Cervical Pedicle Screw Fixation Combined with Laminoplasty for Cervical Spondylotic Myelopathy with Instability

Abstract

Study DesignA retrospective study.PurposeTo evaluate the surgical results of cervical pedicle screw (CPS) fixation combined with laminoplasty for treating cervical spondylotic myelopathy (CSM) with instability.Overview of LiteratureCervical fixation and spinal cord decompression are required for CSM patients with instability. However, only a few studies have reported on CPS fixation combined with posterior decompression for unstable CSM patients.MethodsThirteen patients that underwent CPS fixation combined with laminoplasty for CSM with instability were evaluated in this study. We assessed the clinical and radiological results of the surgical procedures. The Japanese Orthopedic Association (JOA) scoring system was used to evaluate the clinical results. The percentages of sli p, difference in sli p angle between maximum flexion and maximum extension of unstable intervertebrae, and perforation rate of CPS were evaluated.ResultsThe mean JOA scores before surgery, immediately after surgery, and at final follow-up were 9.1, 13.3, and 12.6, respectively. The mean percentages of sli p before surgery, immediately after surgery, and at final follow-up were 9.1%, 3.2%, and 3.5%, respectively; there were significant improvements immediately after surgery and at final follow-up. The difference in sli p angle between the maximum flexion and maximum extension of the unstable intervertebrae changed from 9.0° before surgery to 1.6° at the final follow-up. The perforation rate of CPS was 10.9%.ConclusionsThe results suggest that CPS fixation combined with laminoplasty is an effective surgical procedure for treating CSM with instability.

Cervical Spondylotic Myelopathy: Pathophysiology and Surgical Approaches

“…However, they did not describe the preservation of the muscle attachment at the C2 level in the technique. Conversely, Cho [37] and Sakaura et al [40] preserved the C2 muscle attachment in their technique, and this resulted in lesser loss of cervical lordosis than that reported by Uehara et al [34]. Interestingly, Su et al [36] reported lesser loss of cervical lordosis after performing C3-C6 laminoplasty without preserving the C2 muscle attachment.…”

“…Most of these studies used the JOA score as a parameter of clinical outcome. They reported that laminoplasty provided significant enhancement of the JOA score in the short-term, mid-term, and long-term follow-up [34][35][36][37][38][39]. However, Sakaura et al [40] reported that the average JOA score was at its highest point in 12 months of follow-up and decreased slightly to 14.9 in the final follow-up.…”

“…Furthermore, the recovery rate (RR) of laminoplasty was greater than 50% in the short-term, mid-term, and long-term follow-up [35,[38][39][40][41]. On the other hand, Uehara et al [34] reported that RR was 47.1% in the final follow-up, but 55.9% immediately after operation. They did not explain the reason for this result, but it was probably because they included patients with cervical instability that were more complex.…”

“…Several studies reported that laminoplasty reduced the C2-C7 lordotic angle [34][35][36][37]. These studies used different laminoplasty methods to provide decompression of the spinal cord.…”

“…It is suggested that the preservation of the C2 muscle attachment can maintain the post operation cervical lordosis angle [40]. Uehara et al [34] used open door laminoplasty, and 84.6% of their cases involved the C3 level. However, they did not describe the preservation of the muscle attachment at the C2 level in the technique.…”