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Laminoplasty Techniques for the Treatment of Multilevel Cervical Stenosis  [PDF]
Lance K. Mitsunaga,Eric O. Klineberg,Munish C. Gupta
Advances in Orthopedics , 2012, DOI: 10.1155/2012/307916
Abstract: Laminoplasty is one surgical option for cervical spondylotic myelopathy. It was developed to avoid the significant risk of complications associated with alternative surgical options such as anterior decompression and fusion and laminectomy with or without posterior fusion. Various laminoplasty techniques have been described. All of these variations are designed to reposition the laminae and expand the spinal canal while retaining the dorsal elements to protect the dura from scar formation and to preserve postoperative cervical stability and alignment. With the right surgical indications, reliable results can be expected with laminoplasty in treating patients with multilevel cervical myelopathy.
Laminoplasty Techniques for the Treatment of Multilevel Cervical Stenosis  [PDF]
Lance K. Mitsunaga,Eric O. Klineberg,Munish C. Gupta
Advances in Orthopedics , 2012, DOI: 10.1155/2012/307916
Abstract: Laminoplasty is one surgical option for cervical spondylotic myelopathy. It was developed to avoid the significant risk of complications associated with alternative surgical options such as anterior decompression and fusion and laminectomy with or without posterior fusion. Various laminoplasty techniques have been described. All of these variations are designed to reposition the laminae and expand the spinal canal while retaining the dorsal elements to protect the dura from scar formation and to preserve postoperative cervical stability and alignment. With the right surgical indications, reliable results can be expected with laminoplasty in treating patients with multilevel cervical myelopathy. 1. Introduction While multilevel cervical stenosis may occur for a variety of reasons, it is usually due to cervical spondylosis or ossification of the posterior longitudinal ligament (OPLL). Options for decompression of the canal include either anterior or posterior approaches. For multilevel disease, most surgeons prefer posterior decompression. Posterior decompression has the advantage of addressing multiple levels with one incision. However, this approach is hindered by the late complication of kyphosis with decompression alone or the loss of motion and adjacent segment degeneration if posterior decompression is performed in conjunction with fusion [1, 2]. Laminoplasty is a technique that indirectly decompresses the spinal cord and preserves neck motion by avoiding fusion. This is accomplished by hinging the laminae open on one or both sides to allow the spinal cord to migrate posteriorly away from anterior compressive structures. Laminoplasty was initially described by the Japanese in the early 1970s to treat ossification of posterior longitudinal ligament [3]. By leaving the dorsal structures in situ, laminoplasty was developed to avoid the problems associated with laminectomy, such as kyphosis, instability, and delayed neurologic problems due to scar invasion. Laminoplasty has become increasingly popular in North America as experience with laminoplasty techniques has grown and its application has expanded to treat other causes of multilevel cervical stenosis besides OPLL, such as cervical spondylotic myelopathy (CSM). The goals of this chapter are to discuss the advantages and disadvantages of laminoplasty, key technical points regarding different laminoplasty techniques, along with the complications and outcomes of laminoplasty. 2. Advantages of Laminoplasty Laminoplasty allows the spinal cord and the neuroforamen to be decompressed without directly
Operative Treatment of Cervical Myelopathy: Cervical Laminoplasty  [PDF]
Brett A. Braly,David Lunardini,Chris Cornett,William F. Donaldson
Advances in Orthopedics , 2012, DOI: 10.1155/2012/508534
Abstract: Cervical spondylotic myelopathy (CSM) is a degenerative process which may result in clinical signs and symptoms which require surgical intervention. Many treatment options have been proposed with various degrees of technical difficulty and technique sensitive benefits. We review laminoplasty as a motion-sparing posterior decompressive method. Current literature supports the use of laminoplasty for indicated decompression. We also decribe our surgical technique for an open-door, or “hinged”, laminoplasty. 