Study design This retrospective study analyzed the effects of cervical alignment on surgical results of expansive laminoplasty (ELAP) for cervical spondylotic myelopathy (CSM). Objective To determine the limitation of posterior decompression by ELAP for CSM in the presence of local kyphosis. Summary of background data Several studies have reported that cervical malalignment affected surgical outcomes of ELAP. However, there has been no report to demonstrate crucial determinants of surgical outcomes of ELAP for CSM in relation to cervical sagittal alignment. Methods The study group comprised 114 patients who underwent ELAP for CSM. All were followed up for more than 2 years. The Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy (full score, 17 points) was used to evaluate surgical outcomes for each patient 2 years after surgery. Statistical analysis with multivariate logistic regression models was used to ascertain the risk factors affecting postoperative surgical outcomes. Results The average JOA scores were 9.9 points before surgery and 14 points 2 years after surgery. The recovery rate was 60.2%. Statistical analysis showed that signal intensity change on MRI and local kyphosis were the most crucial risk factors for poor surgical outcomes. Calculated with the logistic regression model, the highest risk of poor recovery was local kyphosis exceeding 13 degrees. Conclusions The influence of cervical malalignment on neurologic recovery after ELAP for CSM was shown. When patients have local kyphosis exceeding 13 degrees, anterior decompression or posterior correction of kyphosis as well as ELAP should be considered. Expansive laminoplasty for CSM is best indicated for patients with local kyphosis less than 13 degrees.

Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy

Object. The technique of cervical laminoplasty was developed to decompress the spinal canal in patients with multilevel anterior compression caused by ossification of the posterior longitudinal ligament or cervical spondylosis. There is a paucity of data confirming its superiority to laminectomy with regard to neurological outcome, preserving spinal stability, preventing postlaminectomy kyphosis, and the development of the “postlaminectomy membrane.” Methods. The authors conducted a metaanalysis of the English-language laminoplasty literature, assessing neurological outcome, change in range of motion (ROM), development of spinal deformity, and complications. Seventy-one series were reviewed, comprising more than 2000 patients. All studies were retrospective, uncontrolled, nonrandomized case series. Forty-one series provided postoperative recovery rate data in which the Japanese Orthopaedic Association Scale was used for assessing myelopathy. The mean recovery rate was 55% (range 20–80%). The authors of 23...

Cervical laminoplasty: a critical review

Background:Cervical spondylosis is part of the aging process and affects most people if they live long enough. Degenerative changes affecting the intervertebral disks, vertebrae, facet joints, and ligamentous structures encroach on the cervical spinal canal and damage the spinal cord, especially in

Cervical spondylotic myelopathy.

Cervical spondylotic myelopathy is a leading cause of spinal cord dysfunction in the adult population. Affected patients represent a large subset of individuals who undergo operative treatment of degenerative cervical conditions. In a study of 450 patients undergoing anterior neck surgery for the treatment of degenerative disc disease, 61% presented with radicular symptoms, 16% had pure myelopathic symptoms, and the remaining 23% had a combination of myelopathy and radiculopathy1.

The subtle clinical findings of early cervical spondylotic myelopathy make diagnosis difficult, and true natural history studies are unavailable. The patients or their relatives notice increasing awkwardness with gait and balance that they attribute to old age or arthritis of the lower extremity joints. Patients may report an insidious onset of clumsiness or diffuse numbness in the hands, resulting in worsening of handwriting or …

Operative treatment of cervical spondylotic myelopathy.

Cervical myelopathy. current diagnostic and treatment strategies.

Study design The study involved elderly patients (age > or = 65), who underwent treatment for cervical spondylotic myelopathy by canal-expansive laminoplasty. Objectives To determine the factors that influence the operative results of canal-expansive laminoplasty for treatment of cervical spondylotic myelopathy in elderly patients. Summary of background data Although there have been previous reports of many operative procedures, to the authors' knowledge there are no reports on the results of surgical treatment for cervical spondylotic myelopathy in elderly patients, treated by a unified surgical procedure. To date, no attempts have been made to predict the results of these procedures. Methods Forty-seven patients (age > or = 65) who underwent canal-expansive laminoplasty were reviewed in this study. The severity of the clinical picture and the quality of operative results were graded according to the Japanese Orthopaedic Association scoring system. Results Of the 13 patients whose period of disability persisted for less than 3 months before the operation, 12 were able to walk after surgery. The operative results of patients more than 80 years of age were not significantly different from those of patients aged between 65 and 79 years. Results of multiple regression analysis indicate that the predictive probability of the postoperative motor function score of the lower extremities was 70%. Conclusions The severity of the clinical picture and the duration of symptoms influenced the outcome of the operation. Despite the advanced age of some patients (> 80), the operation increased the chance of recovery from the disease.

Operative results of canal-expansive laminoplasty for cervical spondylotic myelopathy in elderly patients.

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Operative results of canal-expansive laminoplasty for cervical spondylotic myelopathy in elderly patients.