scholarly journals Role of Decompressive Laminectomy without Instrumentation in the Management of Nurick Grade 4 and 5 Cervical Compressive Myelopathy

2019 ◽  
Vol 10 (01) ◽  
pp. 21-27 ◽  
Author(s):  
Sunil Malagi ◽  
Subhas Konar ◽  
Dhaval P. Shukla ◽  
Dhananjaya I. Bhat ◽  
Nishanth Sadashiva ◽  
...  
Keyword(s):  
Posterior Longitudinal Ligament ◽  
Female Ratio ◽  
Decompressive Laminectomy ◽  
Japanese Orthopedic Association ◽  
Poor Grade ◽  
Cervical Compressive Myelopathy ◽  
The Mean ◽  
Ossified Posterior Longitudinal Ligament ◽  
Compressive Myelopathy

ABSTRACT Introduction: Cervical laminectomy is a very well-known posterior decompressive procedure for cervical compressive myelopathy (CCM). Our objective is to evaluate the functional effect of posterior decompressive laminectomy for poor grade CCM. Methods: This study was an observational retrospective study carried out on patients with poor-grade CCM who underwent decompressive laminectomy from January 2010 to December 2015. Patients with Nurick Grades 4 and 5 (walking with support or bedbound) were included in the study. Clinical data and radiological information were collected from medical records, and objective scales were applied to compare the surgical outcome between preoperative score and postoperative score. Results: A total of 69 patients who underwent decompressive laminectomy for poor grade CCM were included. The mean age was 54.9 years, and the male-to-female ratio was 5.3:1. Ossified posterior longitudinal ligament comprised 52.6% cases. The follow-up data of at least 6 months' duration after surgery was available for 57 (82.6%) cases. On comparing with preoperative Nurick grade at follow-up, 40 of the 57 patients (70.2%) were found to have improvement following surgery by at least one grade. The remaining 17 (29.8%) had either remained the same or had deteriorated further. The mean preoperative modified Japanese Orthopedic Association score was 8.4 ± 2.8, and the mean follow-up score was 11.8±0.3 (P = 0.0001). On multivariate analysis, the number of levels of laminectomy, postoperative deterioration, and anesthesia grade were predictors of outcome. Conclusion: Decompressive laminectomy for poor grade myelopathy is effective in improving functional outcome.

“Skip” corpectomy in the treatment of multilevel cervical spondylotic myelopathy and ossified posterior longitudinal ligament

2010 ◽  
Vol 12 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Sedat Dalbayrak ◽  
Mesut Yilmaz ◽  
Sait Naderi
Keyword(s):  
Vertebral Body ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Japanese Orthopaedic Association Score ◽  
Cervical Lordosis ◽  
The Mean ◽  
Ossified Posterior Longitudinal Ligament ◽  
Multilevel Cervical Spondylotic Myelopathy

Object The authors reviewed the results of “skip” corpectomy in 29 patients with multilevel cervical spondylotic myelopathy (CSM) and ossified posterior longitudinal ligament (OPLL). Methods The skip corpectomy technique, which is characterized by C-4 and C-6 corpectomy, C-5 osteophytectomy, and C-5 vertebral body preservation, was used for decompression in patients with multilevel CSM and OPLL. All patients underwent spinal fixation using C4–5 and C5–6 grafts, and anterior cervical plates were fixated at C-3, C-5, and C-7. Results The mean preoperative Japanese Orthopaedic Association score increased from 13.44 ± 2.81 to 16.16 ± 2.19 after surgery (p < 0.05). The cervical lordosis improved from 1.16 ± 11.74° to 14.36 ± 7.85° after surgery (p < 0.05). The complications included temporary hoarseness in 3 cases, dysphagia in 1 case, C-5 nerve palsy in 1 case, and C-7 screw pullout in 1 case. The mean follow-up was 23.2 months. The final plain radiographs showed improved cervical lordosis and fusion in all cases. Conclusions The authors conclude that the preservation of the C-5 vertebral body provided an additional screw purchase and strengthened the construct. The results of the current study demonstrated effectiveness and safety of the skip corpectomy in patients with multilevel CSM and OPLL.

