Combined expansive open-door laminoplasty with short-segment lateral mass instrumented fusion for multilevel cervical spondylotic myelopathy with short segment instability

Tang, Huan-Ming; Yeh, Kuang‐Ting; Lee, Ru‐Ping; Chen, Ing‐Ho; Yu, Tzai‐Chiu; Liu, Kuan-Lin; Peng, Cheng-Huan; Wang, Jen-Hung; Wu, Wen‐Tien

doi:10.1016/j.tcmj.2015.09.004

Cited by 6 publications

(6 citation statements)

References 25 publications

(28 reference statements)

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“…For extensive decompression at the cervico-thoracic region, anterior surgery is least preferred and the appropriate surgical option is either C3-T3 laminoplasty or C3-T3 laminectomy with instrumented postero-lateral fusion. However, multi-level laminoplasty is contraindicated in patients with kyphotic cervical spine as it may lead to further cord compression due to loss of alignment [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

A rare case of extensive cervico-thoracic ossification of the posterior longitudinal ligament causing myelopathy

Kaliya-Perumal¹,

Tan²,

Oh³

2018

BioMedicine

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Ossification of the posterior longitudinal ligament (OPLL) most commonly occurs in the cervical spine, usually involving two to three segments; however, the disease has the potential to occur anywhere in the spine. We encountered a fifty-one year old male with progressive unsteadiness and bilateral lower limb weakness for a period of six months which eventually became worse resulting in inability to walk without assistance. Neurological examination revealed normal upper limb function; however, the lower limbs demonstrated motor dysfunction. Signs of myelopathy were elicited and the patient was subjected to detailed radiological evaluation. CT and MRI scans revealed an extensive cervico-thoracic continuous OPLL from C3 to T3 causing significant cord compression. In view of the deteriorating neurological status, extensive C3-T3 laminectomy with instrumented posterolateral fusion was done and the patient recovered without any immediate or delayed C5 palsy. This case highlights a rare occurrence or extensive OPLL involving eight segments at the cervico-thoracic region. This report also discusses surgical strategies for managing such extensive presentations and our technique to prevent C5 palsy.

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Section: Discussionmentioning

confidence: 99%

A rare case of extensive cervico-thoracic ossification of the posterior longitudinal ligament causing myelopathy

Kaliya-Perumal¹,

Tan²,

Oh³

2018

BioMedicine

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“…Researchers have successfully treated degenerative multi‐level cervical stenosis and instability with combined open‐door laminoplasty and unilateral screw fixation on the hinged side 7 . Moreover, open‐door laminoplasty with bilateral lateral mass has been utilized for managing multi‐level cervical spondylotic myelopathy and short‐segment instability or correctable local kyphosis 21 . Su et al 31 found that both techniques provide similar outcomes, including maintenance of cervical curvature and improvement of clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

“… 17 , 18 Pavlov ratio is defined as the sagittal diameter of the spinal canal to that of the vertebral body, and the Pavlov ratios of patients at the C5 level were calculated as previously described. 19 , 20 , 21 , 22 All measurements were repeated three times by two assessors, and the mean value was used for analysis.…”

Section: Methodsmentioning

confidence: 99%

Clinical Outcomes of Open‐Door Laminoplasty Combined with Bilateral Lateral Mass Screw Fixation for Multi‐Level Cervical Spinal Stenosis with Traumatic Cervical Instability and Spinal Cord Injury: A Retrospective Study

