No abstract

Background: The efficacy and noninferior of performing modified double-door laminoplasty (MDDL) (C4–C6 laminoplasty plus C3 laminectomy, alongside a dome-like resection of the inferior part of the C2 lamina and the superior part of the C7 lamina) in patients with multilevel cervical spondylotic myelopathy (MCSM) is equivocal. A randomized, controlled trial is warranted. Objective: The objective was to evaluate the clinical efficacy and noninferior of MDDL compared with traditional C3–C7 double-door laminoplasty. Study design: A single-blind, randomized, controlled trial. Methods: A single-blind, randomized, controlled trial was conducted in which patients who with MCSM with greater than or equal to 3 levels of spinal cord compression from the C3 to the C7 vertebral levels were enrolled and assigned to undergo either MDDL group or conventional double-door laminoplasty (CDDL) group in a 1:1 ratio. The primary outcome was the change in the Japanese Orthopedic Association score from baseline to 2-year follow-up. The secondary outcomes included changes in the Neck Disability Index (NDI) score, the Visual Analog Scale (VAS) for neck pain, and imaging parameters. Operative complications were also collected and reported. The outcome measures were compared between the groups at 3 months, 1 year, or 2 years after surgery. Results: A total of 96 patients (mean age 67 years, 39.8% women) underwent randomization. Of these patients, 93 completed 3-month follow-up, 79 completed 1-year follow-up, and 66 completed 2-year follow-up. The changes in the Japanese Orthopedic Association score did not differ significantly between the study groups at the three time points after surgery. With respect to amelioration of neck pain and disability related to neck pain, patients in the MDDL group had a significantly greater decrease in the VAS and NDI component summary score than did those in the CDDL group at 1-year (VAS: −2.5 vs. −3.2, difference −0.7, 95% CI −1.1 to −0.2, P=0.0035; NDI: −13.6 vs. −19.3, difference −5.7, 95% CI −10.3 to −1.1, P=0.0159) and 2-years (VAS: −2.1 vs. −2.9, difference −0.8, 95% CI −1.4 to −0.2, P=0.0109; NDI: −9.3 vs. −16.0, difference −6.7, 95% CI −11.9 to −1.5, P=0.0127). The changes in the range of motion (ROM), the C2–C7 Cobb angle, and the cervical sagittal vertical axis in the MDDL group were significantly less than those in the CDDL group (ROM: −9.2±6.4 vs. −5.0±6.0, P=0.0079; C2–C7 Cobb angle: −7.9±7.8 vs. −4.1±6.2, P=0.0345; cervical sagittal vertical axis: 0.6±0.9 vs. 0.2±0.6, P=0.0233). The MDDL group had less blood loss (428.1 vs. 349.1, P=0.0175) and a lower rate of axial symptoms (27.3 vs. 6.1%, P=0.0475) than the CDDL group. Conclusions: Among patients with MCSM, the MDDL produced similar cervical cord decompression compared with the conventional C3–C7 double-door laminoplasty. The modified laminoplasty was associated with meaningful improvement in amelioration of neck discomfort, maintaining a better cervical ROM and sagittal alignment, decreasing blood loss, and reducing the incidence of axial symptoms.

Rationale:Rosai-Dorfman disease (RDD) is a rare, benign, self-limiting disease, also known as sinus histiocytosis with giant lymphadenopathy. Skeletal involvement is rare, and this isolated bone lesion usually occurs in adults with no other symptoms. It is estimated that 0.6% to 1% of RDD cases have isolated or complicated spinal lesions, which may occur in the bone, dura, and spinal parenchyma, but spinal RDD has no pathologic clinical or imaging features.Patient concerns:A 25-year-old woman presented with complaints of low back pain without obvious causes for a month.Diagnosis:RDD with spinal involvement.Interventions:Resection of the spinous process of the third lumbar spine was performed under epidural anesthesia.Outcomes:At the time of discharge, the patient had no problems with autonomous activities and reported no discomfort. We also followed up the patient at 12 and 36 months after surgery, and the patient reported no discomfort, inconvenience, and no recurrence of symptoms. Imaging examination 1 year after surgery showed no recurrence.Lesson:This case suggests that surgery for RDD with spinal involvement may not require internal fixation.