Comparison of Laminoplasty vs. Laminectomy for Cervical Spondylotic Myelopathy: A Systematic Review and Meta-Analysis

ObjectivesLaminoplasty (LP) and laminectomy (LC) with or without fusion are recommended as treatment procedures for cervical spondylotic myelopathy (CSM). The purpose of this study is to conduct a meta-analysis to analyze the results of CSM patients undergoing LP or LC surgery.MethodsWe systematically and comprehensively searched Web of Science, Cochrane Library, PubMed, EMBASE, OVID, VIP database, Google Scholar, Chinese Bio-medicine Literature database, and China Scientific Journal Full-text database to July 2021 for randomized controlled trials (RCTs) and observational case series that compared LP and LC in patients with CSM. The main endpoints were the surgical process, radiographic outcomes, clinical outcomes, and surgical complications.ResultsA total of 19 were included the inclusion criteria in this meta-analysis (n = 4,348 patients). There was no significant difference in range of motion (ROM), sagittal vertical axis (SVA), Japanese Orthopedic Association (JOA), Cobb angle, visual analog scale (VAS), cervical curvature index (CCI), Nurick score, Neck Dysfunction Index (NDI), and complications. LP was found to be superior than LC in terms of complications of C5 radiculopathy and surperficial infection.ConclusionOur results indicate that LP can achieve better results in C5 radiculopathy and superficial infection in surgical treatment of CSM compared with LC. Further high-quality research is warranted to further verify our findings.Systematic Review RegistrationPRISMA: CRD42018107070.

Surgical management of continuous and mixed type of OPLL in cervical spine: Experience in tertiary level hospital.

Background: Ossification of the posterior longitudinal ligament (OPLL) is a chronically progressive disease of ectopic enchondral and membranous ossification of posterior longitudinal ligament (PLL). Controversy still persists over the superiority of various surgical approaches for cervical OPLL management. Purpose: To see the efficacy of expansive laminoplasty for the management of continuous and mixed type of cervical OPLL retrospectively. Methods: Records of 20 male and 8 female aged 36-72 years (mean, 56.64 years), who underwent surgical treatment posteriorly for continuous and mixed type OPLL by laminoplasty were obtained from the year 2004 - 2020. Clinical features along with imaging studies, which included X -ray/CT /MRI, were done for the diagnosis of OPLL. Multiple variables were studied, including demographics, surgical parameters, complications and functional outcomes. Results: They were followed on an average of 59.86 ± 20.95 months (range, 24 -108 months). The average operative duration was 95 ± 15.52 min (range: 70 - 140), and the intraoperative blood loss was 199.29 ± 33.55 ml. The cervical curvature index reduced to 8.81 ± 1.96 from 11.00 ± 2.49 and the VAS score decreased from 4.25 ± 0.75 to 2.43 ± 1.40. mJOA score improved from 8.64 ± 1.03 to 13.96 ± 1.26 on the last follow-up after surgery (p < 0.01), with average recovery rate of 65.5 %. Conclusions: The management for cervical myelopathy with multilevel stenosis due to continuous and mixed type of OPLL by Laminoplasty is safe and effective.

Morphometric study of sacrum and its clinical implications in population in Bihar

The sacrum is a large triangular bone formed by fusion of five sacral vertebrae and wedged between two hip bones. Dimension of sacrum varies from region to region therefore morphometric study of sacrum in population of Bihar is important for proper fixation during orthopedic procedure in trauma patients. : The objectives of this study was to evaluate the morphometric parameters of sacrum so that a data can be generated from local population. M: The present study was done on 110 human sacra of known sex (62 male and 48 female) collected from department of Anatomy, IGIMS, Patna and also from other medical colleges of Bihar. Maximum length of sacrum, curved length of sacrum, maximum breadth of sacrum, antero-posterior diameter of the body of first sacral vertebra, transverse diameter of the body of first sacral vertebra and maximum length of articular surface of sacrum were measured. Mean value of sacral straight length were 104.55 cm in male and 94.66 cm in female, Curve length 112.03 cm in male and 103.98 cm in female, Width of sacrum 101.53 cm in male and 105.67 cm in female. Transverse diameter of body of 1st sacral vertebra were 46.53 cm and 40.85 cm in male and female respectively, antero-posterior diameter of body of 1st sacral vertebra were 29.89 cm and 27.73 cm in male and female respectively, Length of auricular surface were 56.08 cm and 54.77 cm respectively. Sacral index, curvature index, index of body of first sacral vertebra, corpora-basal index and auricular index were calculated. Morphometric study of sacrum in population of Bihar is important because dimension of sacrum varies from region to region and this is important for proper fixation during orthopedic procedure in trauma patients.

