Double-door cervical laminoplasty with suture anchors: evaluation of the clinical performance of the constructs

Fujishiro, Takashi; Nakano, Atsushi; Baba, Ichiro; Fukumoto, Shingo; Nakaya, Yoshiharu; Neo, Masashi

doi:10.1007/s00586-016-4666-2

Cited by 16 publications

(16 citation statements)

References 27 publications

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“…Fifth, we did not analyze histological or molecular alterations of the elongated rootlets. Lastly, although this rat model could reproduce postoperative environment of the cervical cord after double-door laminoplasty with suture anchors, 28 the other animal models putting surgical materials posteriorly should be tested in the future researches to reproduce laminoplasty using props since various materials have been introduced into this procedure recently. 29 In conclusion, the newly developed rat model of cervical laminectomy was thought to be appropriate for analyzing the mechanisms of C5P since the findings observed in this model were comparable with the clinical course of C5P subsequent to posterior cervical decompression; dysfunction of the deltoid (C5, 6 innervated) appeared 3 days postoperatively and continued.…”

Section: Discussionmentioning

confidence: 99%

An Experimental Rat Model of C5 Palsy Following Posterior Decompression Surgery of the Cervical Spine

Yokota

Fujishiro

Usami

et al. 2021

Spine

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Study Design. Basic in vivo research.Objectives. The aim of this study was to establish an animal model that is appropriate for analyzing the mechanisms of C5 palsy (C5P) and to clarify the structural and functional alterations of cervical roots following posterior decompression. Summary of Background Data. Although C5P is one of the major complications of cervical surgery, the exact pathogenesis of C5P remains unclear partly because of the lack of an appropriate animal model. Tethering of the cervical roots due to posterior cord shift following posterior decompression is thought to be one of the possible factors that cause C5P. Methods. Twenty-eight Sprague-Dawley rats were divided into Group L (cervical laminectomy, N ¼ 18) or Group S (sham surgery, N ¼ 10) and examined up to postoperative day 14 (PO14). Posterior cord shift and the length of the anterior rootlets were quantified by computed tomography-myelogram images. Motor evoked potential (MEP) of the deltoid (C5, 6 innervated) and triceps brachii (C7-T1 innervated), mechanical allodynia, and grip strength of the forepaw (C7-T1 regulated) were measured. Results. All anterior rootlets were elongated as the cord gradually shifted posteriorly postoperatively. The elongation rate of the C6 anterior rootlets was the highest (142% at PO14). The MEP latency of the deltoid was significantly delayed throughout all postoperative time points. However, significant delay in the latency of the triceps brachii was observed only on postoperative day 10. The withdrawal threshold of the forepaw did not change; grip strength of the forelimb decreased at PO14. Conclusion. This model was thought to be appropriate for analyzing the pathogenesis of C5P since our findings were comparable to the clinical course of C5P subsequent to posterior cervical decompression. Although a future study for clarifying histological and molecular alterations will be needed, tethering of the anterior rootlets due to posterior cord shift was suggested to be a probable mechanism causing C5P.

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Section: Discussionmentioning

confidence: 99%

An Experimental Rat Model of C5 Palsy Following Posterior Decompression Surgery of the Cervical Spine

Yokota

Fujishiro

Usami

et al. 2021

Spine

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“…Patients underwent double-door CLP using suture anchors, which has been described in detail elsewhere. 3,7 After the spinous processes were shortened, midline osteotomy of laminae was performed and bilateral hinges were placed. Self-tapping suture anchors were then embedded in the lateral masses.…”

Section: Surgical Methods and Postoperative Coursementioning

confidence: 99%

“…A lthough cervical laminoplasty (CLP) is an established surgery with good clinical outcomes, there are some burdensome specific complications that arise in the perioperative period. [1][2][3] Although rare, one of these serious complications include the symptomatic epidural hematoma (EH). Once neurological conditions severely deteriorate, an emergency evacuation surgery is required.…”

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confidence: 99%

Usefulness of Percutaneous Ultrasonography for Deciding the Need of Surgical Evacuation of Epidural Hematoma After Cervical Double-door Laminoplasty

