Cervical laminoplasty for the treatment of cervical degenerative myelopathy

2009 ◽  
Vol 11 (2) ◽  
pp. 157-169 ◽  
Author(s):  
Paul G. Matz ◽  
Paul A. Anderson ◽  
Michael W. Groff ◽  
Robert F. Heary ◽  
Langston T. Holly ◽  
...  
Keyword(s):  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Consensus Conference ◽  
Functional Improvement ◽  
Cervical Laminoplasty ◽  
Class Iii ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
Cochrane Database ◽  
Stenosis Severity

Object The objective of this systematic review was to use evidence-based medicine to examine the efficacy of cervical laminoplasty in the treatment of cervical spondylotic myelopathy (CSM). Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical laminoplasty and CSM. Abstracts were reviewed and studies meeting the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons and Congress of Neurological Surgeons. Results Cervical laminoplasty has improved functional outcome in the setting of CSM or ossification of the posterior longitudinal ligament. Using the Japanese Orthopaedic Association scale score, ~ 55–60% average recovery rate has been observed (Class III). The functional improvement observed after laminoplasty may be limited by duration of symptoms, severity of stenosis, severity of myelopathy, and poorly controlled diabetes as negative risk factors (Class II). There is conflicting evidence regarding age, with 1 study citing it as a negative risk factor, and another not demonstrating this result. Conclusions Cervical laminoplasty is recommended for the treatment of CSM or ossification of the posterior longitudinal ligament (Class III).

Laminectomy and fusion for the treatment of cervical degenerative myelopathy

2009 ◽  
Vol 11 (2) ◽  
pp. 150-156 ◽  
Author(s):  
Paul A. Anderson ◽  
Paul G. Matz ◽  
Michael W. Groff ◽  
Robert F. Heary ◽  
Langston T. Holly ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Posterior Longitudinal Ligament ◽  
Consensus Conference ◽  
Functional Improvement ◽  
Class Iii ◽  
Level Of Evidence ◽  
Cervical Laminectomy ◽  
Cochrane Database ◽  
Laminectomy And Fusion ◽  
Based Medicine

Object The objective of this systematic review was to use evidence-based medicine to examine the efficacy of cervical laminectomy and fusion for the treatment of cervical spondylotic myelopathy (CSM). Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical laminectomy, fusion, and CSM. Abstracts were reviewed, after which studies that met the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Class I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations which contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer-review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Cervical laminectomy with fusion (arthrodesis) improves functional outcome in patients with CSM and ossification of the posterior longitudinal ligament (OPLL). Functional improvement is similar to laminectomy or laminoplasty for patients with CSM and OPLL. In contrast to laminectomy, cervical laminectomy with fusion it is not associated with late deformity (Class III). Conclusions Laminectomy with fusion (arthrodesis) is an effective strategy to improve functional outcome in CSM and OPLL.

Cervical laminectomy for the treatment of cervical degenerative myelopathy

2009 ◽  
Vol 11 (2) ◽  
pp. 142-149 ◽  
Author(s):  
Timothy C. Ryken ◽  
Robert F. Heary ◽  
Paul G. Matz ◽  
Paul A. Anderson ◽  
Michael W. Groff ◽  
...  
Keyword(s):  
Consensus Conference ◽  
Functional Improvement ◽  
Class Iii ◽  
Level Of Evidence ◽  
Cervical Laminectomy ◽  
Cochrane Database ◽  
Increased Risk ◽  
Strength Based ◽  
Near Term ◽  
Based Medicine

Object The objective of this systematic review was to use evidence-based medicine to examine the efficacy of cervical laminectomy for the treatment of cervical spondylotic myelopathy (CSM). Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical laminectomy and CSM. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Laminectomy has improved functional outcome for symptomatic cervical myelopathy (Class III). The limitations of the technique are an increased risk of postoperative kyphosis compared to anterior techniques or laminoplasty or laminectomy with fusion (Class III). However, the development of kyphosis may not necessarily to diminish the clinical outcome (Class III). Conclusions Laminectomy is an acceptable therapy for near-term functional improvement of CSM (Class III). It is associated with development of kyphosis, however.