scholarly journals Clinical outcomes of laminoplasty for patients with lysosomal storage disease including mucopolysaccharidosis and mucolipidoses: a retrospective cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hidetomi Terai ◽  
Koji Tamai ◽  
Masatoshi Hoshino ◽  
Hiromitsu Toyoda ◽  
Akinobu Suzuki ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Atlantoaxial Instability ◽  
Symptom Improvement ◽  
Posterior Arch ◽  
Type I ◽  
Lysosomal Storage ◽  
Japanese Orthopedic Association ◽  
The Mean

Abstract Background Although the clinical efficacy of laminoplasty in adult cervical spondylotic myelopathy or ossification of posterior longitudinal ligament has been frequently reported, there are only few reports of laminoplasty for patients with lysosome storage diseases (LSDs). Therefore, this study aimed to report the midterm clinical and radiological outcomes of patients with LSDs after cervical laminoplasty. Methods Six patients with LSD who underwent laminoplasty with/without C1 laminectomy for cervical myelopathy were enrolled. Clinical evaluations, including the cervical Japanese Orthopedic Association (cJOA) score and visual analog scale (VAS) scores for upper extremity numbness, and radiographic parameters, including C2–C7 lordotic angle, atlanto-dens interval (ADI), and ⊿ADI, were evaluated preoperatively, at 2 years postoperatively, and at the final follow-up. Results Five patients had mucopolysaccharidoses (type I: n = 1, II: n = 3, VII: n = 1) and one patient had mucolipidoses type III. The mean age of patients at surgery was 27.5 years, and the mean postoperative follow-up period was 61 months. All mucopolysaccharidoses cases required C1 posterior arch resection with C2–C7 laminoplasty. No critical complications were observed postoperatively. There were no significant differences in C2–C7 angle (p = 0.724) and ⊿ADI (p = 0.592) between the preoperative and final follow-ups. The cJOA score and VAS for numbness significantly improved at the final follow-up (p = 0.004 and p = 0.007, respectively). Conclusions The cervical myelopathy in patients with LSD could be safely and effectively treated with laminoplasty with/without C1 posterior arch resection after excluding patients with atlantoaxial instability. Atlantoaxial stability and symptom improvement could be maintained at an average of 5 years postoperatively.

Functional Outcome after Central Corpectomy in Poor-grade Patients with Cervical Spondylotic Myelopathy or Ossified Posterior Longitudinal Ligament

Neurosurgery ◽  
2005 ◽  
Vol 56 (6) ◽  
pp. 1279-1285 ◽  
Author(s):  
Vedantam Rajshekhar ◽  
G Samson Sujith Kumar
Keyword(s):  
Functional Outcome ◽  
Cervical Spondylotic Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Outcome Data ◽  
Functional Improvement ◽  
Prognostic Indicators ◽  
Poor Grade ◽  
Grade 5 ◽  
Ossified Posterior Longitudinal Ligament

