Swan-Neck Deformity following Extensive Cervical Laminectomy

Sim, Franklin H.; SVIEN, HENDRIK J.; Bickel, William H.; JANES, JOSEPH M.

doi:10.2106/00004623-197456030-00014

Cited by 143 publications

(48 citation statements)

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“…8 The preven tive effect of bracing and its efficacy, however, is still under discussion. 6 Herman and Sonntag, 28 considered that immediate fixation with anterior plating facilitates solid fusion, maintains the spinal curvature, and promotes neurological improvement. Callahan et a P 9 and Farcy et a p o preferred posterior fusion in such patients.…”

Section: Discussionmentioning

confidence: 99%

Spinal deformity following surgery for spinal cord tumors and tumorous lesions: analysis based on an assessment of the spinal functional curve

1996

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The mechanism of spinal deformity after surgical removal of a cervical spinal cord tumor or tumorous lesions was studied in 36 patients, based on the spinal functional curve prepared from the intersectional angle. The postoperative spinal deformity depends on the surgical level and the type of operation. In the laminectomy group, kyphosis of the upper cervical spine and compensatory increased lordosis of the lower cervical spine were observed in the C2 laminectomy patients. Localized kyphosis of the spine at the cervicothoracic junction and compensatory increased lordosis of the upper cervical vertebrae were noted in the C7 laminectomy patients. In the laminoplasty group, spinal deformities were less frequently observed, and when present the deformity was limited to a slight increase of lordosis, even in patients who had the facetectomy. These facts demonstrate the preventive effect of the laminoplasty regarding postoperative spinal deformity. Laminoplasty with reconstruction of the erector spinal muscles and the nuchal ligament is recommended for patients with a spinal cord tumor or a tumorous lesion. The spinal functional curve was significant in studying the biomechanics of the vertebral column with the advantage that both alignment and mobility of the spine are simultaneously, respectively and precisely visualized.

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Section: Discussionmentioning

confidence: 99%

Spinal deformity following surgery for spinal cord tumors and tumorous lesions: analysis based on an assessment of the spinal functional curve

1996

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“…However, laminectomy often results in malalignment of the cervical spine, such as kyphotic or swan-neck deformity [19], which may be more frequent than the boomerang sign. Further, if instruments are used to internally stabilize the cervical spine, renewed neurological deficit may develop due to technical complications related to instrumentation.…”

Section: Prevention Of Boomerang Signmentioning

confidence: 99%

Boomerang deformity of cervical spinal cord migrating between split laminae after laminoplasty

Kimura¹,

Gomibuchi

Shimoda

et al. 2000

European Spine Journal

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IntroductionCervical laminoplasty, for which there are three major methods -Z-shaped enlargement [4,11], unilateral enlargement [2,5,8,12,20], and median enlargement [9,15,16] -is a useful method for surgical management of cervical myelopathy due to spinal canal stenosis [2]. Of these, Kurokawa's laminoplasty with median splitting of the spinous processes [15] has become the most widespread method in Japan, because it has certain advantages. The most critical advantage is the maintenance of physiological cervical lordosis through the preservation of the posterior bony architecture. This procedure allows the cervical spinal cord to move posteriorly, and decompresses it by opening the laminae on both sides [15]. Some papers have reported satisfactory clinical outcome without serious operative complications using this procedure and its modification [17,23].However, we have already reported two cases of a curious complication after Kurokawa's laminoplasty [13]. We refer to this complication as a "boomerang sign", as it describes the boomerang shape of the cervical spinal cord caused by migration of the cord between the split laminae following Kurokawa's laminoplasty. The grade of the boomerang deformity progressed following surgery as Abstract Patients with cervical compression myelopathy were studied to elucidate the mechanism underlying boomerang deformity, which results from the migration of the cervical spinal cord between split laminae after laminoplasty with median splitting of the spinous processes (boomerang sign). Thirty-nine cases, comprising 25 patients with cervical spondylotic myelopathy, 8 patients with ossification of the posterior longitudinal ligament, and 6 patients with cervical disc herniation with developmental canal stenosis, were examined. The clinical and radiological findings were retrospectively compared between patients with (B group, 8 cases) and without (C group, 31 cases) boomerang sign. Moderate increase of the grade of this deformity resulted in no clinical recovery, although there was no difference in clinical recovery between the two groups. Most boomerang signs developed at the C4/5 and/or C5/6 level, where maximal posterior movement of the spinal cord was achieved. Widths between lateral hinges and between split laminae in the B group were smaller than in the C group. Flatness of the spinal cord in the B group was more severe than in the C group. In conclusion, the boomerang sign was caused by posterior movement of the spinal cord, narrower enlargement of the spinal canal and flatness of the spinal cord.