The natural history of cervical spondylotic myelopathy

2009 ◽  
Vol 11 (2) ◽  
pp. 104-111 ◽  
Author(s):  
Paul G. Matz ◽  
Paul A. Anderson ◽  
Langston T. Holly ◽  
Michael W. Groff ◽  
Robert F. Heary ◽  
...  
Keyword(s):  
Natural History ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Consensus Conference ◽  
Class I ◽  
Class Iii ◽  
Level Of Evidence ◽  
Cochrane Database ◽  
History Of ◽  
Based Medicine

Object The objective of this systematic review was to use evidence-based medicine to delineate the natural history of cervical spondylotic myelopathy (CSM) and identify factors associated with clinical deterioration. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to the natural history of CSM. Abstracts were reviewed and studies meeting the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. Results The natural history of CSM is mixed: it may manifest as a slow, stepwise decline or there may be a long period of quiescence (Class III). Long periods of severe stenosis are associated with demyelination and may result in necrosis of both gray and white matter. With severe and/or long lasting CSM symptoms, the likelihood of improvement with nonoperative measures is low. Objectively measurable deterioration is rarely seen acutely in patients younger than 75 years of age with mild CSM (modified Japanese Orthopaedic Association scale score > 12; Class I). In patients with cervical stenosis without myelopathy, the presence of abnormal electromyography findings or the presence of clinical radiculopathy is associated with the development of symptomatic CSM in this patient population (Class I). Conclusions The natural history of CSM is variable, which may affect treatment decisions.

Management of anterior cervical pseudarthrosis

2009 ◽  
Vol 11 (2) ◽  
pp. 228-237 ◽  
Author(s):  
Michael G. Kaiser ◽  
Praveen V. Mummaneni ◽  
Paul G. Matz ◽  
Paul A. Anderson ◽  
Michael W. Groff ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Consensus Conference ◽  
Class Iii ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Cervical Spine Surgery ◽  
Cochrane Database ◽  
Strength Based ◽  
Based Medicine

Object The objective of this systematic review was to use evidence-based medicine to identify the best methodology for diagnosis and treatment of anterior pseudarthrosis. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to pseudarthrosis and cervical spine surgery. Abstracts were reviewed, after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Evaluation for pseudarthrosis is warranted, as there may be an association between clinical outcome and pseudarthrosis. The strength of this association cannot be accurately determined because of the variable incidence of symptomatic and asymptomatic pseudarthroses (Class III). Revision of a symptomatic pseudarthrosis may be considered because arthrodesis is associated with improved clinical outcome (Class III). Both posterior and anterior approaches have proven successful for surgical correction of an anterior pseudarthrosis. Posterior approaches may be associated with higher fusion rates following repair of an anterior pseudarthrosis (Class III). Conclusions If suspected, pseudarthrosis should be investigated because there may be an association between arthrodesis and outcome. However, the strength of this association cannot be accurately determined. Anterior and posterior approaches have been successful.

Cervical laminoforaminotomy for the treatment of cervical degenerative radiculopathy

2009 ◽  
Vol 11 (2) ◽  
pp. 198-202 ◽  
Author(s):  
Robert F. Heary ◽  
Timothy C. Ryken ◽  
Paul G. Matz ◽  
Paul A. Anderson ◽  
Michael W. Groff ◽  
...  
Keyword(s):  
Cervical Radiculopathy ◽  
Consensus Conference ◽  
Cervical Disc ◽  
Class Iii ◽  
Level Of Evidence ◽  
Outcomes Measures ◽  
Cochrane Database ◽  
Strength Based ◽  
Based Medicine