Abstract OBJECTIVE: We studied the long-term functional outcome in poor-grade patients (Nurick Grades 4 and 5) with cervical spondylotic myelopathy (CSM) or ossified posterior longitudinal ligament after central corpectomy (CC). We sought to determine whether there were any prognostic factors that could predict functional outcome in these patients. METHODS: Functional outcome data were collected for 72 patients (68 men and 4 women; mean age, 49.7 yr; range, 30–67 yr) with CSM (60 patients) or OPLL (12 patients) of Nurick Grades 4 (55 patients) and 5 (17 patients). Uninstrumented CC was performed at 1 level in 12 patients, at 1 level combined with a discoidectomy at another level in 4 patients, at 2 levels in 50 patients, and at 2 levels plus a discoidectomy in 5 patients. The age at presentation (≤50 yr or &gt;50 yr), grade before surgery (4 or 5), the number of levels operated (1 or &gt;1), diagnosis (CSM or ossified posterior longitudinal ligament), and duration of myelopathic symptoms (≤12 mo or &gt;12 mo) were studied for their effect on the functional outcome noted at the last follow-up. Functional outcome was graded as poor (no change in Nurick grade), fair (improvement of one Nurick grade), good (improvement of two Nurick grades), and cure (follow-up Nurick grade of 0 or 1). RESULTS: The follow-up ranged from 9 to 104 months (mean, 36.3 mo). One patient died 3 weeks after CC after surgery for a perforated duodenal ulcer. There was transient operative morbidity in 12 patients (16.9%). The mean Nurick score improved from 4.24 to 2.47 (P &lt; 0.001). Of the 54 patients (76%) who improved in their Nurick grade, the functional outcome was graded as fair in 13 patients (18.3%), good in 24 patients (33.8%), and cure in 17 patients (23.9%). The functional outcome was poor in 17 patients (23.9%). Functional improvement after CC was uniformly correlated with myelopathic symptoms of 12 months' duration or shorter. The other favorable prognostic indicators for improvement after CC were a diagnosis of CSM and preoperative Nurick Grade 5; however, patients with a preoperative Nurick grade of 4 were more likely to experience a cure. CONCLUSION: More than three-fourths of patients with poor-grade CSM improve in their functional status after CC, with nearly 24% of patients obtaining a cure. Because patients with a duration of myelopathic symptoms of 12 months or less had the best functional outcome, early decompressive surgery should be offered to patients with poor-grade CSM.

Outcome of Thoracic Column Antedisplacement and Fusion in Treatment of Thoracic Myelopathy Caused by Ossification of Posterior Longitudinal Ligament: A Case Series Study

2021 ◽  
Author(s):  
Xiangyang Ma ◽  
Binbin Wang ◽  
Yuyue Chen ◽  
Su Ge ◽  
Xiaobao Zou ◽  
...  
Keyword(s):  
Case Series ◽  
Posterior Longitudinal Ligament ◽  
Cerebrospinal Fluid Leakage ◽  
Thoracic Myelopathy ◽  
Japanese Orthopedic Association ◽  
Canal Diameter ◽  
Case Series Study ◽  
Cord Injury ◽  
The Mean

Abstract BACKGROUND Up to date, surgical outcome of multilevel thoracic ossification of posterior longitudinal ligament (T-OPLL) with high canal occupation ratio is less satisfactory. OBJECTIVE To explore the result of thoracic column antedisplacement and fusion (TCAF) in treatment of multilevel T-OPLL with high canal occupation ratio. METHODS A total of 5 patients who underwent TCAF procedure for T-OPLL were retrospectively reviewed. Parameters including extent of OPLL, thickness of the maximal OPLL (max-OPLL), maximal canal occupying ratio (max-COR) of OPLL, effective canal diameter (ECD) at the max-OPLL level, antedisplacement distance of thoracic columns, ASIA grades, Japanese Orthopedic Association (JOA) scores, and complications were collected and analyzed at preoperation and the last follow-up. RESULTS All patients (5 F, mean age 61.0 yr, mean follow-up 18.0 months) underwent TCAF successfully and no spinal cord injury or cerebrospinal fluid leakage occurred. The mean extent of OPLL was 2.8 vertebral bodies. The mean preoperative thickness of the max-OPLL was 5.9 mm. The average antedisplacement distance of thoracic columns was 5.6 mm. The mean ECD was improved from 6.5 mm to 10.9 mm, and the max-COR was improved from 50.7% to 7.1% at last follow-up. Two patients showed improvement in ASIA grades and JOA scores were significantly improved from 5.6 points to 10.4 points at final follow-up. The overall therapeutic results of 1 patient were classified into good and 4 into fair at last follow-up. CONCLUSION TCAF may be a safe and effective procedure in treatment of multilevel T-OPLL with high canal occupation ratio.

