Cervical myelopathy treated by canal-expansive laminaplasty. Computed tomographic and myelographic findings.

Kimura, Ikuo; Oh-hama, Mitsuru; Shingu, H.

doi:10.2106/00004623-198466060-00012

Cited by 52 publications

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“…These results were comparable with previous studies [3,4,6,7]. We have not been able to find a significant correlation between the extent of canal expansion and the degree of neurological recovery.…”

Section: Discussionsupporting

confidence: 91%

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Canal-expansive laminoplasty in 83 patients with cervical myelopathy

Naito

Ogata

Kurose

et al. 1994

International Orthopaedics

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We have reviewed 83 patients who had undergone canal-expansive laminoplasty for the treatment of cervical myelopathy between 1982 and 1991. The procedures used for laminoplasty were a Z-plasty in 35 patients, unilateral laminoplasty in 19, and sagittal splitting of the spinous processes in 29. At an average follow-up of more than two years and five months, there were no significant differences in clinical results among the three operations, and excellent or good results were obtained in more than 70% of the patients. However, Z-plasty was the least preferable because this procedure had the longest operating time and the greatest intraoperative blood loss. The sagittal splitting procedure is recommended in routine laminoplasty in order to avoid complications at the site of osteotomy, and to allow simultaneous posterior fusion to be easily performed.

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Section: Discussionsupporting

confidence: 91%

“…Ito and Tsuji report that satisfactory improvement can be promoted by a minimal degree of enlargement of the spinal canal [4]. Although the exact extent by which the spinal canal should be enlarged is unknown, an increase of the sagittal diameter by 3 -5 m m seems to be adequate to obtain satisfactory results [3,4,6,7].…”

Section: Discussionmentioning

confidence: 99%

Canal-expansive laminoplasty in 83 patients with cervical myelopathy

Naito

Ogata

Kurose

et al. 1994

International Orthopaedics

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confidence: 99%

Boomerang deformity of cervical spinal cord migrating between split laminae after laminoplasty

Kimura¹,

Gomibuchi

Shimoda

et al. 2000

European Spine Journal

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IntroductionCervical laminoplasty, for which there are three major methods -Z-shaped enlargement [4,11], unilateral enlargement [2,5,8,12,20], and median enlargement [9,15,16] -is a useful method for surgical management of cervical myelopathy due to spinal canal stenosis [2]. Of these, Kurokawa's laminoplasty with median splitting of the spinous processes [15] has become the most widespread method in Japan, because it has certain advantages. The most critical advantage is the maintenance of physiological cervical lordosis through the preservation of the posterior bony architecture. This procedure allows the cervical spinal cord to move posteriorly, and decompresses it by opening the laminae on both sides [15]. Some papers have reported satisfactory clinical outcome without serious operative complications using this procedure and its modification [17,23].However, we have already reported two cases of a curious complication after Kurokawa's laminoplasty [13]. We refer to this complication as a "boomerang sign", as it describes the boomerang shape of the cervical spinal cord caused by migration of the cord between the split laminae following Kurokawa's laminoplasty. The grade of the boomerang deformity progressed following surgery as Abstract Patients with cervical compression myelopathy were studied to elucidate the mechanism underlying boomerang deformity, which results from the migration of the cervical spinal cord between split laminae after laminoplasty with median splitting of the spinous processes (boomerang sign). Thirty-nine cases, comprising 25 patients with cervical spondylotic myelopathy, 8 patients with ossification of the posterior longitudinal ligament, and 6 patients with cervical disc herniation with developmental canal stenosis, were examined. The clinical and radiological findings were retrospectively compared between patients with (B group, 8 cases) and without (C group, 31 cases) boomerang sign. Moderate increase of the grade of this deformity resulted in no clinical recovery, although there was no difference in clinical recovery between the two groups. Most boomerang signs developed at the C4/5 and/or C5/6 level, where maximal posterior movement of the spinal cord was achieved. Widths between lateral hinges and between split laminae in the B group were smaller than in the C group. Flatness of the spinal cord in the B group was more severe than in the C group. In conclusion, the boomerang sign was caused by posterior movement of the spinal cord, narrower enlargement of the spinal canal and flatness of the spinal cord.

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“…The reported long-term results of this procedure have been considered satisfactory. [1][2][3][4][5][6][7][8][9][10][11][12] However, a few patients have exhibited late neurological deterioration after good recovery immediately after surgery. Numerous studies have been performed to elucidate the causes of late deterioration after this procedure.…”

Section: Introductionmentioning

confidence: 99%

“…7,10,12,13 Although spondylotic changes including spur formation and disc herniation have occasionally developed in operated segments after laminoplasty, few patients have required additional surgery for treatment of relapse of neurological deficits. [1][2][3][4][6][7][8][9][10][11][12] It is believed that the spinal cord is rarely compressed by spondylotic changes since it is shifted posteriorly in the enlarged spinal canal after laminoplasty.…”

Section: Introductionmentioning

confidence: 99%

Delayed segmental motor paralysis following laminoplasty: two case reports

et al. 2005

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Study design: Two patients who experienced the onset of segmental motor paralysis several years after laminoplasty are presented. Objectives: To discuss the mechanism of development of delayed segmental motor paralysis following laminoplasty. Setting: A department of orthopaedic surgery in Japan. Methods: One patient experienced motor weakness in his deltoid and biceps muscles on the left side 5 years after laminoplasty. The other patient noticed motor weakness in his deltoid and biceps on the right side 7 years after laminoplasty. CT myelography revealed posterior spur formation and hypertrophic facet joints on the hinged side at the C4-C5 level in both patients. Results: Posterior foraminotomy was performed at the C4-C5 level on the hinged side in both patients. Postoperatively, motor weakness in the deltoid and biceps muscles was improved in both patients. Conclusions: Although spondylotic changes, including spur formation and disc herniation, have occasionally developed in operated segments after laminoplasty, few patients have required additional surgery for treatment of relapse of neurological deficits. It has been believed that spinal cord is rarely compressed by the spondylotic changes since it shifts posteriorly in the enlarged spinal canal. However, laminoplasty disturbs the facet joints since the medial portion of dorsal cortex and cancellous bone in facet joints is drilled out to make a trough. Facet joints disturbed in this fashion undergo degeneration over time after surgery. Nerve roots may occasionally be compressed by degenerated facet joints and spurs that have developed at the entrance of root canal, resulting in segmental motor paralysis several years after laminoplasty. Careful long-term observation is necessary after this procedure.

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Cervical myelopathy treated by canal-expansive laminaplasty. Computed tomographic and myelographic findings.

Cited by 52 publications

References 0 publications

Canal-expansive laminoplasty in 83 patients with cervical myelopathy

Canal-expansive laminoplasty in 83 patients with cervical myelopathy

Boomerang deformity of cervical spinal cord migrating between split laminae after laminoplasty

Delayed segmental motor paralysis following laminoplasty: two case reports

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