Object The objective of this systematic review was to use evidence-based medicine to examine the efficacy of posterior laminoforaminotomy in the treatment of cervical radiculopathy. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to posterior laminoforaminotomy and cervical radiculopathy. Abstracts were reviewed, and studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations which contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Posterior laminoforaminotomy improves clinical outcome in the treatment of cervical radiculopathy resulting from soft lateral cervical disc displacement or cervical spondylosis with resulting narrowing of the lateral recess. All studies were Class III. The most frequent design flaw involved the lack of utilization of validated outcomes measures. In addition, few historical studies included a detailed preoperative analysis of the patients. As such, the vast majority of studies that included both pre- and postoperative assessments with legitimate outcomes measures have been performed since 1990. Conclusions Posterior laminoforaminotomy is an effective treatment for cervical radiculopathy.

Techniques for cervical interbody grafting

2009 ◽  
Vol 11 (2) ◽  
pp. 203-220 ◽  
Author(s):  
Timothy C. Ryken ◽  
Robert F. Heary ◽  
Paul G. Matz ◽  
Paul A. Anderson ◽  
Michael W. Groff ◽  
...  
Keyword(s):  
Iliac Crest ◽  
Class Ii ◽  
Consensus Conference ◽  
Anterior Cervical Discectomy ◽  
Current Evidence ◽  
Class Iii ◽  
Level Of Evidence ◽  
Cervical Discectomy ◽  
Cochrane Database ◽  
Titanium Cages

Object The objective of this systematic review was to use evidence-based medicine to determine the efficacy of interbody graft techniques. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical interbody grafting. Abstracts were reviewed and studies that met the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgerons/Congress of Neurological Surgeons. Results Autograft bone harvested from the iliac crest, allograft bone from either cadaveric iliac crest or fibula, or titanium cages and rectangular fusion devices, with or without the use of autologous graft or substitute, have been successful in creating arthrodesis after 1- or 2-level anterior cervical discectomy with fusion (Class II). Alternatives to autograft, allograft, or titanium cages include polyetheretherketone cages and carbon fiber cages (Class III). Polyetheretherketone cages have been used successfully with or without hydroxyapatite for anterior cervical discectomy with fusion. Importantly, recombinant human bone morphogenic protein-2 carries a complication rate of up to 23–27% (especially local edema) compared with 3% for a standard approach. Conclusions Current evidence does not support the routine use of interbody grafting for cervical arthrodesis. Multiple strategies for interbody grafting have been successful with Class II evidence supporting the use of autograft, allograft, and titanium cages.

Anterior cervical surgery for the treatment of cervical degenerative myelopathy

2009 ◽  
Vol 11 (2) ◽  
pp. 170-173 ◽  
Author(s):  
Paul G. Matz ◽  
Langston T. Holly ◽  
Praveen V. Mummaneni ◽  
Paul A. Anderson ◽  
Michael W. Groff ◽  
...  
Keyword(s):  
Systematic Review ◽  
Scale Score ◽  
Japanese Orthopaedic Association ◽  
Consensus Conference ◽  
Surgical Decompression ◽  
Class Iii ◽  
Level Of Evidence ◽  
Nonoperative Therapy ◽  
Cervical Surgery ◽  
Anterior Cervical Surgery

Object The objective of this systematic review was to use evidence-based medicine to examine the efficacy of anterior cervical surgery for the treatment of cervical spondylotic myelopathy (CSM). Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to anterior cervical surgery and CSM. Abstracts were reviewed, and studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Mild CSM (modified Japanese Orthopaedic Association [mJOA] scale scores > 12) responds in the short term (3 years) to either surgical decompression or nonoperative therapy (prolonged immobilization in a stiff cervical collar, “low-risk” activity modification or bed rest, and antiinflammatory medications) (Class II). More severe CSM responds to surgical decompression with benefits being maintained a minimum of 5 years and as long as 15 years postoperatively (Class III). Conclusions Treatment of mild CSM may involve surgical decompression or nonoperative therapy for the first 3 years after diagnosis. More severe CSM (mJOA scale score ≤ 12) should be considered for surgery depending upon the individual case. The shortcomings of this systematic review are that the group was not able to determine whether an mJOA scale score of 12 was indicative of a more severe CSM disease course, and whether patients who received nonsurgical treatment for 3 years had a significant probability for clinical deterioration after that time point.