A Modified Open-Door Laminoplasty with Reconstruction of the Cervical Posterior Ligamental Complex to Decrease Axial Pain in Cervical Spondylotic Myelopathy

Background:Cervical spondylotic myelopathy patients with multiple segments are usually treated with the posterior approach. But expansive open laminoplasty (ELAP) often results in heavy, rigid, and acid bilges feelings in the neck, shoulder, and back, collectively known as axial symptoms. Objective: To evaluate the effect of modified posterior cervical ligament complex reconstruction and single-door laminoplasty with titanium plate fixation on postoperative axial symptoms in patients. Methods: A retrospective analysis conducted from June 2016 to March 2018 collected more than 132 cases of cervical spondylotic myelopathy at our institute. Group A includes 74 patients and Group B includes 58 patients who use different surgery method. Gender, age, operation time, intraoperative blood loss, post-operative drainage volume, and follow-up time, Visual analogue scoring (VAS), cervical curvature index (CCI) and the cross-sectional area of the posterior cervical muscles of the two groups were recorded. Results: There was statistical significance in the incidence of axial pain 3 months after surgery (P =0.001), 6 months after surgery (P =0.006), and 1 year after surgery (P =0.015). And the VAS score was decreased in group A 1 week (P <0.0001), 1 ,3 month(P=0.0001), 6 months(P=0.0076), and 1 year(P=0.0085) post-surgery compared to group B. Also the CCI and the posterior cervical muscle area between groups A and B (P < 0.0001).Conclusion: Modified single open-door laminoplasty could relieve cervical axial pain in patients with cervical spondylotic myelopathy.

Multivariate analysis of factors associated with spinal cord area in single-door cervical laminoplasty with miniplate fixation

Objectives To explore the factors associated with the increased spinal cord area in single-door cervical laminoplasty (SDCL) with miniplate fixation. Methods A retrospective study enrolled 83 patients underwent SDCL with miniplate fixation and the patient characteristics such as age, gender, tobacco use, alcohol use, diabetes mellitus, hypertension, diagnosis, operative level, etc., were obtained. The opening angle, door shaft position and spinal canal area of the patients were measured after surgery. The sagittal canal diameter (SCD), the C2–7 Cobb angle, the cervical curvature index (CCI), the range of motion (ROM) and the spinal canal area were measured before and after operation. The increased cervical spinal cord area was also measured before and after surgery, and the correlation between the above indicators and the increased cervical spinal cord area was studied through Pearson’s correlation analysis and multivariate logistic regression analysis. Results There were 34 patients in small spinal cord area increment group (SAI group), 29 patients in middle spinal cord area increment group (MAI group) and 20 patients in large spinal cord area increment group (LAI group). The preoperative diagnosis(P = 0.001), door shaft position (P = 0.008), preoperative spinal canal area (P = 0.004) and postoperative spinal canal area (P = 0.015) were significant different among the 3 groups. The multivariate analysis showed that the preoperative diagnosis (OR = 2.076, P = 0.035), door shaft position (OR = 3.425, P = 0.020) and preoperative spinal canal area (OR = 10.217, P = 0.009) were related to increased spinal cord area. Conclusions The preoperative diagnosis, door shaft position and preoperative spinal canal area might be associated with increased spinal cord area after cervical laminoplasty with miniplate fixation. Preoperative symptoms are mostly caused by compression of the spinal cord, so spinal cord area enlargement can bring a better recovery in patients alongside long-term. Spine surgeons should pay more attention to the accuracy of the preoperative diagnosis, the preoperative measurement of spinal canal area and the door shaft position during the operation.

Optical Coherence Tomography Imaging of the Lamina Cribrosa: Structural Biomarkers in Nonglaucomatous Diseases

The lamina cribrosa (LC) is an active structure that responds to the strain by changing its morphology. Abnormal changes in LC morphology are usually associated with, and indicative of, certain pathologies such as glaucoma, intraocular hypertension, and myopia. Recent developments in optical coherence tomography (OCT) have enabled detailed in vivo studies about the architectural characteristics of the LC. Structural characteristics of the LC have been widely explored in glaucoma management. However, information about which LC biomarkers could be useful for the diagnosis, and follow-up, of other diseases besides glaucoma is scarce. Hence, this literature review aims to summarize the role of the LC in nonophthalmic and ophthalmic diseases other than glaucoma. PubMed was used to perform a systematic review on the LC features that can be extracted from OCT images. All imaging features are presented and discussed in terms of their importance and applicability in clinical practice. A total of 56 studies were included in this review. Overall, LC depth (LCD) and thickness (LCT) have been the most studied features, appearing in 75% and 45% of the included studies, respectively. These biomarkers were followed by the prelaminar tissue thickness (21%), LC curvature index (5.4%), LC global shape index (3.6%), LC defects (3.6%), and LC strains/deformations (1.8%). Overall, the disease groups showed a thinner LC (smaller LCT) and a deeper ONH cup (larger LCD), with some exceptions. A large variability between approaches used to compute LC biomarkers has been observed, highlighting the importance of having automated and standardized methodologies in LC analysis. Moreover, further studies are needed to identify the pathologies where LC features have a diagnostic and/or prognostic value.

