Flexibility and alignment of the cervical spine after laminoplasty for spondylotic myelopathy

Abstract

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.

Three-dimensional computed tomography for evaluation of cervical spinal canal enlargement after en bloc open-door laminoplasty

“…In two recent studies from our group, insigni®cant reduction of lordosis was noted after laminoplasty. 14,24 Although this reduction in the lordotic alignment of the postoperative cervical spine did not signi®cantly a ect neurological improvement, biomechanically, it may be inconvenient for the cord to be released from the lesions at posterior vertebral rims. By evaluating the spinal canal using a threedimensional approach, the present series showed that reductions of lordosis were associated with reduced volume of the cervical spinal canal postoperatively.…”

Limitation of activities of daily living accompanying reduced neck mobility after laminoplasty preserving or reattaching the semispinalis cervicis into axis

“…Although there were many reports of good postoperative neurological improvements after laminoplasty for cervical myelopathy [12,23,28], several postoperative problems have also been reported, including late deterioration of myelopathy symptoms [9,15,20,23], C5 root palsies [3,16,17,21,28], axial symptoms [7,11,14,24,25,31], cervical malalignment [8,15,26,28,30] and loss of flexion-extension ROM [1,5,6,13,15,22,26,28,30]. Especially in recent years, a great deal of attention has been paid to axial symptoms as postoperative complications which adversely affect patients' quality of life.…”

Outcomes of surgical intervention for cervical spondylotic myelopathy accompanying local kyphosis (comparison between laminoplasty alone and posterior reconstruction surgery using the screw-rod system)

“…Chiba et al reported that several patients obtained an acceptable clinical outcome after LP alone, even in the context of cervical kyphosis, and they speculated that the slack of the spinal cord, especially in patients showing reduction of multilevel disc height, should allow acceptable recovery [2]. On the other hand, several authors have insisted that the outcome of LP alone for CSM with local kyphosis was not acceptable [3,4]. Baba et al [3] reported that patients with preoperative kyphosis (mean of 11.7°) showed significantly poorer neurological improvement.…”

“…On the other hand, several authors have insisted that the outcome of LP alone for CSM with local kyphosis was not acceptable [3,4]. Baba et al [3] reported that patients with preoperative kyphosis (mean of 11.7°) showed significantly poorer neurological improvement. Suda et al [4] also reported that outcomes of LP for CSM accompanying local kyphosis with an angle exceeding 13°(when coexisted with myelomalacia) and 5°(without myelomalacia) were poorer than those for CSM without local kyphosis in their multivariate logistic regression analysis.…”