1. Introduction Cervical spondylotic myelopathy (CSM) is the natural result of degenerative compression on the cervical spinal cord. The result may be a progressive and stepwise deterioration of neurological function in patients. The chronic debilitating nature of this process justifies surgical decompression. Posterior decompression has been described as a treatment for CSM since the 1940s. Laminectomy was the initial surgical option used. The decompression was performed by rongeurs. However, the insertion of the rongeur in an already limited space available for the cord led often to a decrease in neurological function postoperatively [1–3]. Even with modern approaches to laminectomy using high speed burs, development of postoperative instability has led surgeons to explore more efficacious ways of decompression. In 1977, Hirabayashi and Satomi published their results on multisegment decompression by means of an open-door laminoplasty [4]. This technique allows for adequate posterior decompression of the spinal cord while retaining the posterior elements. This avoids the postoperative instability seen with laminectomy as well as the stiffness and risks of posterior cervical fusion. Additionally, motion is spared due to the absence of a fusion. There have since been multiple techniques for performing a cervical laminoplasty described with supporting literature [4–8]. These techniques include the expansive “open door,” a midline “French Door,” En Bloc resection, spinous process splitting, and Z-Plasty [4, 9]. Outcome studies have supported laminoplasty as a valid treatment for CSM however, no definitive literature shows its superiority to laminectomy in conjunction with a posterior cervical fusion. All surgical strategies appear to be equal in yielding neurologic outcomes, though differences are found in complication reports. Patient selection is crucial prior to proceeding with cervical laminoplasty. Special attention must be paid to sagittal alignment for optimal outcomes. Laminoplasty is ideal for multilevel stenosis (AP canal diameter < 13?mm) due to
Operative Treatment of Cervical Myelopathy: Cervical Laminoplasty  [PDF]
Brett A. Braly,David Lunardini,Chris Cornett,William F. Donaldson
Advances in Orthopedics , 2012, DOI: 10.1155/2012/508534
Abstract: Cervical spondylotic myelopathy (CSM) is a degenerative process which may result in clinical signs and symptoms which require surgical intervention. Many treatment options have been proposed with various degrees of technical difficulty and technique sensitive benefits. We review laminoplasty as a motion-sparing posterior decompressive method. Current literature supports the use of laminoplasty for indicated decompression. We also decribe our surgical technique for an open-door, or “hinged”, laminoplasty.
Y型纳米骨板单开门椎管成形术治疗多节段脊髓型颈椎病的疗效分析
Efficacy of treating multilevel cervical spondylotic myelopathy with single-door laminoplasty via Y type nano-bone plate
 [PDF]

陈金财,曾文添,朱文清,,,莫建文,姬广林
- , 2017, DOI: 10.7652/jdyxb201704030
Abstract: 摘要:目的 探讨Y型纳米骨板单开门颈椎管扩大成形术(EOLP)在治疗多节段脊髓型颈椎病(MCSM)中的应用价值,并作近期疗效分析。方法 自2013年1月至2016年12月应用Y型纳米骨板EOLP治疗MCSM患者79例,以日本矫形外科协会(JOA)评估系统评价术后神经功能的改善情况;测量术前及术后6个月颈椎X线的颈椎曲度变化及C??5椎管矢状径,了解椎管维持和扩大情况;利用术前、术后颈椎MRI评价脊髓受压改善程度;借助三维螺旋CT观察开门侧及门轴侧的骨愈合情况。结果 随访6~36个月,平均(20.4±7.9)个月。术前JOA评分为(8.6±1.3)分,术后6个月为(14.3±1.5)分(P<0.05),JOA改善率为(68.6±15.8)%;术后随访X线片及三维螺旋CT示椎管扩大满意,门轴侧均骨性愈合,开门侧骨质愈合不明显,均未见椎板塌陷和再关门现象;术前C??5节段椎管矢状径为(8.9±1.1)mm,术后6个月为(15.1±1.1)mm,差异有统计学意义(P<0.05),椎管扩大率为(70.8±22.3)%;术前颈椎曲度为(14.8±7.0)°,术后为(15.1±6.7)°,差异无统计学意义(P>0.05)。结论 Y型纳米骨板EOLP在MCSM中应用安全、有效,不仅提供了良好的即刻固定,也为后期开门侧骨性融合提供了可能。
ABSTRACT: Objective To explore the application value of single-door laminoplasty via Y type nano-bone plate in treating multilevel cervical spondylotic myelopathy (MCSM) and analyze the short-term efficacy. Methods From January 2013 to December 2016, 79 cases of MCSM were treated with single-door laminoplasty via Y type nano-bone plate to evaluate the improvement of post-operative neurological function by the Japanese Orthopaedic Association (JOA) evaluation system. We also measured cervical curvature of cervical X-ray and C5 sagittal diameter of the spinal canal before operation and 6 months after operation to understand the maintenance and enlargement of the spinal canal. The improvement degree of spinal cord compression was evaluated by preoperative and postoperative cervical MRI. Osseous healing on the open door side and the door shaft side was observed with the aid of three-dimensional spiral CT. Results Follow-up ranged from 6 to 36 months, with an average of (20.4±7.9) months. Preoperative JOA score was (8.6±1.3) points and JOA score 6 months after operation was (14.3±1.5) points (P<0.05). JOA improvement rate was (68.6±15.8)%; postoperative follow-up X-ray and three-dimensional spiral CT showed that the spinal canal had satisfying enlargement, the door shaft side all had osseous healing, the open door side osseous healing was not obvious, and there was no lamina collapse or reclosing. Sagittal diameter of the C5 spinal canal was (8.9±1.1)mm before operation and (15.1±1.1)mm 6 months after operation (P<0.05). The spinal canal enlargement rate was (70.8±22.3)%, cervical curvature was (14.8±7.0)°preoperatively and (15.1±6.7)°postoperatively with no significant difference (P>0.05). Conclusion EOLP via Y type nano-bone plate is safe and efficacious in treating MCSM. It not only provides a good immediate fixation, but also provides the possibility for the open door side lateral osseous fusion
