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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
Cervical Laminoplasty for Multilevel Cervical Myelopathy  [PDF]
Murali Krishna Sayana,Hassan Jamil,Ashley Poynton
Advances in Orthopedics , 2011, DOI: 10.4061/2011/241729
Abstract: Cervical spondylotic myelopathy can result from degenerative cervical spondylosis, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multi-level myelopathy aims to decompress the spinal cord and maintain stability of the cervical spine. Laminoplasty was major surgical advancement as laminectomy resulted in kyphosis and unsatisfactory outcomes. Hirabayashi popularised the expansive open door laminoplasty which was later modified several surgeons. Laminoplasty has changed the way surgeons approach multilevel cervical spondylotic myelopathy.
Cervical Laminoplasty for Multilevel Cervical Myelopathy  [PDF]
Murali Krishna Sayana,Hassan Jamil,Ashley Poynton
Advances in Orthopedics , 2011, DOI: 10.4061/2011/241729
Abstract: Cervical spondylotic myelopathy can result from degenerative cervical spondylosis, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multi-level myelopathy aims to decompress the spinal cord and maintain stability of the cervical spine. Laminoplasty was major surgical advancement as laminectomy resulted in kyphosis and unsatisfactory outcomes. Hirabayashi popularised the expansive open door laminoplasty which was later modified several surgeons. Laminoplasty has changed the way surgeons approach multilevel cervical spondylotic myelopathy. 1. Introduction Chronic compression of the cervical spinal cord leads to a clinical syndrome of cervical spondylotic myelopathy (CSM). In degenerative cervical spondylosis, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the PLL (OPLL) can all cause spinal cord compression. The effect on spinal cord compression is much more pronounced if a patient has a congentially small spinal canal. The aetiopathogenesis, clinical manifestations, investigations, and nonoperative management are discussed in other articles of this special edition. The primary aims of surgical intervention for multilevel myelopathy are to decompress the spinal cord and maintain stability of the cervical spine. Secondary aims are to minimize complications which include long-term pain and motion loss. This can be achieved by anterior approach and/or posterior approach to cervical spine. Anterior approach would involve multilevel discectomy at times with corpectomy and fusion. Posterior approach would involve laminectomy with or without fusion or laminoplasty. This article will focus on cervical laminoplasty for multilevel myelopathy. 2. Evolution of Laminoplasty Kirita, in 1968, devised a sophisticated operative technique, in which the laminae were thinned and divided at the midline using a high-speed drill followed by their en bloc resection to achieve total decompression of the compressed spinal cord [1]. Although this technique improved the results and bettered the technique of conventional laminectomy, complications like postoperative kyphosis and membrane formation resulted. Oyama et al. reported a Z-plasty (Hattori technique) of the cervical spine laminae in 1973 [2]. This procedure was technically demanding and had not been adopted widely other surgeons. In the year 1977, Hirabayashi et al. described an expansive open door laminoplasty (ELAP), which is a relatively easier and safer procedure than laminectomy [3].
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.
Indications and techniques for anterior cervical plating
Rhee John,Park Jong-Beom,Yang Jun-Young,Riew Daniel
Neurology India , 2005,
Abstract: Anterior cervical plating is commonly performed to stabilize anterior cervical fusions. Modern plating options include dynamic plates, with screws that can either toggle within fixed holes or translate within slotted holes. Regardless of the plating system used, paramount to success and avoidance of complications with plated anterior cervical fusions are meticulous plating techniques, exacting graft carpentry, and understanding the biomechanical limitations of plating in certain situations, such as multilevel corpectomies reconstructed with a single-strut graft. In order to prevent graft-related complications associated with long-strut grafts, additional posterior fixation and fusion, or alternative corpectomy constructs, such as multilevel anterior cervical discectomy and fusion, corpectomy-discectomy, and corpectomy-corpectomy, should be considered instead if the pattern of stenosis allows.
