Treatment of cervical compressive myelopathy with a new dorsolateral decompressive procedure

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> A new dorsolateral decompressive procedure involving a unilateral approach has been devised for the treatment of cervical compressive myelopathy. In this operation, the posterior spinal elements of the contralateral side are not disturbed, and thus, postoperative deformity of the cervical spine can be avoided. Following decompressive surgery via the unilateral approach, the cervical spine was kept more stable compared with the results obtained after wide laminectomy or other expansive laminoplasty procedures.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> Twenty-six patients underwent dorsolateral decompressive surgery, and the patients' clinical and radiological results were examined during the follow-up period to evaluate neurological function and postoperative deformities of the cervical spine. The underlying conditions for myelopathy were cervical spondylosis (19 patients), ossification of posterior longitudinal ligament (three patients), and ossification of yellow ligament (four patients). The follow-up period ranged from 6 to 110 months (average 35.5 months). Functional recovery, which was rated by using the Japanese Orthopaedic Association scoring system, was an average of 56% in all patients (100% being equal to full recovery). The recovery rate was compatible with those attained after other expansive laminoplasty procedures. Radiographically, progression to swan-neck or kyphotic deformity was not observed in any patient. No postoperative spinal instability was noted. Based on computerized tomography myelograph evaluation, the average transectional area of the dural tube at the C4–5 level was expanded from 122 mm<jats:sup>2</jats:sup> to 169 mm<jats:sup>2</jats:sup>, and the transectional area of the spinal cord at the C4–5 level was expanded from 39.6 mm<jats:sup>2</jats:sup> to 52.9 mm<jats:sup>2</jats:sup> after surgery.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> The authors conclude that this operative procedure could be used as a new option for the treatment of cervical compressive myelopathy.</jats:p>

The comparison of hemilaminectomy and laminoplasty procedures in the surgical treatment of cervical spondylotic myelopathy

“…They found that this rate was significantly increased in the postoperative period. In a study conducted by Hidai et al, a significant increase in the anterior-posterior diameter of the spinal canal was detected after the hemilaminectomy (14). Similarly, Hirabayashi et al observed significant increases in the anterior-posterior diameter of the spinal canal in patients that underwent open door laminoplasty (16).…”

“…Hidai et al evaluated patients to whom hemilaminectomy decompression was applied and determined the mean spinal canal area as 169 mm² (14). Ohsawa et al reported the mean spinal canal area in patients that underwent laminoplasty as 144 described the use of laminoplasty in cervical myelopathy which despite the introduction of wide variety of treatment methods including open door laminoplasty, has been among the most widely used methods (17,24).…”

“…In the hemilaminectomy methods, in order to prevent cervical sagittal alignment, paravertebral muscles are stripped unilaterally and muscles in the contralateral area are protected to prevent postoperative instability. In addition, preservation of interspinous and supraspinous ligaments are intended to contribute to the stabilization (14). Moreover, the use of the cervical hemilaminectomy decompression method aims to reduce the operation cost and duration by not using instrumentation and fusion, decrease the perioperative blood loss by stripping the paravertebral muscles unilaterally, prevent paravertebral muscle atrophy, and ease the postoperative axial symptoms (14,25,33).…”

“…In order to prevent these drawbacks, the cervical laminectomy method has been modernized and the cervical hemilaminectomy decompression method has been implemented to preserve the sagittal alignment and stabilization (14,33). Unilateral cervical hemilaminectomy decompression is a surgical procedure developed to reduce complications of current practices used in the treatment of CSM.…”

A less-invasive cervical laminoplasty for spondylotic myelopathy that preserves the semispinalis cervicis muscles and nuchal ligament

“…Preservation of these posterior supporting tissues ensures better postoperative results. 7,11,42,45,47,48,52 In particular, the semispinalis muscles at the C-2 and C-7 levels are important dynamic stabilizers and should be preserved to the fullest extent possible. 3,8,11,17,31,41,44,45,48,51 Preservation of the paravertebral muscles by modified laminoplasty techniques reportedly reduces the incidence of adverse effects of cervical laminoplasty.…”