scholarly journals Posterior Laminectomy and Lateral Mass Screw Fixation for the Treatment of Severe Cervical Spondylotic Myelopathy

Author(s):  
Chuang Li ◽  
Bin Wu ◽  
Yongchao Wu ◽  
Haitao Pan ◽  
Qixin Zheng

Abstract Background Severe and complex cervical spondylotic myelopathy(CSM) requires surgical treatment. The common methods of posterior cervical spine surgery are laminoplasty and laminectomy with lateral mass screw internal fixation. However, the operative effect of this surgical approach is unclear owing to the complexity and severity of CSM in patients who undergo this surgical treatment.Therefore, we aimed to evaluate the clinical effects of posterior cervical laminectomy and lateral mass screw internal fixation in patients with severe and complex CSM. Methods We retrospectively analysed 60patients (48men,12women; mean age59.7 years) with severe and complex CSM who underwent posterior cervical laminectomy and lateral mass screw internal fixation from May 2013 to June 2020. Forty-eight patients underwent laminectomy and lateral mass screw internal fixation;12 patients underwent laminectomy and lateral mass screw internal fixation with 1–2 segmental laminoplasty. C-spine radiographs, computed tomography (CT) scans, and magnetic resonance imaging (MRI) were used to detect any curvature and fusion of the cervical spine, restenosis, and loose/broken internal fixation screws.Clinical efficacy was evaluated using Japanese Orthopaedic Association (JOA)scores, neck disability index(NDI), Odom’s classification, and the visual analogue scale(VAS) for pain. Results Overall effect was satisfactory at the last follow-up (average, 3.6 years [range, 6 months–6 years]), with no restenosis or loosened, slipped, or broken internal fixations. The anterior curvature angle of lordosis (n=46)was not significantly different from baseline at the last follow-up(P>0.05). The cervical kyphosis angle (n=14)was significantly improved at the last follow-up compared with the baseline value (P<0.05), as were the JOA, NDI, and VAS scores(all P<0.05). Odom’s classifications at the last follow-up were excellent, good, and fair in 45, 12, and three patients, respectively. Conclusions Posterior cervical laminectomy and lateral mass screw internal fixation achieved satisfactory clinical results in severe and complex CSM cases.Combining this surgical method with laminoplasty of 1–2 spinal segments stabilised the cervical spine and provided spinal decompression while preventing excessive backward drift of the cervical spinal cord, resulting in fewer complications.

2021 ◽  
pp. 219256822110391
Author(s):  
Yakubu Ibrahim ◽  
Hao Li ◽  
Geng Zhao ◽  
Suomao Yuan ◽  
Yiwei Zhao ◽  
...  

Study Design: Retrospective. Objectives: To present rarely reported complex fractures of the upper cervical spine (C1-C2) and discuss the clinical results of the posterior temporary C1-2 pedicle screws fixation for C1-C2 stabilization. Methods: A total of 19 patients were included in the study (18 males and 1 female). Their age ranged from 23 to 66 years (mean age of 39.6 years). The patients were diagnosed with complex fractures of the atlas and the axis of the upper cervical spine and underwent posterior temporary C1-2 pedicle screws fixation. The patients underwent a serial postoperative clinical examination at approximately 3, 6, 9 months, and annually thereafter. The neck disability index (NDI) and the range of neck rotary motion were used to evaluate the postoperative clinical efficacy of the patients. Results: The average operation time and blood loss were 110 ± 25 min and 50 ± 12 ml, respectively. The mean follow-up was 38 ± 11 months (range 22 to 60 months). The neck rotary motion before removal, immediately after removal, and the last follow-up were 68.7 ± 7.1°, 115.1 ± 11.7°, and 149.3 ± 8.9° ( P < 0.01). The NDI scores before and after the operation were 42.7 ± 4.3, 11.1 ± 4.0 ( P < 0.01), and the NDI score 2 days after the internal fixation was removed was 7.3 ± 2.9, which was better than immediately after the operation ( P < 0.01), and 2 years after the internal fixation was removed. The NDI score was 2.0 ± 0.8, which was significantly better than 2 days after the internal fixation was taken out ( P < 0.001). Conclusions: Posterior temporary screw fixation is a good alternative surgical treatment for unstable C1-C2 complex fractures.


2020 ◽  
Author(s):  
Beiping Ouyang ◽  
Xiaobao Zou ◽  
Ling Ni ◽  
Su Ge ◽  
Yuyue Chen ◽  
...  