Sacrococcygeal Morphologic and Morphometric Risk Factors for Idiopathic Coccydynia: A Magnetic Resonance Imaging Study

Study Design: Retrospective case-control study. Objectives: To evaluate the sacrococcygeal morphologic and morphometric features in idiopathic coccydynia using magnetic resonance imaging (MRI). Methods: MRI scans from 60 patients with idiopathic coccydynia were compared with scans of 60 controls. Assessment of coccygeal morphology included coccygeal segmentation, coccygeal types, bony spicules, sacrococcygeal joint fusion, and intercoccygeal joint fusion and subluxation. Morphometric parameters included coccygeal straight and curved lengths, coccygeal curvature index, sacrococcygeal and intercoccygeal joint angles, sacral straight and curved lengths, sacral curvature index, sacral angle, sacrococcygeal straight and curved lengths, sacrococcygeal curvature index, and sacrococcygeal angle. Results: The coccydynia group included 28 males and 32 females, with a mean age of 36.1 years. Type II coccyx and bony spicules were more common in coccydynia, P = 0.003 and 0.01, respectively. Sacrococcygeal joints were fused less commonly in coccydynia, P = 0.02. Intercoccygeal joint subluxation was more common in coccydynia, P = 0.007. The sacral angle was lower in coccydynia, P = 0.01. The sacrococcygeal curved length was higher in coccydynia, P < 0.001. The sacrococcygeal curvature index was lower coccydynia, P < 0.001. In females only, the coccygeal curvature index was lower in coccydynia patients, P = 0.04. In males only, the intercoccygeal angle was lower in coccydynia patients, P = 0.02. Conclusions: Type II coccyx, bony spicules, intercoccygeal joint subluxation were more common, and sacrococcygeal joint fusion was less common in coccydynia patients. Sacral angle and sacrococcygeal curvature index were lower, while sacrococcygeal curved length was higher in coccydynia patients. Level of Evidence: Level 3. Case-control study.

Impact of Elevation - Glaciation - Tectonics on landscape characteristics of the watersheds in Bhagirathi valley, Garhwal Himalaya

Terrain attributes of watersheds i.e., mean , maximum, minimum elevation, mean slope elevation, mean aspect, HI (Hypsometrical Integral), Plan and Profile curvature index were determined using ASTER DEM in Bhagirathi basin, Uttaarakhand. These attributes are used in determine the impact of elevation, glaciations and tectonic processes on terrain characteristics of the watersheds. The scatter diagrame between altitude and terrain attribute were used to analyse th impact of altitude and impact of glacition is revealed through Box Whisker diagram using moderate and fully glacier watersheds. The results indicated that permanent snowline altitude is important that determine the watershed density in particular elevation and bear direct relationship with area and degree of glaciations. It is found that slope, STD of elevation in glacier basin, profile and plan curvature, relief influenced by glaciations.

A New Posterior Extensor Attachment-Point Reconstruction Technique for Cervical Spondylotic Myelopathy Involving C2 Segment: Clinical Outcome and Safety

Background and Study Aim Cervical spondylotic myelopathy (CSM) is a common degenerative disease that mainly occurs in elder patients, leading to different degrees of neurological dysfunction. Spinal cord involvement is mainly distributed at the C3–C7 segments, but it may also involve up to the C2 level. This study aimed to assess the clinical efficacy and safety of open-door laminoplasty using a new extensor attachment-point reconstruction technique for treating CSM involving the C2 segment. Patients and Methods Fifty-nine patients with CSM involving the C2 segment and undergoing open-door laminoplasty were included in this retrospective study. Based on the titanium plate used in the operation, patients were divided into two groups, a reconstructed titanium plate fixation (RPF) group (n = 28) and a conventional titanium plate fixation (CPF) group (n = 31). Improvements in neurological function, cervical range of motion (ROM), cervical curvature index (CCI), preservation of posterior cervical muscle mass, and axial symptoms were compared between the two groups. Results There were no significant differences in operative time and intraoperative blood loss between the groups (p > 0.05). The Japanese Orthopaedic Association (JOA) score significantly increased in both groups postsurgery (p < 0.05); the neurological recovery rate was similar between the two groups (64.1 ± 13.3% vs. 65.9 ± 14.7%, p > 0.05). There was no significant loss of cervical ROM in either group (p > 0.05). The anteroposterior dural sac diameter at the C2 level was significantly enlarged in both groups (p < 0.05). Alternatively, CCI was significantly reduced in the CRP group (p < 0.05) but unchanged in the RPF group (p > 0.05). The cross-sectional area of the posterior cervical muscles was also significantly reduced in the CPF group (p < 0.05) but maintained in the RPF group (p > 0.05). Finally, axial symptoms were more severe in the CPF group than in the RPF group (p < 0.05). Conclusion Laminoplasty is an effective surgical procedure for CSM involving the C2 segment. The reconstructed titanium plate achieved superior maintenance of cervical curvature and reduced both muscle atrophy and severity of axial symptoms compared with titanium conventional plates.