Interlaminar Bony Fusion After Cervical Laminoplasty: Its Characteristics and Relationship With Clinical Results

Iizuka, Haku; Iizuka, Yoichi; Nakagawa, Yumi; Nakajima, Takashi; Toda, Naofumi; Shimegi, Atsushi; Tsutsumi, Satoshi; Takagishi, Kenji

doi:10.1097/01.brs.0000203707.79269.6a

Cited by 33 publications

(21 citation statements)

References 15 publications

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“…Segmental ROM at C2-3, which is the proximal adjacent segment, showed the most significant decrease during both flexion-extension and rotation. At C2-3, as Iizuka et al 6 suggested, the lifted C-3 lamina appeared to collide with the inferior edge of the C-2 lamina during both extension and rotation (see Videos 1 and 2, which demonstrate the reduction of ROM both in flexion-extension and in rotation by the collision of lifted laminae). We think that this is the mechanism by which the segmental ROM at C2-3 decreased omnidirectionally and that this is one of reasons C2-3 is the level most frequently involved in laminar fusion.…”

Section: Figmentioning

confidence: 96%

“…However, almost all of these studies assessed neither total cervical ROM nor segmental ROM but only partial cervical flexion-extension ROM (C2-7 angle), using lateral radiographs. [1][2][3][4][5][6]11,13,15,16,18,21,22,26,28 That assessment method is useless when the C-7 vertebra is masked by shoulder girdle shadows. We obtained similar results in our study; we found that C2-7 ROM during flexion-extension decreased significantly by 23% after laminoplasty.…”

Section: Discussionmentioning

confidence: 99%

“…We think that this is the mechanism by which the segmental ROM at C2-3 decreased omnidirectionally and that this is one of reasons C2-3 is the level most frequently involved in laminar fusion. 6,22,28 No study has investigated coupled motion in the cervical spine after laminoplasty. Normal coupled lateral bending during rotation occurs in the opposite direction at the upper cervical level and in the same direction at the subaxial spine, and coupled motion is thought to be driven by the oblique orientation of the apophyseal joint.…”

Section: Figmentioning

confidence: 99%

“…12,22,28 Although laminoplasty has advantages such as a lower incidence of postoperative cervical kyphosis and preservation of range of motion (ROM), many authors have reported a significant decrease in cervical ROM after laminoplasty despite the good postoperative neurological improvements experienced by their patients. [1][2][3][4][5][6]11,12,[15][16][17][18][20][21][22]25,26,28 However, they have investigated using only 2D flexion and extension on lateral radiographs. To our knowledge, there has been no report of 3D motion analysis about cervical laminoplasty, including coupled motion and precise intervertebral motion.…”

mentioning

confidence: 99%

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In vivo 3D kinematic changes in the cervical spine after laminoplasty for cervical spondylotic myelopathy

Nagamoto

Iwasaki

Sugiura

et al. 2014

SPI

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Object Cervical laminoplasty is an effective procedure for decompressing the spinal cord at multiple levels, but restriction of neck motion is one of the well-known complications of the procedure. Although many authors have reported on cervical range of motion (ROM) after laminoplasty, they have focused mainly on 2D flexion and extension on lateral radiographs, not on 3D motion (including coupled motion) nor on precise intervertebral motion. The purpose of this study was to clarify the 3D kinematic changes in the cervical spine after laminoplasty performed to treat cervical spondylotic myelopathy. Methods Eleven consecutive patients (6 men and 5 women, mean age 68.1 years, age range 57–79 years) with cervical spondylotic myelopathy who had undergone laminoplasty were included in the study. All patients underwent 3D CT of the cervical spine in 5 positions (neutral, 45° head rotation left and right, maximum head flexion, and maximum head extension) using supporting devices. The scans were performed preoperatively and at 6 months after laminoplasty. Segmental ROM from Oc–C1 to C7–T1 was calculated both in flexion-extension and in rotation, using a voxel-based registration method. Results Mean C2–7 flexion-extension ROM, equivalent to cervical ROM in all previous studies, was 45.5° ± 7.1° preoperatively and 35.5° ± 8.2° postoperatively, which was a statistically significant 33% decrease. However, mean Oc–T1 flexion-extension ROM, which represented total cervical ROM, was 71.5° ± 8.3° preoperatively and 66.5° ± 8.3° postoperatively, an insignificant 7.0% decrease. In focusing on each motion segment, the authors observed a statistically significant 22.6% decrease in mean segmental ROM at the operated levels during flexion-extension and a statistically insignificant 10.2% decrease during rotation. The most significant decrease was observed at C2–3. Segmental ROM at C2–3 decreased 24.2% during flexion-extension and 21.8% during rotation. However, a statistically insignificant 37.2% increase was observed at the upper cervical spine (Oc–C2) during flexion-extension. The coupling pattern during rotation did not change significantly after laminoplasty. Conclusions In this first accurate documentation of 3D segmental kinematic changes after laminoplasty, Oc–T1 ROM, which represented total cervical ROM, did not change significantly during either flexion-extension or rotation by 6 months after laminoplasty despite a significant decrease in C2–7 flexion-extension ROM. This is thought to be partially because of a compensatory increase in segmental ROM at the upper cervical spine (Oc–C2).