scholarly journals Effect of preservation of the C-6 spinous process and its paraspinal muscular attachment on the prevention of postoperative axial neck pain in C3–6 laminoplasty

2015 ◽  
Vol 22 (3) ◽  
pp. 221-229 ◽  
Author(s):  
Eiji Mori ◽  
Takayoshi Ueta ◽  
Takeshi Maeda ◽  
Itaru Yugué ◽  
Osamu Kawano ◽  
...  
Keyword(s):  
Neck Pain ◽  
Spinous Process ◽  
Posterior Longitudinal Ligament ◽  
Paraspinal Muscle ◽  
Vas Scores ◽  
The Mean ◽  
Axial Neck Pain ◽  
Process Length ◽  
Preservation Technique

OBJECT Axial neck pain after C3–6 laminoplasty has been reported to be significantly lesser than that after C3–7 laminoplasty because of the preservation of the C-7 spinous process and the attachment of nuchal muscles such as the trapezius and rhomboideus minor, which are connected to the scapula. The C-6 spinous process is the second longest spinous process after that of C-7, and it serves as an attachment point for these muscles. The effect of preserving the C-6 spinous process and its muscular attachment, in addition to preservation of the C-7 spinous process, on the prevention of axial neck pain is not well understood. The purpose of the current study was to clarify whether preservation of the paraspinal muscles of the C-6 spinous process reduces postoperative axial neck pain compared to that after using nonpreservation techniques. METHODS The authors studied 60 patients who underwent C3–6 double-door laminoplasty for the treatment of cervical spondylotic myelopathy or cervical ossification of the posterior longitudinal ligament; the minimum follow-up period was 1 year. Twenty-five patients underwent a C-6 paraspinal muscle preservation technique, and 35 underwent a C-6 nonpreservation technique. A visual analog scale (VAS) and VAS grading (Grades I–IV) were used to assess axial neck pain 1–3 months after surgery and at the final follow-up examination. Axial neck pain was classified as being 1 of 5 types, and its location was divided into 5 areas. The potential correlation between the C-6/C-7 spinous process length ratio and axial neck pain was examined. RESULTS The mean VAS scores (± SD) for axial neck pain were comparable between the C6-preservation group and the C6-nonpreservation group in both the early and late postoperative stages (4.1 ± 3.1 vs 4.0 ± 3.2 and 3.8 ± 2.9 vs 3.6 ± 3.0, respectively). The distribution of VAS grades was comparable in the 2 groups in both postoperative stages. Stiffness was the most prevalent complaint in both groups (64.0% and 54.5%, respectively), and the suprascapular region was the most common site in both groups (60.0% and 57.1%, respectively). The types and locations of axial neck pain were also similar between the groups. The C-6/C-7 spinous process length ratios were similar in the groups, and they did not correlate with axial neck pain. The reductions of range of motion and changes in sagittal alignment after surgery were also similar. CONCLUSIONS The C-6 paraspinal muscle preservation technique was not superior to the C6-nonpreservation technique for preventing postoperative axial neck pain.

scholarly journals Myofacial Release for the Management of Cervical Compressive Myelopathy – Case Study

2021 ◽  
Vol 1 (2) ◽  
pp. 1-5
Author(s):  
Patitapaban Mohanty ◽  
Keyword(s):  
Soft Tissue ◽  
Disc Herniation ◽  
Cord Compression ◽  
Surgical Decompression ◽  
Cervical Cord ◽  
Myofascial Release ◽  
Cervical Compressive Myelopathy ◽  
Compressive Myelopathy

Cervical compressive myelopathy commonly occurs due to degeneration or disc herniation. The persons with cervical meylopathy are usually advised for surgical decompression. Person with signs of cervical cord compression was treated with myofacial release and found to be improved in signs as well as the symptoms. Total 34 numbers of similar cases (31 males and 3 females) age ranging from 25 to 61 years were treated by myofascial release of periscapular soft tissue structures over last 2 & ½ years (2017 to 2020) and found to return back to their activities after 6 months of follow up.

