Outcome Evaluation of Modified Uninstrumented Open-door Cervical Laminoplasty for Ossified Posterior Longitudinal Ligament with Cervical Myelopathy

Dhillon, Charanjit Singh; Ega, Shrikant; Tantry, Raviraj; Medagam, Narendra Reddy; Chhasatia, Nilay; Pophale, Chetan S; Khatavi, Anand

doi:10.4103/ortho.ijortho_207_19

Cited by 4 publications

(2 citation statements)

References 31 publications

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“…We use an uninstrumented variant developed by us to keep the gap open and provide support for the hinge to heal. A non-absorbable polyester suture material such as Ethibond (© Johnson & Johnson Medical N.V., Belgium) is used to keep the laminar flaps elevated [10]. The wound is closed over layers and a drain is kept.…”

Section: Posterior Cervical Laminoplastymentioning

confidence: 99%

Surgical Management of Cervical Myelopathy: Current Algorithm

Dhillon,

Chhasatia

2023

ijs

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Cervical myelopathy (CM) is a progressive disorder associated with a varied spectrum of etiological factors. Cervical spondylotic myelopathy (CSM) encompasses two-thirds of the cases of CM, while ossified posterior longitudinal ligament (OPLL) and ossified ligamentum flavum (OLF) are significant regional etiological factors. Microvascular disruption, resulting from repetitive dynamic compression or static pressure to the spinal cord, is attributed as a primary pathophysiological mechanism for CM. Magnetic resonance imaging (MRI) is the investigation of choice to assess the spinal cord. Lateral cervical radiographs are crucial for lordosis assessment, and tomographic scans (CT) can delineate the extent of OPLL and OLF. Non-surgical treatment is usually not successful once the patient develops progressive myelopathy. Anterior cervical procedures are ideal for one or two level disc-osteophytes complexes or in patients with kyphotic cervical alignment. Laminoplasty is an effective motion-preserving option in patients with adequate cervical lordosis. Laminectomy or laminoplasty and fusion are optimal for patients with significant preoperative neck pain. Posterior surgery is preferred over anterior surgery for CM involving three or more levels. Older age at presentation, longer duration of symptoms, and severity of pre-operative symptoms are adverse prognostic factors. Progressive cervical myelopathy is a surgical disease, and early intervention is rewarded with better outcomes. Keywords: Cervical myelopathy, Cervical spondylotic myelopathy, OPLL, OLF, Laminoplasty, Laminectomy, ACDF, Cervical corpectomy.

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Section: Posterior Cervical Laminoplastymentioning

confidence: 99%

Surgical Management of Cervical Myelopathy: Current Algorithm

Dhillon,

Chhasatia

2023

ijs

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“…Dhillon et al also observed that the JOA score signi cantly increased after UODL in patients with cervical OPLL (from 9.2 ± 1.1 13.7 ± 0.9)(17). Cha et al reported (18) that in patients with multilevel cervical myelopathy, the JOA score roses from 9.4 ± 3.3 preoperatively to 13.8 ± 2.2 after one year following UODL.…”

mentioning

confidence: 92%

Choice of open side affects clinical outcomes of unilateral open-door laminoplasty for inconsistent cervical ossification of posterior longitudinal ligament

Qiao,

Zhang,

et al. 2024

Preprint

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Background The best open side for a unilateral open-door laminoplasty (UODL) to treat inconsistent cervical ossification of the posterior longitudinal ligament (OPLL) must be identified. Methods Retrospective analysis involving 31 individuals with inconsistent OPLL who received UODL between January 2016 and December 2018 were divided into two groups: when the side of the open door was consistent to the larger ossification occupancy area side, patients were placed into the Consistent Group; when the side of the open door was contralateral to the larger ossification occupancy area side, patients were placed into the Contralateral Group. The following parameters were evaluated; neck disability index (NDI) score, Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, postoperative laminoplasty opening width and angle, and diameter of spinal cord ratio. To assess the clinical results between the two groups, the spinal cord shift was also evaluated. Results Patient demographics and major problems did not differ significantly between groups. Transient pain in the deltoid region was more frequent in the Consistent Group. The diameter-to-spinal cord ratio, VAS and NDI scores did not significantly differ from one another, opening width and angle in postoperative laminoplasty between the two groups. The JOA scores improved in the Consistent Group. The diameter of spinal cord ratio was more significantly improved in the Consistent Group, as well as the spinal cord shift. Conclusions For inconsistent cervical OPLL, the side of the open door that was consistent with the larger ossification occupancy area side is preferred in UODL.

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Choice of the Open Side in Unilateral Open-Door Laminoplasty for Cervical Ossification of the Posterior Longitudinal Ligament

Tang

Zhou

Wang

et al. 2020

Spine

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Study Design. Retrospective study. Objective. To determine the optimal open side in unilateral open-door laminoplasty (UODL) for lateral cervical ossification of posterior longitudinal ligament (OPLL). Summary of Background Data. No literature has reported which side of the vertebral arch should be chosen as the open side in UODL for lateral cervical OPLL. Methods. Patients with lateral cervical OPLL who were treated with UODL between 2013 and 2018 were retrospectively analyzed in two groups: Group A, where the open side was contralateral to the ectopic bone, and Group B, where the open side was ipsilateral to the ectopic bone. The Japanese Orthopaedic Association (JOA) Score, JOA recovery rate, spinal canal enlargement rate, cervical range of motion (ROM), and spinal cord area (SCA) were measured to evaluate and compare the clinical outcomes between the two groups. Statistical analysis was performed by t test and Hotelling T2 test. Results. There was no significant difference in patient demographics and major complications between the two groups. The postoperative JOA Score and JOA recovery rate in Group A were significantly higher than those in Group B. There was no significant difference in cervical ROM within or between the two groups during the 2-year follow-up period, nor was there significant difference in spinal canal enlargement between the two groups. However, both postoperative SCA and increased SCA in Group A were significantly higher than those in Group B. Conclusion. The contralateral open side approach is preferable to the ipsilateral open side approach in UODL for lateral cervical OPLL.Level of Evidence: 3

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Outcome Evaluation of Modified Uninstrumented Open-door Cervical Laminoplasty for Ossified Posterior Longitudinal Ligament with Cervical Myelopathy

Cited by 4 publications

References 31 publications

Surgical Management of Cervical Myelopathy: Current Algorithm

Surgical Management of Cervical Myelopathy: Current Algorithm

Choice of open side affects clinical outcomes of unilateral open-door laminoplasty for inconsistent cervical ossification of posterior longitudinal ligament

Choice of the Open Side in Unilateral Open-Door Laminoplasty for Cervical Ossification of the Posterior Longitudinal Ligament

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