Efficacy of Modified Expansive Open-Door Laminoplasty for Cervical Myelopathy  [PDF]
Eiren Toh, Yukihiro Yamamoto, Daisuke Sakai, Masato Sato, Masahiko Watanabe, Joji Mochida
Surgical Science (SS) , 2012, DOI: 10.4236/ss.2012.312112
Abstract: Objectives: Expansive open-door laminoplasty is used widely for the treatment of cervical spondylosis and Ossification of the Posterior Longitudinal Ligament (OPLL). We have developed a unique modification of the surgical procedure to keep the lamina expanded, with the aim of preventing reclosure of the vertebral arch. To examine the effectiveness of and problems associated with the modified expansive open-door laminoplasty technique developed at our institution by evaluating the surgical outcomes. Methods and Materials: Fifty-six patients (46 men and 10 women) underwent the modified expansive open-door laminoplasty and were followed up for at least 1 year. Thirty-eight had Cervical Spondylotic Myelopathy (CSM) and 18 had OPLL. The patients were 34 to 89 years of age (mean: 60.9 years). The severity of myelopathy was evaluated according to the Japanese Orthopaedic Association’s scoring system. Surgical outcomes were evaluated using Hirabayashi’s system for determining recovery rate. In the radiographic analysis, the following angles were measured before and after surgery: lordosis angle and Range of Motion (ROM) at C2 - C7 on lateral radiographs, and opening angle on computerized tomography (CT). The presence and absence of axial pain and postoperative C5 palsy were also evaluated. Results: The rate of JOA score improvement was about 60%, the lordosis angle observed on lateral radiographs was maintained. ROM decreased after surgery in both the CSM and OPLL groups, and the extent of the decrease was similar to that in previous reports. The opening angle of the lamina was 62°- 65° on post-operative CT. Axial pain was reported by 34% of patients. Conclusions: Our modified procedure produced satisfactory postoperative outcomes based on the clinical data and imaging findings for both CSM and OPLL. The advantage of this procedure is that it avoids potential complications associated with bone grafts or implants.
Lift-up laminoplasty for myelopathy caused by ossification of the posterior longitudinal ligament of the cervical spine
Takami T,Ohata K,Goto T,Nishikawa M
Neurology India , 2004,
Abstract: Background and Aims: We have utilized lift-up laminoplasty to treat patients with myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. The preliminary surgical outcome with computer-assisted morphological assessment is presented. Material and Methods: The surgical technique of lift-up laminoplasty includes standard posterior exposure of the cervical spine, en-bloc laminectomy, and expansion of the cervical canal by lift-up of the laminae with custom-designed hydroxyapatite laminar spacers and stabilization of the laminae using titanium miniplates. From 1998 to 2003, 10 consecutive patients with cervical myelopathy secondary to OPLL have been treated with this method and comprehensively evaluated. Care was taken to tailor the treatment to individual patients by using different sizes of spacers to adjust the degree of expansion depending on the amount of stenosis of the cervical spine. The degree of expansion of the cervical canal was altered by design, based on the preoperative imaging simulation. Results: Preliminary surgical outcome, evaluated at 6 months after surgery, revealed a significant improvement of neurological function. Image analysis revealed that the cervical canals were significantly expanded, with a mean reduction of 13.1% in the stenosis ratio. Lift-up laminoplasty was effective in the treatment of patients with myelopathy secondary to cervical OPLL, and the amount of expansion could be individually adjusted at the discretion of the surgeon. Conclusion: Although analysis with a larger population and a longer follow-up period needs to be undertaken, our method of lift-up laminoplasty appears to be a viable choice among standard posterior cervical approaches for cervical OPLL.
