Laminoplasty Does not Lead to Worsening Axial Neck Pain in the Properly Selected Patient With Cervical Myelopathy

Stephens, Byron F.; Rhee, John M.; Neustein, Thomas M.; Arceo, Rafael

doi:10.1097/brs.0000000000002308

Cited by 37 publications

(38 citation statements)

References 11 publications

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“…Many studies on pain after laminoplasty focus on axial neck pain, which negatively affects clinical outcomes [22][23][24][25][26][27]. Our study extended these results, clarifying that neck or shoulder pain is an indicator of poor results for cervical function, such as the movements involved in drinking or looking up or down [10].…”

Section: Discussionsupporting

confidence: 75%

“…In particular, pain in the arms or hands directly degraded the QOL. These results specifically emphasize the importance of perioperative and postoperative pain management [25,26,28,29]. To reduce pain, for example, it might be better to select laminectomy and fusion surgery over laminoplasty for patients with axial pain or a kyphotic preoperative C2-C7 alignment [26].…”

Section: Discussionmentioning

confidence: 94%

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Clinical indicators of surgical outcomes after cervical single open-door laminoplasty assessed by the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire

et al. 2019

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Study design Retrospective cohort study. Objectives The old-version JOA score for cervical myelopathy (CM) is an evaluation system performed by medical providers that focuses only on neurological function. The purpose of this study was to evaluate patient-reported outcomes using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and to clarify clinical factors that affect the therapeutic effectiveness for CM. Setting Single institute in Japan. Methods We reviewed surgical outcomes for 126 CM patients who were treated by single open-door laminoplasty and were followed at least 2 years. We assessed clinical information, JOACMEQ, JOA scores, and radiographic parameters. Patients were grouped according to effective or ineffective surgical outcomes as defined by the JOACMEQ using logistic regression analyses. Results Laminoplasty resulted in functional improvement in the cervical spine and extremities for 40-50% of the patients, while bladder function showed only minimal recovery. Multivariable analyses revealed that a significant postoperative reduction in neck or shoulder pain influenced the effective functional recovery of the cervical spine. A reduction in arm or hand pain favorably affected the postoperative upper extremity function. Lower age and a postoperative decrease in limb pain were correlated with significantly improved function of the lower extremities. A postoperative reduction in arm pain enhanced the QOL recovery. Conclusions The JOACMEQ makes it possible to analyze multiple aspects of surgical outcomes for patients who undergo cervical spine surgery. Open-door laminoplasty did not provide favorable results for some patients, which highlights the importance of assessing the indications for this procedure and managing postoperative pain.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 94%

Clinical indicators of surgical outcomes after cervical single open-door laminoplasty assessed by the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire

et al. 2019

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“…After intraoperative xation with lateral mass screws, the trend of progressive cervical curvature loss and high frequency of kyphosis deformities were effectively controlled, but the cervical curvature became smaller in some patients still existence [3,5]. From the analysis on anatomy and biomechanics, both open-door laminoplasty and laminectomy will destroy the spinous process, vertebral plate and posterior ligaments complex to varying degrees, resulting in loss of effective attachment points of the cervical posterior muscle group, weakening of the muscle tension band, loss or straightenness of curvature due to the failure to maintain the original cervical curvature [4,6,9,[11][12]. It has been reported that maintaining a good physiological curvature can make cervical spine more elastic, relieve shock and buffer stress during movement, and play a role in protecting the spinal cord [7].…”

Section: Discussionmentioning

confidence: 99%

“…Neurological recovery rate= (postoperative score -preoperative score)/ (17 -preoperative score) × 100%. Axial symptoms (AS) are often manifested as postoperative neck pain with neck and shoulder stiffness, tension, and discomfort of sore and swollen [9]. According to the evaluation criteria developed by Hosono et al [10].…”

Section: Imaging Evaluationmentioning

confidence: 99%

Cervical curvature changes following laminectomy with lateral mass screw fixation: Does it relate with spinal cord shift and clinical efficacy

