Selective Laminoplasty After the Preoperative Diagnosis of the Responsible Level Using Spinal Cord Evoked Potentials in Elderly Patients With Cervical Spondylotic Myelopathy

Kato, Yoshihiro; Kojima, Takanori; Kataoka, Hideo; Imajo, Yasuaki; Yara, Takahiro; Yoshida, Yuichiro; Imagama, Takashi; Taguchi, Toshihiko

doi:10.1097/bsd.0b013e3181929ca2

Cited by 11 publications

(8 citation statements)

References 22 publications

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“…Another assumption is that recovery from long-tract signs such as gait disturbance may be more marked if the decompression area is large and cranial. The intervertebral levels involved, as determined by radiographic and electrophysiological analyses in elderly patients, were previously reported to be C3-C4 or C4-C5 [16][17][18][19][20], and the results of this study concur with this. If this theory is correct, elderly patients may achieve satisfactory recovery because the primary lesion can be located more cranially in these patients than in younger patients.…”

Section: Discussionsupporting

confidence: 82%

The effects of surgery on locomotion in elderly patients with cervical spondylotic myelopathy

et al. 2013

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Purpose This study aimed to evaluate the effects of surgery on locomotor ability in patients with cervical spondylotic myelopathy (CSM) and compare the results between elderly and younger patients. Methods A total of 369 consecutive patients who underwent expansive laminoplasty for CSM were prospectively analysed. Patients were divided into two age groups of C75 years (elderly group, 76 patients) and \75 years (younger group, 293 patients). Locomotor ability was estimated using part of the functional independence measure (FIM). The sum of gait and stairs items [functional independence measure (locomotion), FIM-L; possible scores, 2-14] and neurological status were estimated using the Japanese Orthopaedic Association (JOA) score (possible score, 0-17). Pre-operative neurological anamnesis was reviewed, and the surgical results of elderly patients with or without co-existing neurological history were evaluated to determine the origin of locomotor disability.Results Peri-operative FIM-L and JOA scores were significantly lower in the elderly group than in the younger group, and the opposite was true for improved FIM score. Cerebral infarction and previous lumbar surgery were identified as neurological co-morbidities in the elderly group. However, there was no significant difference in surgical results between elderly patients with and without co-existing neurological disorders. Conclusions Decompression surgery can improve locomotor ability and decrease nursing care requirements among elderly patients with CSM. However, other neurological diseases can co-exist in elderly patients, making it difficult to diagnose the origin of locomotor disability. Therefore, detailed peri-operative work-up and timely decompression should be given priority to avoid progression towards fixed locomotor disability.

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Section: Discussionsupporting

confidence: 82%

The effects of surgery on locomotion in elderly patients with cervical spondylotic myelopathy

et al. 2013

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“…Several less invasive methods, such as muscle preservation concepts of exposure of the cervical spinal laminae developed by Shiraishi [ 8 ], selective laminoplasty [ 16 ], C3–C6 laminoplasty [ 17 ], and cervical laminoplasty with C3 laminectomy [ 18 ], have been reported for preventing surgery-associated problems such as axial neck pain and loss of cervical lordosis by reducing damage to the paraspinal muscles and nuchal ligaments. Our MEOLP combines the advantages of these methods and has comparable neurologic recoveries and very less axial neck pain during the longer period of follow-up [ 16 , 18 , 19 ]. Compared to C3–C6 laminoplasty developed by Hosono et al, our method also restores better postoperative neck ROM and cervical lordosis at medium-term follow-up [ 17 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

The Midterm Surgical Outcome of Modified Expansive Open-Door Laminoplasty

Yeh

Lee

Chen

et al. 2016

BioMed Research International

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Laminoplasty is a standard technique for treating patients with multilevel cervical spondylotic myelopathy. Modified expansive open-door laminoplasty (MEOLP) preserves the unilateral paraspinal musculature and nuchal ligament and prevents facet joint violation. The purpose of this study was to elucidate the midterm surgical outcomes of this less invasive technique. We retrospectively recruited 65 consecutive patients who underwent MEOLP at our institution in 2011 with at least 4 years of follow-up. Clinical conditions were evaluated by examining neck disability index, Japanese Orthopaedic Association (JOA), Nurick scale, and axial neck pain visual analog scale scores. Sagittal alignment of the cervical spine was assessed using serial lateral static and dynamic radiographs. Clinical and radiographic outcomes revealed significant recovery at the first postoperative year and still exhibited gradual improvement 1–4 years after surgery. The mean JOA recovery rate was 82.3% and 85% range of motion was observed at the final follow-up. None of the patients experienced aggravated or severe neck pain 1 year after surgery or showed complications of temporary C5 nerve palsy and lamina reclosure by the final follow-up. As a less invasive method for reducing surgical dissection by using various modifications, MEOLP yielded satisfactory midterm outcomes.

