Long-term follow-up of cervical spondylotic myelopathy treated by canal-expansive laminoplasty

Kimura, Ikuo; Shingu, H.; Nasu, Y.

doi:10.1302/0301-620x.77b6.7593114

Cited by 198 publications

(103 citation statements)

References 4 publications

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“…Studies involving patients with cervical kyphosis [15°were excluded because this is considered to be a contraindication for posterior surgery by many researchers [20]. Studies involving patients with cervical myelopathy caused by OPLL were excluded because this condition is different from CSM in terms of etiology, pathogenesis, and natural history; hence, this may have affected the surgeon's decision making regarding the surgical approach used.…”

Section: Exclusion Criteriamentioning

confidence: 99%

Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis

et al. 2013

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Purpose To compare the clinical outcomes, complications, and surgical trauma between anterior and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy. Study design Systematic review and meta-analysis. Methods We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases for randomized controlled trials or non-randomized controlled trials that compared anterior and posterior surgical approaches for the treatment of multilevel cervical spondylotic myelopathy. Exclusion criteria were non-controlled studies, combined anterior and posterior surgery, follow-up \1 year, cervical kyphosis [15°, and cervical myelopathy caused by ossification of the posterior longitudinal ligament. The main end points included: recovery rate; Japanese Orthopedic Association (JOA) score; reoperation rate; complication rate; blood loss; and operation time. Subgroup analysis was conducted according to the mean number of surgical segments. Result A total of eight studies were included in the metaanalysis; none of which were randomized controlled trials. All of the selected studies were of high quality as indicated by the Newcastle-Ottawa scale. In five studies involving 351 patients, the preoperative JOA score was similar between the anterior and posterior groups [P [ 0.05, WMD: -0.00 (-0.56, 0.56)]. In four studies involving 268 patients, the postoperative JOA score was higher in the anterior group compared with the posterior group [P \ 0.05, WMD: 0.79 (0.16, 1.42)]. For recovery rate, there was significant heterogeneity among the four studies involving 304 patients, hence, only descriptive analysis was performed. In seven studies involving 447 patients, the postoperative complication rate was significant higher in the anterior group compared with the posterior group [P \ 0.05, odds ratio: 2.60 (1.63, 4.15)]. Of the 245 patients in the 8 studies who received anterior surgery, 21 (8.57 %) received reoperation. Of the 285 patients who received posterior surgery, only 1 (0.3 %) received reoperation. The reoperation rate was significantly higher in the anterior group compared with the posterior group (P \ 0.001). In the 3 studies involving 236 patients compared subtotal corpectomy and laminoplasty/laminectomy, blood loss and operation time were significantly higher in the anterior subtotal corpectomy group compared with the posterior laminoplasty/laminectomy group [P \ 0.05, WMD: 150.10 (63.53, 236.66) and P \ 0.05, WMD: 59.17 (45.69, 72.66)]. Conclusion The anterior approach was associated with better postoperative neural function than the posterior approach in the treatment of multilevel cervical spondylotic myelopathy. There was no apparent difference in the neural function recovery rate. The complication and reoperation rates were significantly higher in the anterior group compared with the posterior group. The surgical trauma associated with corpectomy was significantly higher than that associated with laminoplasty/laminectomy.

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Section: Exclusion Criteriamentioning

confidence: 99%

Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis

et al. 2013

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“…Excellent longterm results have been reported using this technique [3][4][5][6][7]. Clinical follow-up studies have shown that laminoplasty generally results in greater patient satisfaction and lower complication rates than laminectomy [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Relationship between the laminoplasty opening size and the laminoplasty opening angle, increased sagittal canal diameter and the prediction of spinal canal expansion following open-door cervical laminoplasty