Operative Outcomes for Cervical Degenerative Disease: A Review of the Literature  [PDF]
Kazuya Nishizawa,Kanji Mori,Yasuo Saruhashi,Yoshitaka Matsusue
ISRN Orthopedics , 2012, DOI: 10.5402/2012/165050
Abstract: To date, several studies were conducted to find which procedure is superior to the others for the treatment of cervical myelopathy. The goal of surgical treatment should be to decompress the nerves, restore the alignment of the vertebrae, and stabilize the spine. Consequently, the treatment of cervical degenerative disease can be divided into decompression of the nerves alone, fixation of the cervical spine alone, or a combination of both. Posterior approaches have historically been considered safe and direct methods for cervical multisegment stenosis and lordotic cervical alignment. On the other hand, anterior approaches are indicated to the patients with cervical compression with anterior factors, relatively short-segment stenosis, and kyphotic cervical alignment. Recently, posterior approach is widely applied to several cervical degenerative diseases due to the development of various instruments. Even if it were posterior approach or anterior approach, each would have its complication. There is no Class I or II evidence to suggest that laminoplasty is superior to other techniques for decompression. However, Class III evidence has shown equivalency in functional improvement between laminoplasty, anterior cervical fusion, and laminectomy with arthrodesis. Nowadays, each surgeon tends to choose each method by evaluating patients’ clinical conditions. 1. Introduction Cervical degenerative disease can result in manifestations distinct from degenerative disease of extremities. The cervical vertebrae contain the spinal cord; its compression by means of deteriorated cervical spine may lead to a generalized debility that sometimes culminates in tetraparesis as well as significant pain. When symptoms do not respond to conservative treatment, surgical treatment is considered. The goal of surgical treatment should be to decompress the nerves, restore the alignment of the vertebrae, and stabilize the spine. Consequently, the treatment of cervical degenerative disease can be divided into decompression of the nerves alone, fixation of the cervical spine alone or a combination of both. In addition, it can be divided into anterior or posterior procedures in terms of approach to the cervical spine. The purpose of this paper is to review the features of the operative treatment of cervical degenerative disease and outline the advantages and disadvantages of each approach and technique. 2. Posterior Approach Posterior approaches have historically been considered safe and direct methods for cervical compression myelopathy with favorable clinical outcomes without fatal
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
Oblique Corpectomy to Manage Cervical Myeloradiculopathy  [PDF]
Chibbaro Salvatore,Makiese Orphee,Bresson Damien,Reiss Alisha,Poczos Pavel,George Bernard
Neurology Research International , 2011, DOI: 10.1155/2011/734232
Abstract: Background. The authors describe a lateral approach to the cervical spine for the management of spondylotic myeloradiculopathy. The rationale for this approach and surgical technique are discussed, as well as the advantages, disadvantages, complications, and pitfalls based on the author's experience over the last two decades. Methods. Spondylotic myelo-radiculopathy may be treated via a lateral approach to the cervical spine when there is predominant anterior compression associated with either spine straightening or kyphosis, but without vertebral instability. Results. By using a lateral approach, the lateral aspect of the cervical spine and the vertebral artery are easily reached and visualized. Furthermore, the lateral part of the affected intervertebral disc(s), uncovertebral joint(s), vertebral body(ies), and posterior longitudinal ligament can be removed as needed to decompress nerve root(s) and/or the spinal cord. Conclusion. Multilevel cervical oblique corpectomy and/or lateral foraminotomy allow wide decompression of nervous structures, while maintaining optimal stability and physiological motion of the cervical spine. 1. Introduction Cervical spondylotic myelopathy (CSM) and cervical spondylotic radiculopathy (CSR) are classically approached by anterior single or multiple disc space decompression [1, 2], multilevel corpectomy [3], laminectomy [4–10], or laminoplasty [11–18]. More recently, techniques using lateral multiple oblique corpectomy (MOC) and/or foraminotomy [19–28] have been used with increasing frequency. In general, when three or more levels are affected, the preferred techniques remain either an anterior multilevel corpectomy or a posterior route such as laminectomy, open door laminoplasty, and posterior foraminotomy. However, the best management of such pathology (especially if 3 or more levels are involved) remains controversial. The authors consider the cervical spine lateral approach a valid and safe option to treat such pathologies as it provides very good clinical results and maintains long-term spinal stability. The goal of this paper is to further and critically present the idea and rationale of the cervical spine lateral approach with its advantages, disadvantages, complications, and pitfalls in a critical review of their last 2 decades experience. 2. Technique Indication Predominant anterior compression associated with either straightening or kyphosis of the cervical spine in the absence of instability is the general indication for the proposed technique. In cases of both anterior and posterior compression, the posterior
Anterior Surgery in Multilevel Stenosis of the Lower Cervical Spine: Technical Indications and Personal Experience. 12 Years Follow-Up  [PDF]
Alessandro Landi, Nicola Marotta, Cristina Mancarella, Carlotta Morselli, Roberto Tarantino, Andrea Ruggeri, Roberto Delfini
International Journal of Clinical Medicine (IJCM) , 2014, DOI: 10.4236/ijcm.2014.54027
Abstract:


Objective: cervical spondylotic myelopathy is a progressive degenerative cervical spine disease. During later stages of segmental degeneration, kyphosis of the cervical spine can occur and further compromise the spinal cord and nerve roots. Optimal surgical approach remains controversial. The choice to perform an anterior, posterior or combined approach depends on: sagittal alignment, number of involved levels, main compression localization, and clinical status. The anterior approach is recommended when compression involves primarily anterior horn of spinal cord. Methods: between January 2001 and December 2005, 121 patients (42 F, 79 M, mean age 62 years) were operated for cervical spondylosis (98 myelopathy, 23 radiculopathy). Anterior surgical approach was performed in 81 patients. 63 patients were operated performing multilevel discectomy and fusion (ACDF) and 18 patients performing corpectomy and fusion and anterior plating (ACCF). Preoperative documentation collected consisted of cervical X-ray (static-dynamic), cervical spine TC, cervical MRI. Clinical documentation permitted us to obtained clinical status of each patient based on JOA, NDI and VAS. A Clinical and radiological follow-up was performed at 1 month, 3 months, 1 year, 6 years, 12 years. Results: the fusion rate was calculated based on the static and dynamic X-ray

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