Laminoplasty

Abstract: Study Design. The authors retrospectively analyzed the prevalence and features of neck and shoulder pain (axial symptoms) after anterior interbody fusion and laminoplasty in patients with cervical spondylotic myelopathy. Objectives. To reveal the difference in prevalence of postoperative axial symptoms between anterior interbody fusion and laminoplasty and to clarify the pathogenesis of axial symptoms after laminoplasty. Summary of Background Data. Out come of the cervical surgery is evaluated on neurologic status alone; axial symptoms after laminoplasty rarely have been investigated. Such symptoms, however, are often severe enough to interfere with a person's daily activity. Methods. Ninety-eight patients had surgery for their disability secondary to cervical spondylotic myelopathy. Of those patients, 72 had laminoplasty, and 26 had anterior interbody fusion. The presence or absence of axial symptoms was investigated before and after surgery. The duration, severity, and laterality of symptoms were also recorded. Results. The prevalence of postoperative axial symptoms was significantly higher after laminoplasty than after anterior fusion (60% vs. 19%; P<0.05). In 18 patients (25%) form the laminoplasty group, the chief complaints after surgery were related to axial symptoms for more than 3 months, whereas in the anterior fusion groupo, no patient reported having such severe pain after surgery. Conclusions. The prevalence and severity of axial symptoms after laminoplasty proved to be higher and more serious than has been believed. Such symptoms should be considered in the evaluation of the outcome of cervical spinal surgery.

Abstract: 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.

Abstract: Study design A literature review was conducted to integrate and compile available reports on postoperative C5 palsy. Objectives To review the clinical features, possible pathogenesis, and procedures for treatment and prevention of postoperative C5 palsy as a complication of surgery for cervical compression myelopathy. Summary of background data Although postoperative C5 palsy develops in approximately 5% of patients after decompression surgery of the cervical spine, its pathogenesis and the options for prevention and treatment remain unidentified and many controversies exist. Method We reviewed and analyzed papers published from 1986 to 2002 regarding C5 palsy as a postoperative complication. Statistical comparisons were made when appropriate. Results Postoperative C5 palsy is reported to occur in an average of 4.6% of patients after surgery for cervical compression myelopathy. No significant differences were noted between patients undergoing anterior decompression and fusion and laminoplasty, nor were distinctions apparent between unilateral hinge laminoplasty and French-door laminoplasty, or between cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. Two theories were put forth to account for the pathogenesis of C5 palsy: nerve root injury and segmental spinal cord disorder. Neither of these hypotheses has been consistently supported and evidence to refute each hypothesis can be found in the literature. Recently, surgeons have advocated foraminotomy combined with laminoplasty to prevent or treat C5 palsy, but further studies into the efficacy of this procedure are needed. Although patients with C5 palsy generally have a good prognosis for neurologic and functional recovery, those with severe paralysis require significantly longer recovery times when compared to more mild cases. Conclusion The incidence of postoperative C5 palsy has been reported at 4.6% after surgery for cervical compression myelopathy and this value has not varied with different surgical procedures or disease etiologies. The pathogenesis of postoperative C5 palsy remains unclear at the present time. Patients with postoperative C5 palsy generally have a good prognosis for functional recovery, but the severely paralyzed cases required significantly longer recovery times than the mild cases.

Abstract: 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...