Gu¹,

Zhang

Shen

et al. 2015

Eur Spine J

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Objective To clarify the relationship between the laminoplasty opening size (LOS), the laminoplasty opening angle (LOA) and the increase in sagittal canal diameter (SCD) and to predict the amount of canal enlargement during open-door cervical laminoplasty (ODCL). Methods Formula describing the relationship between LOS and LOA, the increase in SCD was deduced. The parameters of pre-and postoperative computed tomography scans of 36 patients who had undergone laminoplasty surgery were measured by picture archiving and communication system (PACS) software, and the amount of canal enlargement of these patients was predicted when the opening size of laminoplasty was 8, 10, 12, 14 and 16 mm according to the formula. Results For equivalent LOS, the amount of canal enlargement with each opening size differed throughout the cervical region. When the C3-C7 LOS was 10 mm the SCD increased [4.1 mm, and the canal area increased in C3-C6 [88 mm 2 , and the canal area increased in C7 [ 80 mm 2 .When the C3-C7 LOS was 12 mm, the SCD increased [5.2 mm, and the canal area increased in C3-C6 [104 mm 2 , and the canal area increased in C7 [ 94 mm 2 . Conclusion Formula accurately showed the relationship between the LOS and the increase in SCD achieved by ODCL. The amount of canal enlargement following ODCL could be predicted by the formula. LOS of 10-12 mm at C3-C7 might be optimal during ODCL.

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“…Laminoplasty provides spinal cord decompression via canal expansion, thus allowing the cord to migrate posteriorly while preserving posterior bone stock and architecture. Various laminoplasty techniques have been described, and the literature is replete with follow-up studies that have demonstrated better clinical outcomes and patient satisfaction [3,20,21,23,24,26,35,36,37,43,48,50]. Relatively few reports have demonstrated the biomechanical effects laminoplasty has on the cervical spine [4,28,29].…”

Section: Discussionmentioning

confidence: 99%

“…Laminoplasty eliminates many of these complications and achieves decompression of the spinal cord by allowing the cord to migrate posteriorly away from the compressive lesion, while preserving the posterior bone stock and architecture [22,23]. Clinical follow-up studies have shown that laminoplasty generally results in greater patient satisfaction and lower complication rates than laminectomy [2,18,20,24,26,36,37,49,50].…”

mentioning

confidence: 99%

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Biomechanics of cervical laminoplasty: kinetic studies comparing different surgical techniques, temporal effects and the degree of level involvement

Puttlitz

Deviren

Smith

et al. 2004

European Spine Journal

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Laminoplasty is a common surgical technique used to treat cervical myelopathy. Both voids and contradictory information exist in the literature with regard to the initial and long-term biomechanical consequences of cervical laminoplasty. In order to clarify the existing literature, as well as provide clinically useful information, we identified three specific aims: (1) to measure the long-term differences in kinetics between the open door laminoplasty (ODL) and French door laminoplasty (FDL) techniques; (2) to delineate differences in primary and long-term cervical motion after laminoplasty; and (3) to determine whether inclusion of additional levels in the laminoplasty procedure results in a change in immediate cervical biomechanics. The study design involved both an animal (caprine) model and in vitro surgical simulation. We kinematically evaluated the cervical spine specimens (C2-C7) by applying pure bending moment loads to the cephalad vertebra (C2), while constraining the caudal vertebra (C7). Resultant intervertebral rotations (C3-C6) were determined via stereophotogrammetry. Overall, the data indicate that both FDL and ODL significantly reduce range of motion 6 months postoperatively, compared with the un-operated spine. There were no significant differences between the two techniques after 6 months. We also showed that ODL produces a significant reduction in motion 6 months postoperatively compared with the immediate postoperative condition. Finally, the data indicated that extending the laminoplasty from two to four levels did not significantly change range of motion. The choice of technique should be based upon the surgeon's experience with these technically demanding procedures. In addition, initial stability considerations should not affect the decision to extend the laminoplasty to adjacent levels. Finally, the data also suggest that early changes in biomechanics should not be a major factor when considering whether immobilization of the cervical spine is necessary after laminoplasty. In fact, our temporal study, as well as previously reported clinical data, indicates that one should expect significantly decreased intervertebral motion 6 months after laminoplasty. Therefore, early physical therapy should be considered to preserve a more physiologic pattern of cervical range of motion.

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Long-term follow-up of cervical spondylotic myelopathy treated by canal-expansive laminoplasty

Cited by 198 publications

References 4 publications

Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis

Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis

Relationship between the laminoplasty opening size and the laminoplasty opening angle, increased sagittal canal diameter and the prediction of spinal canal expansion following open-door cervical laminoplasty

Biomechanics of cervical laminoplasty: kinetic studies comparing different surgical techniques, temporal effects and the degree of level involvement

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