Radiographic assessment of cervical subaxial fusion

2009 ◽  
Vol 11 (2) ◽  
pp. 221-227 ◽  
Author(s):  
Michael G. Kaiser ◽  
Praveen V. Mummaneni ◽  
Paul G. Matz ◽  
Paul A. Anderson ◽  
Michael W. Groff ◽  
...  
Keyword(s):  
Class Ii ◽  
Consensus Conference ◽  
Reliable Indicator ◽  
Class Iii ◽  
Radiographic Assessment ◽  
Distance Measurements ◽  
Level Of Evidence ◽  
Angle Measurements ◽  
Cochrane Database ◽  
Based Medicine

Object The objective of this systematic review was to use evidence-based medicine to identify the best methodology for radiographic assessment of cervical subaxial fusion. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical fusion. Abstracts were reviewed and studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Pseudarthrosis is best assessed through the absence of motion detected between the spinous processes on dynamic radiographs (Class II). The measurement of interspinous distance on dynamic radiographs of ≥ 2 mm is a more reliable indicator for pseudarthrosis than angular motion of 2° based on Cobb angle measurements (Class II). Similarly, it is also understood that the pseudarthrosis rate will increase as the threshold for allowable motion on dynamic radiographs decreases. The combination of interspinous distance measurements and identification of bone trabeculation is unreliable when performed by the treating surgeon (Class II). Identification of bone trabeculation on static radiographs should be considered a less reliable indicator of cervical arthrodesis than dynamic films (Class III). Conclusions Consideration should be given to dynamic radiographs and interspinous distance when assessing for pseudarthrosis.

Postlaminoplasty cervical range of motion: early results

2007 ◽  
Vol 6 (5) ◽  
pp. 386-390 ◽  
Author(s):  
Suk-Hyung Kang ◽  
Seung-Chul Rhim ◽  
Sung-Woo Roh ◽  
Sang-Ryong Jeon ◽  
Hyun-Chul Baek
Keyword(s):  
Range Of Motion ◽  
Japanese Orthopaedic Association ◽  
Cervical Canal ◽  
Cervical Laminoplasty ◽  
Duration Of Symptoms ◽  
Cervical Range Of Motion ◽  
Curvature Index ◽  
Before And After ◽  
The Mean

Object The authors studied cervical range of motion (ROM) before and after cervical laminoplasty to determine factors associated with cervical ROM in patients with cervical myelopathy. Methods Between July 2003 and August 2005, 20 patients underwent a modified Hirabayashi-type unilateral open-door laminoplasty to treat multilevel cervical spondylosis or ossification of the posterior longitudinal ligament (OPLL). Clinically, the authors assessed Japanese Orthopaedic Association (JOA) score, duration of symptoms, disease entity, and the age and sex of patients to ascertain the relation of these factors to ROM before and after cervical laminoplasty. Intraoperative findings such as ligament detachment from the C-2 spinous process and cervicothoracic junction involvement were noted. Radiological and imaging findings such as the length of the lesion, cervical axial canal area, antero-posterior (AP) diameter of the cervical canal, angle of the opened lamina after surgery, cervical sagittal angles, cervical curvature index (CCI), and signal change of the cord on magnetic resonance imaging were evaluated. The mean follow-up period was 19.45 months (range 13–38 months). The preoperative average ROM in 18 patients (after excluding two patients with trauma) was 36.73 ± 15.73°; postoperatively it was 25.24 ± 16.06°. Thus, ROM decreased by 9.64 ± 10.09° (31.80%) after surgery (p = 0.002), reflecting the mean in the same 18 patients. Preoperative ROM was related to the age of patients, CCI, preoperative JOA score, and AP diameter of the cervical canal. In cases of OPLL the ROM was lower than that in cases of spondylosis. Postoperative cervical ROM was related to preoperative ROM, postoperative AP diameter of the cervical canal, laminar angle, patient age, and follow-up duration. None of the studied parameters, however, correlated with a decreased cervical ROM. Conclusions Cervical ROM was reduced after cervical laminoplasty. Postlaminoplasty cervical ROM had a positive correlation with extended motion; however, gradually it became reduced. In this study, no correlative factor was associated with a reduction in cervical ROM. Further study is also needed.