Efficacy and results of expansive laminoplasty in patients with severe cervical myelopathy due to cervical canal stenosis  [cached]
Agrawal D,Sharma B,Gupta A,Mehta V
Neurology India , 2004,
Abstract: Aims and objectives: To assess the efficacy and results of expansive laminoplasty in advanced (Nurick's Grade III or greater) cervical myelopathy. Materials and Methods: We reviewed data in 24 patients who underwent cervical laminoplasty from January 1999 to December 2002. Nuricks grading was used for quantifying the neurological deficits and outcome analysis was done using Odom's criteria. A modified Hirabayashi's open door laminoplasty was done using Titanium miniplates and screws in 22 patients, autologous bone in one and hydroxyapatite spacer in one patient. Observations: There were 3 females and 21 males with a mean age of 56 years (range 39-72 years). Four patients presented in Nuricks Grade III, 15 in Grade IV and five in Grade V. MR imaging showed MSCS in 21 cases, OPLL in nine cases and ligamentum flavum hypertrophy in nine cases with cord signal changes being present in 19 cases. Results: All patients with duration of symptoms less than three years, and 50 % with duration ranging from three to six years had improvement by at least one Nurick's grade following surgery. Eighty-seven per cent Grade IV patients (ambulatory with support) improved to Grade III (ambulatory without support) following laminoplasty. Using Odom's criteria, 23 patients (95.8%) had a good to fair outcome. Conclusions: Cord decompression with expansive laminoplasty using titanium miniplate fixation may improve the neurological outcome even in patients presenting late, and improvement by even one grade may have major 'quality of life' benefits for these patients.
Anterior Cervical Spinal Surgery for Multilevel Cervical Myelopathy.  [PDF]
Jung-Ju Huang,Lih-Huei Chen,Chi-Chien Niu,Tsai-Sheng Fu
Chang Gung Medical Journal , 2004,
Abstract: Background: In multilevel spinal cord compression caused by cervical spondylosis, surgeonsface the choice of performing a posterior route as a laminectomy orlaminoplasty, or an anterior route as multiple adjacent interbody decompressionsor corpectomies. The anterior cervical operation is not considered bysome clinicians because of concerns about complications and the complexityof multilevel anterior cervical surgery.Methods: In this retrospective study, 14 patients with multilevel cervical spondylosiswho were operated on via an anterior route were enrolled to evaluate thecomplexity, safety, and clinical results. The collected parameters were operationtime, blood loss, hospital days, and early and late complications forevaluating the operative complexity, radiographic follow-up for evaluatingfusion, graft problems, implants problems, and the recovery rate using theJapanese Orthopaedic Association score (JOA score) for evaluating the operativeresults.Results: The mean operation time was 363.4 min, and blood loss was 431.4 ml. Anearly complication was noted in 1 patient with combined deep vein thrombosisand a pulmonary embolism. Late complications were screw breakage in1 patient and screw loosening in 5 patients. The mean duration of follow-upwas 21.9 months. The mean recovery rate of the JOA score was 38.8% postoperativelyand 51.9% at the final follow-up. The fusion rate was 100% inthis series.Conclusions: Anterior cervical decompression and fusion for multilevel stenosis requires alonger operation time than posterior procedures; however, the clinical resultsare satisfactory.
Laminoplasty and Laminectomy Hybrid Decompression for the Treatment of Cervical Spondylotic Myelopathy with Hypertrophic Ligamentum Flavum: A Retrospective Study  [PDF]
Huairong Ding, Yuan Xue, Yanming Tang, Dong He, Zhiyang Li, Ying Zhao, Yaqi Zong, Yi Wang, Pei Wang
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0095482
Abstract: Objective To report the outcomes of a posterior hybrid decompression protocol for the treatment of cervical spondylotic myelopathy (CSM) associated with hypertrophic ligamentum flavum (HLF). Background Laminoplasty is widely used in patients with CSM; however, for CSM patients with HLF, traditional laminoplasty does not include resection of a pathological ligamentum flavum. Methods This study retrospectively reviewed 116 CSM patients with HLF who underwent hybrid decompression with a minimum of 12 months of follow-up. The procedure consisted of reconstruction of the C4 and C6 laminae using CENTERPIECE plates with spinous process autografts, and resection of the C3, C5, and C7 laminae. Surgical outcomes were assessed using Japanese Orthopedic Association (JOA) score, recovery rate, cervical lordotic angle, cervical range of motion, spinal canal sagittal diameter, bone healing rates on both the hinge and open sides, dural sac expansion at the level of maximum compression, drift-back distance of the spinal cord, and postoperative neck pain assessed by visual analog scale. Results No hardware failure or restenosis was noted. Postoperative JOA score improved significantly, with a mean recovery rate of 65.3±15.5%. Mean cervical lordotic angle had decreased 4.9 degrees by 1 year after surgery (P<0.05). Preservation of cervical range of motion was satisfactory postoperatively. Bone healing rates 6 months after surgery were 100% on the hinge side and 92.2% on the open side. Satisfactory decompression was demonstrated by a significantly increased sagittal canal diameter and cross-sectional area of the dural sac together with a significant drift-back distance of the spinal cord. The dural sac was also adequately expanded at the time of the final follow-up visit. Conclusion Hybrid laminectomy and autograft laminoplasty decompression using Centerpiece plates may facilitate bone healing and produce a comparatively satisfactory prognosis for CSM patients with HLF.
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