Abstract Background: Intraspinal upper cervical C1-C2 tumors pose a challenge in resection. Internal fixation has routinely been used to prevent the occurrence of instability after atlantoaxial laminectomy for resection of C1-C2 intraspinal tumors, that sacrifices the motion of upper cervical spine. We therefore present this report to evaluate the efficacy and safety of one-stage posterior resection of these tumors through the atlantoaxial lamina space without internal fixation.Methods: Ten suitably selected patient with C1-C2 intraspinal tumors were included in this study (period January 2016 to January 2018). All the patients underwent one-stage posterior resection through atlantoaxial lamina space without internal fixation. The efficacy of the procedure was documented by comparing postoperative and preoperative outcome scores [The visual analogue scores (VAS), Japanese Orthopedic Association scores (JOA), neck disability index (NDI)], cervical physiological curvature and range of flexion-extension. Safety was assessed by documenting the complications associated with surgery and subsequent sequale. Results: 6 Male and 4 female patients with mean age 36 years (range 17 years to 50 years) underwent total tumor resection through posterior only approach using the atlantoaxial lamina space for the following tumors: 4 neurofibromas, 3 schwannomas and 3 meningiomas. The mean follow-up was 31.2 months (range 24–36 months). These patients’ pathological types included. Postoperative VAS and NDI were lower than those of pre-operation with statistical significance (p < 0.05) while postoperative JOA was higher than that of pre-operation (p < 0.05). The physiological curvature and activity of cervical spine were maintained at latest follow up. Three patients suffered cerebrospinal fluid leakages that was managed consertaviley with no added intervention required. No patient had local recurrence at latest follow-up.Conclusion: One-stage posterior resection through atlantoaxial lamina space without fixation is an effective and safe treatment for the upper cervical intraspinal tumor. In our experience this technique can remove tumor completely and does not cause instability to C1-C2 joint.


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

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.


2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
FengNing Li ◽  
ZhongHai Li ◽  
Xuan Huang ◽  
Zhi Chen ◽  
Fan Zhang ◽  
...  

To compare the clinical efficacy and radiological outcome of treating 4-level cervical spondylotic myelopathy (CSM) with either anterior cervical discectomy and fusion (ACDF) or “skip” corpectomy and fusion, 48 patients with 4-level CSM who had undergone ACDF or SCF at our hospital were analyzed retrospectively between January 2008 and June 2011. Twenty-seven patients received ACDF (Group A) and 21 patients received SCF. Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, and Cobb’s angles of the fused segments and C2-7 segments were compared in the two groups. The minimum patient follow-up was 2 years. No significant differences between the groups were found in demographic and baseline disease characteristics, duration of surgery, or follow-up time. Our study demonstrates that there was no significant difference in the clinical efficacy of ACDF and SCF, but ACDF involves less intraoperative blood loss, better cervical spine alignment, and fewer postoperative complications than SCF.


2009 ◽  
Vol 11 (5) ◽  
pp. 521-528 ◽  
Author(s):  
Kenzo Uchida ◽  
Hideaki Nakajima ◽  
Ryuichiro Sato ◽  
Takafumi Yayama ◽  
Erisa S. Mwaka ◽  
...  

Object The effects of sagittal kyphotic deformities or mechanical stress on the development of cervical spondylotic myelopathy, or the reduction and fusion of kyphotic sagittal alignment have not been consistently documented. The aim in this study was to determine the effects of kyphotic sagittal alignment of the cervical spine in terms of neurological morbidity and outcome after 2 types of surgical intervention. Methods The authors retrospectively reviewed the records of 476 patients who underwent cervical spine surgeries for spondylotic myelopathy between 1993 and 2006 at their university medical center. Among these were identified 43 patients—30 men and 13 women, with a mean age of 58.8 years—who had cervical kyphosis exceeding 10° on preoperative sagittal lateral radiographs obtained in the neutral position, and their cases were analyzed in this study. Anterior decompression with interbody fusion was conducted in 28 patients, and en bloc open-door C3–7 laminoplasty in 15 patients. Both pre- and postoperative neurological, radiographic, and MR imaging findings were assessed in both surgical groups. Results The mean preoperative kyphotic angle in all 43 patients was 15.9 ± 5.9° in the neutral position. Segmental instability was noted in 26 patients (61%) and reversed dynamic spinal canal stenosis at the level above the local kyphosis in 22 (51%). Preoperative T2-weighted MR images showed high-intensity signal within the cord at and around the level of maximal compression or segmental instability in 28 patients (65%). The mean kyphotic angle in both the neutral and flexion positions was significantly smaller at 4–6 weeks after surgery in the anterior spondylectomy group than in the laminoplasty group (p < 0.001). Furthermore, the angle in the neutral position was significantly smaller on follow-up in the anterior spondylectomy group than in the laminoplasty group (p = 0.034). The transverse area of the spinal cord was significantly larger in the anterior spondylectomy group than in the laminoplasty group on follow-up (p = 0.037). Preoperative neurological scores (assessed using the Japanese Orthopaedic Association scale) and improvement on follow-up ≥ 2 years after treatment (average 3.3 years) were not significantly different between the 2 groups; however, there was a significant difference in Japanese Orthopaedic Association score at 4–6 weeks postoperatively (p = 0.047). Conclusions Kyphotic deformity and mechanical stress in the cervical spine may play an important role in neurological dysfunction. In a select group of patients with kyphotic deformity ≥ 10°, adequate correction of local sagittal alignment may help to maximize the chance of neurological improvement.


2003 ◽  
Vol 3 (6) ◽  
pp. 489-495 ◽  
Author(s):  
H.Gordon Deen ◽  
Barry D Birch ◽  
Robert E Wharen ◽  
Ronald Reimer

Sign in / Sign up

Export Citation Format

Share Document