Nakaya¹,

Hayama²,

Nakano³

et al. 2021

Clinical Spine Surgery: A Spine Publication

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Objective: The objective of this study was to investigate the diagnostic utility of percutaneous ultrasonography (PUS) for postoperative epidural hematoma (EH) as a postoperative complication. Summary of Background Data:We investigated the usefulness of PUS for determining the need of surgical evacuation of postoperative EH by comparing the postoperative magnetic resonance imaging (MRI) and PUS of the spinal cord.Materials and Methods: This study included patients who underwent cervical laminoplasty using suture anchors. Regular MRI and PUS were performed 1 week postoperatively. Whenever the patients exhibited neurological deterioration, MRI and PUS were performed. The spinal cord decompression status was classified into 3 grades using MRI and PUS. The existence of spinal pulsation was determined by PUS.Results: One hundred thirty-one patients were investigated. The decompression status by MRI and PUS, and the pulsation status by PUS showed a correlation with neurological deterioration (P < 0.001). Four cases showed postoperative neurological deterioration and required revision surgery. The decompression status in these cases was classified as "poor" by both MRI and PUS, and as "no-pulsation" by PUS pulsation. The sensitivity and specificity for neurological deterioration was 100% and 95.1% in MRI decompression, 100% and 92.9% in PUS decompression, and 100% and 99.2% in PUS pulsation, respectively.Conclusions: This is the first report that the disappearance of spinal pulsation was associated with neurological deterioration. PUS was useful in determining the need of surgical evacuation for postoperative EH. PUS should be the first choice of examination in the event of postoperative neurological deterioration following a cervical laminoplasty. When the disappearance of pulsation is confirmed, an additional hematoma evacuation surgery should be considered immediately without undertaking MRI.

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“…The maintenance of opened lamina originated from suture fixation in the earlier reports of laminoplasty, which had a certain probability of lamina re-closure. To better maintain the decompression effect, spacers from autologous bone and hydroxyapatite ( 11 ), lateral mass suture anchors ( 12 ), as well as titanium plates ( 13 ) have been used in clinical practice with corresponding technical features. Most methods attained an effective long-term stabilization effect, yet the early firmness of internal fixation titanium plates was better than that of spacers fixed by suture.…”

Section: Introductionmentioning

confidence: 99%

Initial clinical experiences of the muscle-preserving double door cervical laminoplasty with adjustable mini plates

Zhang²,

Yan³

2023

Front. Surg.

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Shirashi's double door laminoplasty method was a popular decompression procedure for cervical myelopathy. In this paper, we introduced a modified double door laminoplasty based on Shirashi's method with preliminary results. This study retrospectively analyzed 22 patients who underwent modified double door laminoplasty. During procedure, a single segment of the unilateral lamina was separated from the cervical semispinalis muscle and the multifidus muscle space for the preparation of lamina groove. A self-developed mini titanium plate was used to fix the inner side of the spinous process to complete the fixation after open-door process. The VAS, JOA scores and QoL scale were recorded for pain assessment, neurological and functional recovery. The overall curvature and range of motion of C2–C7 were measured with x-ray images. Changes in sagittal diameter of spinal canal were measured by CT scans. MRI was used to measure the cross-sectional area of cervical paravertebral muscles. All 22 patients successfully recovered with this procedure. The mean operation time, blood loss and follow-up durations were 117 ± 25 min, 149 ± 32 ml and 16.1 ± 3.6 months respectively. The preoperative, 3-month postoperative and 12-month postoperative JOA scores were 9.35 ± 3.25, 13.74 ± 4.86 and 15.73 ± 5.19 respectively. with improvement rates of 57.4% and 83.4%. Mean VAS scores before, 3 months after and 12 months after surgery were 1.81 ± 0.79, 2.82 ± 1.56 and 2.18 ± 1.34 respectively. The C2–7 lordotic angle and overall range of motion shows no statistical difference preoperatively and 12 post-surgery. The average sagittal diameter of the cervical spinal canal was enlarged from 9.15 ± 1.55 mm to 14.25 ± 1.46 mm. The average area of cervical paravertebral volume measured preoperatively and 3 months post operation was 84% of pre-operative value respectively. This value was improved to 93% of the preoperative value at 12 months post-surgery. This paper introduced initial experience on a modified posterior cervical double-door laminoplasty that was based on Shirashi's method, featuring creating bilateral laminar grooves on both sides and fixing central gap with self-developed mini plates. This procedure prevented obvious axial symptoms and improved patients' quality of life, which provided a baseline for further research with larger cohorts.

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Double-door cervical laminoplasty with suture anchors: evaluation of the clinical performance of the constructs

Abstract: The constructs of double-door cervical laminoplasty with suture anchors are stable with a high rate of fusion at the hinges. However, if the procedure is performed at C3, special modifications should be made to avoid lamina closure.

Cited by 16 publications

References 27 publications

An Experimental Rat Model of C5 Palsy Following Posterior Decompression Surgery of the Cervical Spine

An Experimental Rat Model of C5 Palsy Following Posterior Decompression Surgery of the Cervical Spine

Usefulness of Percutaneous Ultrasonography for Deciding the Need of Surgical Evacuation of Epidural Hematoma After Cervical Double-door Laminoplasty

Initial clinical experiences of the muscle-preserving double door cervical laminoplasty with adjustable mini plates

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