment for Cervical Spondylotic Myelopathy: Follow-up of Minimum 4 Years Postoperatively

2019 ◽  
Vol 10 (4) ◽  
pp. 425-432
Author(s):  
Håkan Löfgren ◽  
Aras Osman ◽  
Anders Blomqvist ◽  
Ludek Vavruch
Keyword(s):  
Clinical Outcome ◽  
Cobb Angle ◽  
Cervical Spondylotic Myelopathy ◽  
Sagittal Alignment ◽  
Neck Disability Index ◽  
Clear Correlation ◽  
Cervical Lordosis ◽  
Radiographic Measurements ◽  
C7 Slope

Objectives: The aims of this study were to evaluate the incidence of sagittal malalignment including kyphosis following cervical laminectomy without fusion as treatment for cervical spondylotic myelopathy and to assess any correlation between malalignment and clinical outcome. Study Design: Retrospective cohort study. Methods: In all, 60 patients were followed up with conventional radiography at an average of 8 years postoperatively. The cervical lordosis (C2-C7 Cobb angle), C2-C7 sagittal vertical axis (cSVA) and C7 slope were measured on both preoperative and postoperative images. Patients completed a questionnaire covering Neck Disability Index (NDI), visual analogue scale for neck pain, and general health (EQ-5D). Results: Mean C2-C7 Cobb angle was 8.6° (SD 9.0) preoperatively, 3.4° (10.7) postoperatively and 9.6° (14.5) at follow-up. Ultimately, 3 patients showed >20° cervical kyphosis. Mean cSVA was 16.3 mm (SD 10.2) preoperatively, 20.6 mm (11.8) postoperatively, and 31.6 mm (11.8) at follow-up. Mean C7 slope was 20.4° (SD 8.9) preoperatively, 18.4° (9.4) postoperatively, and 32.6° (10.2) at follow-up. The preoperative to follow-up increase in cSVA and C7 slope was statistically significant (both P < .0001), but not for cervical lordosis. The preoperative to follow-up change in cSVA correlated moderately with preoperative cSVA ( r = 0.43, P = .002), as did the corresponding findings regarding C7 slope ( r = 0.52, P = .0001). A comparison of radiographic measurements with clinical outcome showed no strong correlations. Conclusions: No preoperative to follow-up change in cervical lordosis was found in this group; 5.0% developed >20° kyphosis. No clear correlation between sagittal alignment and clinical outcome was shown.

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.

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