Liu

et al. 2023

Orthopaedic Surgery

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Objectives:The prevalence of multi-level cervical spinal stenosis complicated with traumatic cervical instability and spinal cord injury (MCSS-TCISCI) is low, and the optimal surgical approach remains unclear. Open-door laminoplasty combined with bilateral lateral mass screw fixation (ODL-BLMSF) is a relatively new surgical technique; however, its clinical effectiveness in managing MCSS-TCISCI has not been well-established. This study aims to assess the clinical value of ODL-BLMSF against MCSS-TCISCI. Methods:We retrospectively analyzed 20 cases of MCSS-TCISCI treated with ODL-BLMSF from July 2016 to June 2020. Radiographic alterations of all included patients were measured using plain radiographs, CT scans, and MRI scans. Cervical lordosis was evaluated using C2-C7 Cobb angle and cervical curvature index (CCI) on lateral radiographs, and Pavlov ratio at the C5 level. Neurological functional recovery was assessed using Japanese Orthopaedic Association (JOA) scores and Nurick grade, while neck and axial symptoms were assessed using the neck disability index (NDI) and the visual analog scale (VAS). The paired t-test was utilized for statistical analysis.Results: All included patients were followed up for an average period of 26.5 months (range: 24-30 months) after ODL-BLMSF. The average Pavlov ratio at the C5 level significantly improved from 0.57 AE 0.1 preoperatively to 1.13 AE 0.1 and 1.12 AE 0.04 at 6 months postoperatively and at the last follow-up (t = 16.347, 16.536, p < 0.001). Importantly, this approach significantly increased the JOA score from 5.0 AE 2.6 before surgery to 11.65 AE 4.3 and 12.1 AE 4.3 at 6 months postoperatively and at the last follow-up (t = 9.6, À9.600, p < 0.001), with an average JOA recovery rate of 59.1%; and the average Nurick disability score decreased from 3.0 AE 1.3 (preoperative) to 1.65 AE 1.22 and 1.5 AE 1.2 (6 months postoperatively and at last follow-up) (t = 5.111, 1.831, p < 0.001). Meanwhile, the NDI score decreased from 30.3 AE 4.3 preoperatively to 13.2 AE 9.2 at 6 months (t = 12.305, p < 0.001), and to 12.45 AE 8.6 at the final follow-up (t = 13.968, p < 0.001), while the VAS score decreased from 4.0 AE 1.5 preoperatively to 1.5 AE 0.7 at 6 months (t = 9.575, p < 0.001), and to 1.15 AE 0.7 at the final follow-up (t = 10.356, p < 0.001). Conclusion:ODL-BLMSF can effectively dilate the stenotic spinal canal to decompress the spinal cord, maintain good cervical alignment and stability, and improve the recovery of neurological function and neck function. This technique is suitable for treating selected cases of MCSS-TCISCI.

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“…Indirect decompression of the spinal cord, a posterior bony ceiling to protect the neural elements, and motion of the spinal segments can be preserved by expanding the spinal canal posteriorly. However, the posterior procedure is contraindicated in patients with segmental instability, major kyphotic alignment, or major anterior pathology [34]. When a patient presents with long-level stenosis combined with short-level segmental instability, local kyphosis, or major anterior pathology, long-level anterior decompression and fusion with or without posterior instrumented fusion may be indicated.…”

Section: Introductionmentioning

confidence: 99%

Medium-term clinical outcomes of laminoplasty with adjunct short anterior fusion in multilevel cervical myelopathy

Yeh

Lee

et al. 2019

Tzu Chi Med J

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Objectives:Expansive open-door laminoplasty (EOLP) is effective for multilevel cervical spondylotic myelopathy (MCSM). When MCSM is combined with one- or two-level segmental kyphosis, instability, or major anterior foci, EOLP with short-segment anterior cervical fusion (ACF) results in good short-term neurological recovery and can preserve postoperative range of motion (ROM). The objective of this study was to evaluate the medium-term clinical outcomes of this procedure and to analyze the risk factors affecting the neurological function at the last follow-up.Materials and Methods:A total of 87 patients were enrolled in this retrospective study conducted from January 2007 to May 2011. These patients exhibited MCSM with combined short segmental kyphosis, instability, or major anterior pathology, and received EOLP and short-segment anterior fusion. The follow-up period lasted at least 60 months. The radiographic outcomes were collected from plain radiographs with dynamic views checked preoperatively and at the last follow-up. Neurological status and visual analog scale scores for neck pain were evaluated. Logistic regression analysis was then applied to determine the correlation between radiographic parameters and rates of neurological recovery.Results:The mean Japanese Orthopedics Association recovery rate at the last follow-up was 77.8%. The improvement in functional scores and reduction in neck pain were statistically significant. The most influential risk factor affecting neurologic recovery was preoperative functional status.Conclusions:EOLP followed by short-segment ACF is a favorable treatment for patients with MCSM with concomitant short-segment kyphosis, instability, or major anterior pathology.

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Combined expansive open-door laminoplasty with short-segment lateral mass instrumented fusion for multilevel cervical spondylotic myelopathy with short segment instability

Cited by 6 publications

References 25 publications

A rare case of extensive cervico-thoracic ossification of the posterior longitudinal ligament causing myelopathy

A rare case of extensive cervico-thoracic ossification of the posterior longitudinal ligament causing myelopathy

Clinical Outcomes of Open‐Door Laminoplasty Combined with Bilateral Lateral Mass Screw Fixation for Multi‐Level Cervical Spinal Stenosis with Traumatic Cervical Instability and Spinal Cord Injury: A Retrospective Study

Medium-term clinical outcomes of laminoplasty with adjunct short anterior fusion in multilevel cervical myelopathy

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