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Section: Figmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Figmentioning

confidence: 99%

mentioning

confidence: 99%

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In vivo 3D kinematic changes in the cervical spine after laminoplasty for cervical spondylotic myelopathy

Nagamoto

Iwasaki

Sugiura

et al. 2014

SPI

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“…Postoperative interlaminar bony fusion with reduced cervical ROM has been reported to occur in patients undergoing laminoplasty (Seichi et al 2001, Kawaguchi et al 2003, Iizuka et al 2006). In our modified method with secure anchor fixation, the ROM values were not compromised, which may have been due to the possibility of undergoing early physiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Open-door laminoplasty for multilevel cervical spon-dylotic myelopathy: Good outcome in 12 patients using suture anchor fixation

Yang¹,

Niu²,

Chen³

et al. 2008

Acta Orthopaedica

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Background and purpose In the classic Hirabayashi procedure, the lamina door is tethered open by sutures between the spinous process and facet capsule or paravertebral muscle. Our early experiences showed, however, that the loosened sutures result in dislodgement and reclosure of the lifted lamina. We present a modified method to ensure secure fixation and prevent restenosis due to hinge closure.Patients and methods 12 patients with cervical spondylotic myelopathy underwent unilateral open-door laminoplasty using suture anchor fixation between 2000 and 2004. The sutures were tied and fixed onto the holed lateral mass screws, instead of using the conventional suture technique. We used radiography, MRI, and CT for imaging studies. The Nurick score was used to assess severity of myelopathy, and the Japanese Orthopedic Association (JOA) score was used to evaluate clinical outcomes before surgery and at the last follow-up visit.Results All patients experienced functional improvement of at least 1 Nurick score after surgery. The JOA score for the 12 patients increased significantly from 6.9 (SD 3.0) before surgery to 13 (SD 1.6) at final follow-up. Postoperative radiography and CT showed increased sagittal diameter and canal expansion. Average preoperative and postoperative ranges of motion for the cervical spine were 48 (SD 4.6) and 36 (SD 2.7), respectively. No neurological deterioration due to hinge reclosure and no major surgery-related complications were observed during the follow-up period.Interpretation Open-door laminoplasty using suture anchor fixation effectively maintains expansion of the

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Sagittal Balance Concept Applied to the Craniovertebral Junction

Obeid

Cawley

2019

Surgery of the Cranio-Vertebral Junction

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Interlaminar Bony Fusion After Cervical Laminoplasty: Its Characteristics and Relationship With Clinical Results

Abstract: Postoperative interlaminar bony fusion occurred in 53% of patients, with marked frequency at C2/3 after laminoplasty. It did not influence neurologic recovery, but it did reduce the postoperative sagittal ROM of the cervical spine.

Cited by 33 publications

References 15 publications

In vivo 3D kinematic changes in the cervical spine after laminoplasty for cervical spondylotic myelopathy

In vivo 3D kinematic changes in the cervical spine after laminoplasty for cervical spondylotic myelopathy

Open-door laminoplasty for multilevel cervical spon-dylotic myelopathy: Good outcome in 12 patients using suture anchor fixation

Sagittal Balance Concept Applied to the Craniovertebral Junction

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