Hou

Sun²,

Liu

et al. 2020

Preprint

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Background Laminectomy with lateral mass screw fixation (LCSF) is an effective operation type for the treatment of cervical spondylotic myelopathy (CSM), however, the cervical curvature loss is often observed in some patients after operation. Will the cervical curvature change affect the spinal cord drift distance and the decompression effect? The aim of this study is to investigate the effects of different cervical curvature on spinal cord drift distance and clinical efficacy. Methods A total of 78 cases of CSM patients underwent LCSF were included in this retrospective study. The cervical curvature was measured according to the Bordon method 6 months after the operation, and the patients were divided into two groups. Group A: 42 cases with reduced cervical curvature (0 < the cervical lordosis depth < 7 mm) and group B: 36 cases with normal cervical curvature (7 mm ≤ the cervical lordosis depth ≤ 17 mm). The spinal cord drift distance, laminectomy width, neurological functional recovery, axial symptom (AS) severity and the occurrence of C5 palsy in both groups were observed. Results The cervical lordosis depth was (5.1 ± 1.2) mm in group A and (12.3 ± 2.4) mm in group B (P < 0.05). The laminectomy width was (21.5 ± 2.6) mm in group A and (21.9 ± 2.8) mm in group B (P > 0.05). The spinal cord drift distance was (1.9 ± 0.4) mm in group A and (2.6 ± 0.7) mm in group B, with statistically significant difference between the two groups (P < 0.05). The postoperative JOA scores in both groups were significantly increased (P < 0.05), and there was no significant difference in the neurological recovery rate (61.5% vs 62.7%) between the two groups (P > 0.05). According to the grading standard of AS, the severity of AS in group A was significantly higher than that in group B (P < 0.05). Three cases (7.1%) of C5 palsy occurred in group A and 4 cases (11.1%) occurred in group B (P > 0.05). Conclusion After LCSF, more than half of the patients had cervical curvature loss. The smaller of the cervical curvature was, the shorter distance the spinal cord drifted backward. The loss of cervical curvature was related to the severity of axial symptoms, rather than the improvement of neurological function and C5 palsy.

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“…The Neck Disability Index (NDI), first introduced by Vernon et al in 1991, 55 has been widely translated, repeatedly validated, and extensively used for measurement of pain and functional outcome in the cervical spine. 31,38,47,[56][57][58][59][60][61][62] Similarly, the introduction of the Japanese Orthopaedic Association (JOA) myelopathy scale, 63 and its subsequent adaptation into the modified JOA (mJOA) to fit the North American context, 64 has been instrumental in studies of degenerative cervical myelopathy. 31,35,38,47,62,65,66 The entire list of outcome measures for spine surgery is extensive, and categorically includes measures aimed at various aspects of care as well as particular populations.…”

Section: Reporting Of Outcomesmentioning

confidence: 99%

Quality and Safety Improvement in Spine Surgery

Jiang

Wilson

Badhiwala

et al. 2020

Global Spine Journal

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Study Design: Review article. Objectives: A narrative review of the literature on the current advances and limitations in quality and safety improvement initiatives in spine surgery. Methods: A comprehensive literature search was performed using Ovid MEDLINE focusing on 3 preidentified concepts: (1) quality and safety improvement, (2) reporting of outcomes and adverse events, and (3) prediction model and practice guidelines. The search was conducted under appropriate subject headings and using relevant text words. Articles were screened, and manuscripts relevant to this discussion were included in the narrative review. Results: Quality and safety improvement remains a major research focus attracting investigators from the global spine community. Multiple databases and registries have been developed for the purpose of generating data and monitoring the progress of quality and safety improvement initiatives. The development of various prediction models and clinical practice guidelines has helped shape the care of spine patients in the modern era. With the reported success of exemplary programs initiated by the Northwestern and Seattle Spine Team, other quality and safety improvement initiatives are anticipated to follow. However, despite these advancements, the reporting metrics for outcomes and adverse events remain heterogeneous in the literature. Conclusion: Constant surveillance and continuous improvement of the quality and safety of spine treatments is imperative in modern health care. Although great advancement has been made, issues with reporting outcomes and adverse events persist, and improvement in this regard is certainly needed.

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Laminoplasty Does not Lead to Worsening Axial Neck Pain in the Properly Selected Patient With Cervical Myelopathy

Abstract: 3.

Cited by 37 publications

References 11 publications

Clinical indicators of surgical outcomes after cervical single open-door laminoplasty assessed by the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire

Clinical indicators of surgical outcomes after cervical single open-door laminoplasty assessed by the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire

Cervical curvature changes following laminectomy with lateral mass screw fixation: Does it relate with spinal cord shift and clinical efficacy

Quality and Safety Improvement in Spine Surgery

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