Long-term results of double-door laminoplasty using hydroxyapatite spacers in patients with compressive cervical myelopathy

Kimura, Atsushi; Seichi, Atsushi; Inoue, Hirokazu; Hoshino, Yuichi

doi:10.1007/s00586-011-1724-7

Cited by 47 publications

(38 citation statements)

References 17 publications

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“…Furthermore, although preservation of the terminal ligaments may confer biomechanical stability, this cadaveric study cannot address long-term sequelae of more stabilized cervical vertebrae, especially at C2-3, which can become ossified after laminoplasty, 23 possibly conveying recalcitrant stenosis at this level. 11 This, of course, would require long-term clinical data.…”

Section: Discussionmentioning

confidence: 99%

“…2,3,5,16,28 Despite these advantages, reports have shown that ODL may lead to persistent neck and shoulder pain, progressive loss of ROM, and progressive cervical kyphosis. [6][7][8]11,29 There are various approaches used to perform cervical laminoplasty, many of which involve spinous process resection and disruption of intervening interspinales musculature and supraspinous ligaments (intraspinous and supraspinous ligaments [ISLs]). 5,9,20 Alternative methods have been reported that retain the dorsal ligamentous complex, and small cohorts have shown it may protect from loss of sagittal balance, while not statistically reducing cervical ROM.…”

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confidence: 99%

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Biomechanics of open-door laminoplasty with and without preservation of posterior structures

Healy¹,

Lubelski

West

et al. 2016

Journal of Neurosurgery: Spine

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laboratory iNveStigatioNC erviCal open-door laminoplasty (ODL) decompresses the spinal canal while maintaining nearphysiological cervical range of motion (ROM). In contrast to a standard laminectomy, which leads to postlaminectomy kyphosis in 15%-43% of cases, ODL is purported to reduce this adverse outcome. 2,3,5,16,28 Despite these advantages, reports have shown that ODL may lead to persistent neck and shoulder pain, progressive loss of ROM, and progressive cervical kyphosis. [6][7][8]11,29 There are various approaches used to perform cervical laminoplasty, many of which involve spinous process resection and disruption of intervening interspinales musculature and supraspinous ligaments (intraspinous and supraspinous ligaments [ISLs]). 5,9,20 Alternative methods have been reported that retain the dorsal ligamentous complex, and small cohorts have shown it may protect from loss of sagittal balance, while not statistically reducing cervical ROM. obJective Cervical open-door laminoplasty (ODL) is designed to decompress the spinal cord, maintain motion, and prevent postlaminectomy kyphosis. Many traditional laminoplasty techniques involve disruption of the posterior ligamentous structures, most notably the C7-T1 supraspinous ligament and interspinales muscle complex (intraspinous and supraspinous ligaments [ISLs]). methodS Eight human cervical cadaveric specimens (C2-T1) were used to investigate the subaxial kinematics following ODL with varying degrees of posterior element disruption. Ligamentous integrity was preserved and specimens were tested utilizing force control in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) in the native state, and following 1) C3-7 ODL, 2) ODL with terminal ISL resection, 3) ODL with C3-7 spinous process resection, and 4) C3-7 laminectomy. Range of motion (ROM) was measured across C2-T1, "global," and at the segmental level. reSultS Compared with ODL, sectioning the terminal ISLs resulted in global ROM increases by 7.9% in FE, 2.4% in LB, and 5.6% in AR (p > 0.05), whereas laminectomy increased global ROM by 36.0% in FE (p = 0.002) and a 26.3% increase in AR ROM (p = 0.01). When considering segmental ROM, resection of the terminal ISLs increased ROM in FE by 36.5% at C2-3 (p = 0.019) and 25.4% at C7-T1 (p > 0.05). Segmental increases following C3-7 spinous process resection averaged less than 3% per level, compared with up to 40% increases in ROM per level after laminectomy. coNcluSioNS Laminectomy resulted in the greatest increase in global cervical ROM. Resection of the ISLs at C2-3 and C7-T1 increased segmental ROM at these specific levels to a similar extent that laminectomy increased ROM at each cervical level. This segmental ROM may contribute to pain or postprocedural deformity and highlights the importance of the ISLs at the terminal ends of the ODL.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Biomechanics of open-door laminoplasty with and without preservation of posterior structures

Healy¹,

Lubelski

West

et al. 2016

Journal of Neurosurgery: Spine

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“…This technique is well established and the reported complication rates are acceptable, but some problems such as axial symptoms or C5 palsy have not been fully resolved [4][5][6]. The long term results of this technique is satisfactory, with the preservation of the enlarged cervical canal area and the maintenance of JOA scores for cervical myelopathy (JOA score, Table 1, maximum score 17 points) [7].…”

