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

Abstract

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.

Early expansive single sided laminoplasty decompression treatment severe traumatic cervical spinal cord injury

“…In this study, opendoor laminoplasty was implemented because of its low surgical difficulty, short time, limited trauma and enough spinal canal area compared with double-door laminoplasty (41). At least one year of follow-up, only two cases cervical kyphosis were found; this low incidence may be related to the routinely protection of the posterior cervical muscles and reconstruction the C2 extensor attachment points (42,43). In addition, due to the retention of lamina medial cortex on the hinge side and the use of titanium plates, no reclosed opendoor was observed during follow-up.…”

Safety and Efficacy of Combined Imbrication Axle Reconstruction and Z-Type Titanium Plate Fixation for Hinge Fracture Displacement During Open-Door Laminoplasty

“…Considering laminectomy has a large damage to the bony structure and posterior ligament complex, spinal surgeons tend to apply open-door laminoplasty to maintain the relative integrity of the spinal canal. 2,6,[8][9][10][11] As the number of surgical cases increase, studies on complications associated with open-door laminoplasty are gradually increasing; the most common of these is hinge fracture during the surgical process. Hinge fracture can occur in C 3-7 segments.…”

“…The vertical distances from C 3 to C 6 vertebral posterior inferior angle to line A was calculated as CCI =(a1+a2+a3+a4)/A × 100%. 2 On cross-sectional computed tomography (CT), we assessed the angle formed by extending the connecting line…”

“…Traditional suture anchor fixation for open-door laminoplasty is associated with a higher incidence of cervical curvature loss and kyphosis. [17][18] However, with the clinical application of a new internal fixation system titanium plate 2,4,7,9,15-17 and various modified preservation techniques for posterior muscularligament complex, 2,10,11 the issue of postoperative cervical curvature loss has gradually decreasedin clinical practice. Yang et al 2 designed a new type of titanium plate that could reconstruct the attachment point of the posterior extensors, and the CCI was well preserved in the follow-up examination.Even with the use of the titanium plate alone, the similar results were reported by Wang et al, 19 who confirmed that the postoperative cervical lordosis decreased slightly with no statistical difference.…”

Minimally invasive laminar lift and posterior cervical laminoplasty via the intermuscular approach: a canine model study

“…However, posterior cervical laminoplasty has been reported to induce a high incidence of postoperative axial symptoms (such as pain and stiffness) [21][22][23][24][25] , which reduce significantly patient satisfaction. The etiological mechanisms of postoperative axial symptoms following posterior cervical laminoplasty have not been fully understood, but are thought to be related to surgical injury to the posterior cervical spinous process-ligament-muscle complex 26,27 .…”