We investigated lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy. Fifty-five patients (32 men and 23 women) were studied, with an average follow-up of 2.4 years. Radiological examination included evaluation of lordosis of the cervical spine and spinal cord, degree of enlargement of bony spinal canal, and the magnitude of posterior cord migration. We also correlated these changes with neurological improvement. Postoperatively, there was an average of 5% loss of cervical spine lordosis (P > 0.01) on radiographs and 12% reduction in the lordotic alignment of the spinal cord (P > 0.05) on magnetic resonance imaging. Postoperatively, the size of the bony spinal canal increased by 48%. Posterior cord migration showed a significant correlation with the preoperative cervical spine and spinal cord lordosis (P < 0.05). Thirty-seven (67%) patients with neurological improvement exceeding 50% showed significant posterior cord migration following laminoplasty compared with those demonstrating less than 50% improvement (P = 0.01). Our results suggest that a significant neurological improvement is associated with posterior cord migration after cervical laminoplasty.
This paper describes 27 patients who had a spinal fracture and underwent an anterior or a posterior spinal decompression, with or without spinal instrumentation, for late neuro logical compromise secondary to post-traumatic vertebral collapse associated with osteo porosis. Five males and 22 females were studied, with an average follow-up of 3.7 years. The patients developed delayed neurological compromise due to osteoporotic vertebral collapse 1 month to 1. 5 years following insignificant spinal fractures. Abnormal hypermo bility at the collapsed spinal level with gradual retropulsion of fracture fragments into the spinal canal appeared to contribute to late paralysis. This pathology is treated surgically either anteriorly or posteriorly, but we recommend transpedicular posterolateral decom pression and stabilization with a screw-rod construct because of technical ease and minimum invasion.
The long term effects of laminoplasty on cervical movement and alignment were investigated by radiography and CTscans in a study of 56 patients with multisegmental myelopathy who had undergone a C3 to C7 open-door laminoplasty. Follow up averaged 5.8 years. Satisfactory neurological improvement occurred in 73%. Cervical flexion decreased by 35% and extension by 57%; the decrease of both movements was statistically significant. Decreased vertebral slip, as well as slightly reduced lordosis, was seen after operation. Increase in measured canal size after operation and at follow up was 48% and 40%; 8% of the expanded canal size was lost at the last follow up. Expansive open-door laminoplasty leads to a better neurological prognosis in this group of patients, while maintaining an increase in canal size and preserving spinal stability. R6sum& Les effets gt long terme de la laminoplastie sur la mobilitd et l'alignement du rachis cervical ont dtg dtudids par radiographie et tomodensitomitrie. Le travail a portd sur 56 patients atteints de myilopathie spondylitique multisegmentaire, ayant subi une laminoplastie ouverte C 3 -C 7 avec une greffe osseuse rdalisant un espaceur autogkne. Le recul est en moyenne de 5.8 ans (de 2 ~ 10.4) et les rdsultats ont montrd une amdlioration neurologique satisfaisante darts 73% des cas. La flexion itait diminude de 35% et l'extension de 57%. Cette diminution de la mobiReprint requests to: H. Baba lit~ dtait statistiquement significative. On a dgalement observd une rdduction du glissement vertebral et une ldg~re rdduction de la lordose. L'augmentation de la taille du canal apr~s l'intervention chirurgicale dtait de 48% et de 40% au dernier examen; glce moment elle avait disparu dans 8% des cas. Les laminoplasties ouvertes dtendues assurent un meilleur pronostic neuroIogique chez les patients atteints de spondylite multisegmentaire en maintenant la taille du canal et en prdservant la stabilit~ vert~brale.
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