Section: Introductionmentioning

confidence: 98%

Clinical results of and patient satisfaction with cervical laminoplasty for considerable cord compression with only slight myelopathy

et al. 2011

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Purpose There is no established consensus on the indications for surgery in patients with considerable cord compression but only slight myelopathy. The purpose of this study is to stimulate discussion about the indications for surgery in these patients. Methods The records of consecutive patients who underwent cervical laminoplasty (CLP) during 3.5 years were reviewed. Those patients whose pre-operative Japanese Orthopaedic Association score (JOA score, maximum 17) for cervical myelopathy was 16 points or more, indicating that they had very slight myelopathy, were selected. The postoperative JOA scores of these patients were checked via a chart review, and they were sent a survey asking about their degree of satisfaction with the results of surgery.

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“…This method has become the gold standard for cervical myelopathy surgical interventions, particularly when there is multilevel involvement. Good long term surgical outcomes have been reported with this procedure [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 89%

Compression Myelopathy Caused by Anterolisthesis and Hypertrophic Ligamentumflavum in the Adjacent Segment 11years after Cervical Laminoplasty-A Case Report and Review of the Literature

Dohzono¹

2014

Glob J Medical Clin Case Rep

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Introduction: Symptomatic adjacent segment disease after anterior cervical decompression and fusion has been well described, but there have been few reports of symptomatic adjacent segment disease after cervical laminoplasty. Case report:The authors report on a 69-year-old female gradually developed gait disturbance due to C7 anterolisthesis and ligamentumflavum thickening with an onset 11 years after conventional C3-7 laminoplasty. The patient underwent laminectomy from C6 to T1 and was able to return to ambulation. However, she experienced further deterioration in her ambulatory status four years after the second surgery, due to further anterior slippage of C7.Finally; she underwent posterior decompression and fusion from C5 to T3. The patient was able to return to ambulation with the assistance of a cane despite some level of spasticity. Conclusion:Compression myelopathy may occur as a late effect adjacent segment disease that produces a deteriorated condition after conventional cervical laminoplasty. Anterolisthesis with thickened ligamentumflavum at the cervico-thoracic junction needs to be fused and instrumented.laminoplasty. The purpose of this paper is to describe the details of this rare case and review the literature. Case PresentationA 69-year-old woman was admitted to our department due to gradual onset of difficulty in walking. She had undergone a spinous process-splitting laminoplasty from C3 to C7 11 years ago. The surgical results were uneventful, and she had been free from the preoperative symptoms for ten years.She presented with a twelve month history of bilateral lower extremity numbness and muscle weakness. Though the symptoms were getting worse, she had not previously had a medical examination. She was subsequently transferred to the emergency room due to lower extremity paresis.She was not able to stand up or ambulate at the time of admission. Physical examination revealed significant motor weakness in both lower extremities. Sensory disturbance was observed on her trunk and both lower extremities.Plain X-ray of the cervical spine three years after laminoplasty showed facet joint osteoarthritis at C7-T1 that was not observed at Abbreviations ROM: Range of Motion IntroductionCervical laminoplasty was first reported by Hirabayashi in 1983 [1]. This method has become the gold standard for cervical myelopathy surgical interventions, particularly when there is multilevel involvement. Good long term surgical outcomes have been reported with this procedure [2-6].However, anterior cervical fusion is still a widely used procedure for cases having a lesion at one or two levels.Several studies compared the surgical outcomes and complications for these two procedures [7][8][9][10][11][12][13][14][15]. There appeared to be no difference in clinical outcome, but a de-novo lesion has been reported as an adjacent segment disease with long-term follow up after anterior fusion.Recently we experienced a rare case of cervico-thoracic spondylolisthesis with hypertrophy of the ligamentumflavum as an ad...

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Long-term results of double-door laminoplasty using hydroxyapatite spacers in patients with compressive cervical myelopathy

Cited by 47 publications

References 17 publications

Biomechanics of open-door laminoplasty with and without preservation of posterior structures

Biomechanics of open-door laminoplasty with and without preservation of posterior structures

Clinical results of and patient satisfaction with cervical laminoplasty for considerable cord compression with only slight myelopathy

Compression Myelopathy Caused by Anterolisthesis and Hypertrophic Ligamentumflavum in the Adjacent Segment 11years after Cervical Laminoplasty-A Case Report and Review of the Literature

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