Gamma Knife surgery for invasive pituitary macroadenoma

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 26-30 ◽  
Author(s):  
Mooseong Kim ◽  
Sunghwa Paeng ◽  
Seyoung Pyo ◽  
Yeonggyun Jeong ◽  
Sunil Lee ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Pituitary Macroadenoma ◽  
Female Ratio ◽  
Fractionated Radiotherapy ◽  
The Mean

ObjectPituitary adenomas have been treated using a variety of modalities including resection, medication, fractionated radiotherapy, and stereotactic radiosurgery. The policy has been that all adenomas should first be treated with resection to reduce the volume of the tumor. The authors' study was conducted to determine the efficacy of using Gamma Knife surgery (GKS) for pituitary adenomas invading the cavernous sinus.MethodsOf 397 patients with pituitary tumors who underwent GKS between October 1994 and October 2005, 68 patients had pituitary macroadenomas invading the cavernous sinus. Sixty-seven cases were available for follow up. The mean age of the patients in these cases was 42.8 years (range 14–73 years). The male/female ratio was 0.8:1. The mean adenoma volume was 9.3 cm3. A total of 24 patients had undergone craniotomies and resection, and 11 patients had undergone transsphenoidal surgery prior to GKS. The mean follow-up period was 32.8 months. Tumor control was defined as a decrease or no change in tumor volume after GKS. Endocrinological improvement was defined as a decline in hormone levels to below 50% of the pre-GKS level.Tumor control was achieved in 95.5% of the cases. Endocrinological improvement was achieved in 68% of 25 patients. One patient suffered hypopituitarism after GKS.Conclusions Gamma Knife surgery is a safe and effective treatment for invasive pituitary macroadenoma with few complications.

Conservative management of ossification of the posterior longitudinal ligament

2011 ◽  
Vol 30 (3) ◽  
pp. E2 ◽  
Author(s):  
Martin H. Pham ◽  
Frank J. Attenello ◽  
Joshua Lucas ◽  
Shuhan He ◽  
Christopher J. Stapleton ◽  
...  
Keyword(s):  
Conservative Management ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Japanese Orthopaedic Association Score ◽  
Clinical Progression ◽  
Association Score ◽  
Rate Of Progression ◽  
The Mean ◽  
High Chance

Object Ossification of the posterior longitudinal ligament (OPLL) can result in significant myelopathy. Surgical treatment for OPLL has been extensively documented in the literature, but less data exist on conservative management of this condition. Methods The authors conducted a systematic review to identify all reported cases of OPLL that were conservatively managed without surgery. Results The review yielded 11 published studies reporting on a total of 480 patients (range per study 1–359 patients) over a mean follow-up period of 14.6 years (range 0.4–26 years). Of these 480 patients, 348 (72.5%) were without myelopathy on initial presentation, whereas 76 patients (15.8%) had signs of myelopathy; in 56 cases (15.8%), the presence of myelopathy was not specified. The mean aggregate Japanese Orthopaedic Association score on presentation for 111 patients was 15.3. Data available for 330 patients who initially presented without myelopathy showed progression to myelopathy in 55 (16.7%), whereas the other 275 (83.3%) remained progression free. In the 76 patients presenting with myelopathy, 37 (48.7%) showed clinical progression, whereas 39 (51.5%) remained clinically unchanged or improved. Conclusions Patients who present without myelopathy have a high chance of remaining progression free. Those who already have signs of myelopathy at presentation may benefit from surgery due to a higher rate of progression over continued follow-up.

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