Cervical laminoplasty to enlarge the spinal canal in multilevel ossification of the posterior longitudinal ligament with myelopathy

Tomita, Katsuro; Nomura, Susumu; Umeda, Shinya; Baba, H.

doi:10.1007/bf00451594

Cited by 77 publications

(27 citation statements)

References 6 publications

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“…In contrast to the disruption of neural elements seen in trauma, chronic cord .compression due to ossification of the posterior longitudinal ligament [26,28,29,33,40] and calcification of the ligamentum flavum [3,8,13,19] is characterized by a relative maintenance of elasticity and functional reversibility of neurological deficits. Some reports have discussed the radiological morphology of mechanical spinal cord compression as it relates to symptoms and postoperative improvement [1,4,21,36,38].…”

Section: Introductionmentioning

confidence: 88%

Quantitative analysis of the spinal cord motoneuron under chronic compression: an experimental observation in the mouse

et al. 1996

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We investigated quantitative changes in spinal cord motoneurons following chronic compression using a mouse model of cervical cord compression. Twenty-five tip-toe-walking Yoshimura (twy) mice with calcified mass lesions compressing the spinal cord posterolaterally at the C1-C2 vertebral levels were compared with five Institute of Cancer Research (ICR) mice that served as controls. Spinal cord motoneurons in the anterior grey horn between the C1 and C3 spinal cord segments were Nissl-stained and counted topographically and then analysed in relation to the extent of spinal cord compression. The number of motoneurons in C1-C3 spinal cord segments decreased significantly with a linear correlation with the transverse area of the spinal cord when the cord was compressed to 50-70% of control values. A significant reduction in the number of motoneurons occurred at the C2-C3 spinal cord segment compressed at the C1-C2 vertebral level. In contrast, at the level rostral to the C1 vertebra, the number of motoneurons increased significantly in proportion to the magnitude of compression. The current study demonstrates that a number of neurons, morphologically consistent with anterior horn cells, were observed at a rostral site absolutely free of external compression where no such cells normally exist.

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Section: Introductionmentioning

confidence: 88%

Quantitative analysis of the spinal cord motoneuron under chronic compression: an experimental observation in the mouse

et al. 1996

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“…12,48 Laminoplasty was compared to ACF in 6 studies of treatment for CSM. 3,7,20,41,43,47 In their Class III study, Wada et al 43 compared subtotal corpectomy (23 patients, mean 2.5 operated levels, average age 53 years, and a 15 year followup) to opendoor laminoplasty (24 patients with an average age of 56 years, 12year followup). The JOA scale scores improved in both groups: from 7.9 to 13.4 in the corpectomy group, and from 7.4 to 12.2 in the laminoplasty group.…”

Section: Comparison With Other Techniquesmentioning

confidence: 99%

Cervical laminoplasty for the treatment of cervical degenerative myelopathy

Ryken

Heary²,

Matz

et al. 2009

SPI

101

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Object The objective of this systematic review was to use evidence-based medicine to examine the efficacy of cervical laminoplasty in the treatment of cervical spondylotic myelopathy (CSM). Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical laminoplasty and CSM. Abstracts were reviewed and studies meeting the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons and Congress of Neurological Surgeons. Results Cervical laminoplasty has improved functional outcome in the setting of CSM or ossification of the posterior longitudinal ligament. Using the Japanese Orthopaedic Association scale score, ~ 55–60% average recovery rate has been observed (Class III). The functional improvement observed after laminoplasty may be limited by duration of symptoms, severity of stenosis, severity of myelopathy, and poorly controlled diabetes as negative risk factors (Class II). There is conflicting evidence regarding age, with 1 study citing it as a negative risk factor, and another not demonstrating this result. Conclusions Cervical laminoplasty is recommended for the treatment of CSM or ossification of the posterior longitudinal ligament (Class III).

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“…The possibility for traumatic manipulation increases the risk of a CSF leak during an anterior decompression in comparison with a posterior approach, 31,54 because laminoplasty or laminectomy obviates direct manipulation of OPLL. Hence, although anterior decompression of the spinal cord by resection of the ossified ligament combined with anterior fusion can achieve more satisfactory results than a posterior approach, 43,45,54,56 the surgeon must take into account the risk of a CSF leak. Additionally, when choosing an anterior approach, the surgeon must be aware of intra-and postoperative management strategies to treat a CSF leak and minimize manipulation of the thecal sac to avoid any spinal cord damage.…”

mentioning

confidence: 99%

Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature

Mazur¹,

Jost²,

Schmidt³

et al. 2011

FOC

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Object Anterior decompression is an effective way to treat cervical myelopathy associated with ossification of the posterior longitudinal ligament (OPLL); however, this approach is associated with an increased risk of a dural tear and resultant CSF leak because fusion of the dura with the ossified PLL is common in these cases. The authors review the literature and present an algorithm for treatment of CSF leaks in these patients. Methods A MEDLINE review was performed to identify papers related to CSF leak after anterior decompression for OPLL, and data were summarized to identify treatment options for various situations. A treatment algorithm was identified based on these findings and the experience of the authors. Results Eleven studies were identified that presented data on intra- and postoperative management of a CSF leak during ventral surgery for OPLL. The incidence of cervical dural tears and CSF leaks after anterior decompression procedures for OPLL ranged from 4.3% to 32%. Techniques including preventative measures, intraoperative dural repair with various materials, and postoperative drainage or shunt placement have all been used. Conclusions Although direct dural repair is the preferred treatment for CSF leak, this technique is not always technically possible. In these cases, intraoperative adjuncts in combination with postoperative measures can be used to decrease the pressure gradient across the dural tear.

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Cervical laminoplasty to enlarge the spinal canal in multilevel ossification of the posterior longitudinal ligament with myelopathy

Cited by 77 publications

References 6 publications

Quantitative analysis of the spinal cord motoneuron under chronic compression: an experimental observation in the mouse

Quantitative analysis of the spinal cord motoneuron under chronic compression: an experimental observation in the mouse

Cervical laminoplasty for the treatment of cervical degenerative myelopathy

Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature

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