Limited laminectomy and foraminal decompression combined with internal fixation for treating multi-segment cervical spondylotic myelopathy

Abstract

Laminectomy is an effective surgical treatment for multi-segment cervical spondylotic myelopathy (M-CSM) but usually results in C5 palsy. Some surgical techniques to restore the spinal sequence, increase the intervertebral foramen diameter, and limit the spinal cord drift distance have been proposed; however, it is unclear whether these procedures can avoid this complication. To investigate the clinical efficacy of limited laminectomy and foraminal decompression with fixation (LLFDF) for improving neurological recovery and preventing C5 palsy. A total of 71 patients with M-CSM were retrospectively analyzed. Thirty-nine of them were treated with LLFDF (group A) and 32 with normal laminectomy with fixation (NLF; group B) after 3 months of formal conservative treatment. Pre- and postoperative neurological function, spinal cord drift distance, cervical curvature index (CCI), and number of C5 palsy cases were recorded and analyzed. There was no significant intergroup difference in the surgical time or intraoperative blood loss ( P >.05). The laminectomy widths in groups A and B were 16.7 ± 2.6 mm and 21.8 ± 2.9 mm, respectively ( P <.01), while the spinal cord drift distances were 2.3 ± 0.4 mm and 3.6 ± 0.7 mm, respectively ( P <.01). The mean Japanese Orthopedic Association score of both groups increased significantly after surgery ( P <.01), and no significant difference was noted at any observation time points ( P >.05). Both groups demonstrated significant CCI improvements after surgery compared with those before surgery ( P <.01). There were 2 cases of C5 palsy in group A (5.1%) and 8 cases in group B (25.0%), and the difference was significant ( P <.05). LLFDF can relieve spinal compression and considerably promote neurological recovery. Moreover, it restricts excessive spinal cord back drifting and decreases the incidence of C5 palsy.

Cervical curvature changes following laminectomy with lateral mass screw fixation: Does it relate with spinal cord shift and clinical efficacy

“…By removing the posterior laminae, the volume of the spinal canal was effectively enlarged and the spinal cord moves backwards under the action of the tension band, thus avoiding the lasting damage caused by the compressions. It is suitable for patients with multi-segment cervical disc herniation, continuous ossi cation of posterior longitudinal ligament, severe spinal canal encroachment and clamp type of compression [1,[3][4][5][6]8]. Some literatures had reported that for the patients underwent laminectomy without xation, the cervical curvature will have a lost of 4 o in the short-term follow-up (1 year after operation) [6], and 21% (9/42) of patients developed postlaminectomy deformity in median follow-up (4 years after operation) [11].…”

“…Some literatures had reported that for the patients underwent laminectomy without xation, the cervical curvature will have a lost of 4 o in the short-term follow-up (1 year after operation) [6], and 21% (9/42) of patients developed postlaminectomy deformity in median follow-up (4 years after operation) [11]. After intraoperative xation with lateral mass screws, the trend of progressive cervical curvature loss and high frequency of kyphosis deformities were effectively controlled, but the cervical curvature became smaller in some patients still existence [3,5]. From the analysis on anatomy and biomechanics, both open-door laminoplasty and laminectomy will destroy the spinous process, vertebral plate and posterior ligaments complex to varying degrees, resulting in loss of effective attachment points of the cervical posterior muscle group, weakening of the muscle tension band, loss or straightenness of curvature due to the failure to maintain the original cervical curvature [4,6,9,[11][12].…”

“…Theoretically, during laminectomy, the laminectomy width is only required to be greater than the transverse diameter of the corresponding segment of the spinal cord. Zhao et al [5]. found that the postoperative neurological function of the patients recovered signi cantly by setting the laminectomy width as 16.7 mm.…”

“…C5 palsy was manifest as postoperative deltoid and/or biceps paralysis without obvious cause, mainly manifested as mild muscle weakness. Some patients may have intractable pain or sensory disturbance in the C5 innervation area [5]. All data were measured and graded by two doctors independently, and the average of the two was used as the nal result.…”

“…In addition to providing strong immediate stability, it can also achieve correction of the cervical sagittal sequence through a longer arm of force [3][4]. Moreover, selective laminectomy can be performed intraoperatively according to the range and width of the prominent tissues [5].…”