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“…Further surgical parsimony may be gained by using intraoperative electrophysiological techniques. 13 Once again it is worth noting that the patients undergoing miPCD in this study were older, treated at more levels, had similar lengths of hospitalization, avoided the use of fusion, and avoided the use of spinal instrumentation, suggesting that future studies may focus on health resource utilization and costeffectiveness.…”

Section: Minimally Invasive Posterior Cervical Decompression For Dcmmentioning

confidence: 99%

A comparison of minimally invasive posterior cervical decompression and open anterior cervical decompression and instrumented fusion in the surgical management of degenerative cervical myelopathy

Abbas

Spurgas

Szewczyk

et al. 2016

FOC

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OBJECTIVE Minimally invasive posterior cervical decompression (miPCD) has been described in several case series with promising preliminary results. The object of the current study was to compare the clinical outcomes between patients undergoing miPCD with anterior cervical discectomy and instrumented fusion (ACDFi). METHODS A retrospective study of 74 patients undergoing surgery (45 using miPCD and 29 using ACDFi) for myelopathy was performed. Outcomes were categorized into short-term, intermediate, and long-term follow-up, corresponding to averages of 1.7, 7.7, and 30.9 months, respectively. Mean scores for the Neck Disability Index (NDI), neck visual analog scale (VAS) score, SF-12 Physical Component Summary (PCS), and SF-12 Mental Component Summary (MCS) were compared for each follow-up period. The percentage of patients meeting substantial clinical benefit (SCB) was also compared for each outcome measure. RESULTS Baseline patient characteristics were well-matched, with the exception that patients undergoing miPCD were older (mean age 57.6 ± 10.0 years [miPCD] vs 51.1 ± 9.2 years [ACDFi]; p = 0.006) and underwent surgery at more levels (mean 2.8 ± 0.9 levels [miPCD] vs 1.5 ± 0.7 levels [ACDFi]; p < 0.0001) while the ACDFi patients reported higher preoperative neck VAS scores (mean 3.8 ± 3.0 [miPCD] vs 5.4 ± 2.6 [ACDFi]; p = 0.047). The mean PCS, NDI, neck VAS, and MCS scores were not significantly different with the exception of the MCS score at the short-term follow-up period (mean 46.8 ± 10.6 [miPCD] vs 41.3 ± 10.7 [ACDFi]; p = 0.033). The percentage of patients reporting SCB based on thresholds derived for PCS, NDI, neck VAS, and MCS scores were not significantly different, with the exception of the PCS score at the intermediate follow-up period (52% [miPCD] vs 80% [ACDFi]; p = 0.011). CONCLUSIONS The current report suggests that the optimal surgical strategy in patients requiring dorsal surgery may be enhanced by the adoption of a minimally invasive surgical approach that appears to result in similar clinical outcomes when compared with a well-accepted strategy of ventral decompression and instrumented fusion. The current results suggest that future comparative effectiveness studies are warranted as the miPCD technique avoids instrumented fusion.

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Selective Laminoplasty After the Preoperative Diagnosis of the Responsible Level Using Spinal Cord Evoked Potentials in Elderly Patients With Cervical Spondylotic Myelopathy

Abstract: Preliminary clinical results for selective laminoplasty were satisfactory in all but 1 case. Although long-term results are not yet available, we consider this method to be less invasive and capable of giving satisfactory clinical results and benefits for elderly patients.

Cited by 11 publications

References 22 publications

The effects of surgery on locomotion in elderly patients with cervical spondylotic myelopathy

The effects of surgery on locomotion in elderly patients with cervical spondylotic myelopathy

The Midterm Surgical Outcome of Modified Expansive Open-Door Laminoplasty

A comparison of minimally invasive posterior cervical decompression and open anterior cervical decompression and instrumented fusion in the surgical management of degenerative cervical myelopathy

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