scholarly journals Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament

2016 ◽  
Vol 24 (1) ◽  
pp. 100-107 ◽  
Author(s):  
Chang Kyu Lee ◽  
Dong Ah Shin ◽  
Seong Yi ◽  
Keung Nyun Kim ◽  
Hyun Chul Shin ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cobb Angle ◽  
Clinical Outcomes ◽  
Sagittal Alignment ◽  
Short Form ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Cervical Laminoplasty ◽  
Sf 36 ◽  
Cervical Sagittal Alignment

OBJECT The goal of this study was to determine the relationship between cervical spine sagittal alignment and clinical outcomes after cervical laminoplasty in patients with ossification of the posterior longitudinal ligament (OPLL). METHODS Fifty consecutive patients who underwent a cervical laminoplasty for OPLL between January 2012 and January 2013 and who were followed up for at least 1 year were analyzed in this study. Standing plain radiographs of the cervical spine, CT (midsagittal view), and MRI (T2-weighted sagittal view) were obtained (anteroposterior, lateral, flexion, and extension) pre- and postoperatively. Cervical spine alignment was assessed with the following 3 parameters: the C2–7 Cobb angle, C2–7 sagittal vertical axis (SVA), and T-1 slope minus C2–7 Cobb angle. The change in cervical sagittal alignment was defined as the difference between the post- and preoperative C2–7 Cobb angles, C2–7 SVAs, and T-1 slope minus C2–7 Cobb angles. Outcome assessments (visual analog scale [VAS], Oswestry Neck Disability Index [NDI], 36-Item Short-Form Health Survey [SF-36], and Japanese Orthopaedic Association [JOA] scores) were obtained in all patients pre- and postoperatively. RESULTS The average patient age was 56.3 years (range 38–72 years). There were 34 male patients and 16 female patients. Cervical laminoplasty for OPLL helped alleviate radiculomyelopathy. Compared with the preoperative scores, improvement was seen in postoperative VAS and JOA scores. After laminoplasty, 35 patients had kyphotic changes, and 15 had lordotic changes. However, cervical sagittal alignment after laminoplasty was not significantly associated with clinical outcomes in terms of postoperative improvement of the JOA score (C2–7 Cobb angle: p = 0.633; C2–7 SVA: p = 0.817; T-1 slope minus C2–7 lordosis: p = 0.554), the SF-36 score (C2–7 Cobb angle: p = 0.554; C2–7 SVA: p = 0.793; T-1 slope minus C2–7 lordosis: p = 0.829), the VAS neck score (C2–7 Cobb angle: p = 0.263; C2–7 SVA: p = 0.716; T-1 slope minus C2–7 lordosis: p = 0.497), or the NDI score (C2–7 Cobb angle: p = 0.568; C2–7 SVA: p = 0.279; T-1 slope minus C2–7 lordosis: p = 0.966). Similarly, the change in cervical sagittal alignment was not related to the JOA (p = 0.604), SF-36 (p = 0.308), VAS neck (p = 0.832), or NDI (p = 0.608) scores. CONCLUSIONS Cervical laminoplasty for OPLL improved radiculomyelopathy. Cervical laminoplasty increased the probability of cervical kyphotic alignment. However, cervical sagittal alignment and clinical outcomes were not clearly related.

Sign in / Sign up

Export Citation Format

Share Document