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“…Lastly, the C3-4 subluxation that occurred in a different patient is a known, but infrequent, complication of cervical laminectomies; care must be taken not to compromise the facet joints and increase the risk of postlaminectomy instability. 6,34 Despite the chronic complication rate of 22% (n = 12), most of the complications were relatively minor (neck stiffness) and many of our patients were grateful for the ON pain relief. No cases of deafferentation syndrome or anesthesia dolorosa, vertigo/imbalance, or death were observed in our series.…”

Section: Complicationsmentioning

confidence: 81%

Long-term outcomes of intradural cervical dorsal root rhizotomy for refractory occipital neuralgia

Gande

Chivukula

Moossy³

et al. 2016

JNS

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OBJECT Occipital neuralgia (ON) causes chronic pain in the cutaneous distribution of the greater and lesser occipital nerves. The long-term efficacy of cervical dorsal root rhizotomy (CDR) in the management of ON has not been well described. The authors reviewed their 14-year experience with CDR to assess pain relief and functional outcomes in patients with medically refractory ON. METHODS A retrospective chart review of 75 ON patients who underwent cervical dorsal root rhizotomy, from 1998 to 2012, was performed. Fifty-five patients were included because they met the International Headache Society's (IHS) diagnostic criteria for ON, responded to CT-guided nerve blocks at the C-2 dorsal nerve root, and had at least one follow-up visit. Telephone interviews were additionally used to obtain data on patient satisfaction. RESULTS Forty-two patients (76%) were female, and the average age at surgery was 46 years (range 16–80). Average follow up was 67 months (range 5–150). Etiologies of ON included the following: idiopathic (44%), posttraumatic (27%), postsurgical (22%), post–cerebrovascular accident (4%), postherpetic (2%), and postviral (2%). At last follow-up, 35 patients (64%) reported full pain relief, 11 (20%) partial relief, and 7 (16%) no pain relief. The extent of pain relief after CDR was not significantly associated with ON etiology (p = 0.43). Of 37 patients whose satisfaction-related data were obtained, 25 (68%) reported willingness to undergo repeat surgery for similar pain relief, while 11 (30%) reported no such willingness; a single patient (2%) did not answer this question. Twenty-one individuals (57%) reported that their activity level/functional state improved after surgery, 5 (13%) reported a decline, and 11 (30%) reported no difference. The most common acute postoperative complications were infections in 9% (n = 5) and CSF leaks in 5% (n = 3); chronic complications included neck pain/stiffness in 16% (n = 9) and upper-extremity symptoms in 5% (n = 3) such as trapezius weakness, shoulder pain, and arm paresthesias. CONCLUSIONS Cervical dorsal root rhizotomy provides an efficacious means for pain relief in patients with medically refractory ON. In the appropriately selected patient, it may lead to optimal outcomes with a relatively low risk of complications.

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Swan-Neck Deformity following Extensive Cervical Laminectomy

Cited by 143 publications

References 0 publications

Spinal deformity following surgery for spinal cord tumors and tumorous lesions: analysis based on an assessment of the spinal functional curve

Spinal deformity following surgery for spinal cord tumors and tumorous lesions: analysis based on an assessment of the spinal functional curve

Boomerang deformity of cervical spinal cord migrating between split laminae after laminoplasty

Long-term outcomes of intradural cervical dorsal root rhizotomy for refractory occipital neuralgia

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