CLINICAL OBSERVATION OF POSTERIOR CERVICAL DECOMPRESSIVE LAMINECTOMY AND LATERAL MASS SCREW FIXATION COMBINED WITH FORAMINOTOMY FOR CERVICAL RADICULO-MYELOPATHY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FANGZhao ,  TIANRong , SUNTianwei , JIAYutao , XUTiantong , SHENQingfeng , XIAGang , LIUYang , LIHuiming

Department of Spine Surgery, Tianjin Union Medical Centre, Tianjin, 300121, P. R. China;

Corresponding author：

TIANRong, Email: happyzhao999@163.com

Keywords：

Cervical spine degeneration; Cervical radiculo-myelopathy; Posterior cervical decompression; Cervical curvature

DOI：

10.7507/1002-1892.20160199

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Objective To evaluate the effectiveness of posterior cervical decompressive laminectomy and lateral mass screw fixation combined with foraminotomy for treating cervical radiculo-myelopathy. Methods Between January 2010 and January 2012, 58 patients with cervical radiculo-myelopathy were treated by posterior cervical decompressive laminectomy and lateral mass screw fixation combined with foraminotomy. There were 31 males and 27 females, with an average age of 52.7 years (range, 41-72 years). The mean disease course was 5.4 years (range, 3-15 years). The preoperative Japanese Orthopaedic Association (JOA) score was 7.8±1.3, and visual analogue scale (VAS) score was 6.8±1.7. There were 37 cases of inter-vertebral disc herniation and ligamentum flavum hypertrophy, 11 cases of vertebral osteophyte formation with the osteophyte spinal canal occupational ratio of 51.7%±18.1%, and 10 cases of inter-vertebral disc herination with cervical instability. Preoperative cervical curvature was (-5.5±12.5)°. The fixed segments included C_3-7 in 29 cases, C_4-7 in 19 cases, and C_3-6 in 10 cases. Foraminotomy was performed in 135 nerve foramina (mean, 2.33 foramina). Results The mean operation time was 204 minutes (range, 167-260 minutes), and the mean blood loss was 273 mL (range, 210-378 mL). No injury of vertebral artery or nerve root occurred during operation. Postoperative subcutaneous hematoma and cervical axial pain occurred in 1 case and 8 cases, respectively; and no nerve root palsy was observed. The patients were followed up 2.1-4.3 years (mean, 3.4 years). The postoperative JOA score was significantly increased to 14.1±1.7 (t=-27.672, P=0.000), with an improvement rate of 68.5%±21.9%. Postoperative VAS score was significantly decreased to 2.1±1.1 (t=15.168, P=0.000). The imaging examination showed adjacent segmental degeneration in 1 patient, who had no clinical symptom. There was no screw loosening or pseudoarthrosis formation during follow-up. The cervical curvature was (13.6±5.1)° at 5 days and was (13.2±4.8)° at 2 years, showing significant difference when compared with preoperative one (P < 0.05). The osteophyte spinal canal occupational ratio was 36.5%±10.4% at 2 years, showing significant difference when compared with preoperative one (t=6.921, P=0.000). Conclusion The procedure of posterior cervical decompressive laminectomy and lateral mass screw fixation combined with foraminotomy is effect in treating cervical radiculo-myelopathy. The spinal cord and nerve root can be adequately decompressed by laminectomy and foraminotomy. The lateral mass screw fixation can correct the cervical curvature and further reduce the tension to spinal cord.

Citation： FANGZhao, TIANRong, SUNTianwei, JIAYutao, XUTiantong, SHENQingfeng, XIAGang, LIUYang, LIHuiming. CLINICAL OBSERVATION OF POSTERIOR CERVICAL DECOMPRESSIVE LAMINECTOMY AND LATERAL MASS SCREW FIXATION COMBINED WITH FORAMINOTOMY FOR CERVICAL RADICULO-MYELOPATHY. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(8): 980-984. doi: 10.7507/1002-1892.20160199 Copy

1.	Du W, Zhang P, Shen Y, et al. Enlarged laminectomy and lateral mass screw fixation for multilevel cervical degenerative myelopathy associated with kyphosis. Spine J, 2014, 14(1):57-64.
2.	Fraser J, Härtl R. Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine, 2007, 6(4):298-303.
3.	De la Garza-Ramos R, Xu R, Ramhmdani S, et al. Long-term clinical outcomes following 3-and 4-level anterior cervical discectomy and fusion. J Neurosurg Spine, 2016, 24(6):885-891.
4.	Goffin J, Geusens E, Vantomme N, et al. Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech, 2004, 17(2):79-85.
5.	Hirai T, Okawa A, Arai Y, et al. Middle-term results of a prospective comparative study of anterior decompression with fusion and posterior decompression with laminoplasty for the treatment of cervical spondylotic myelopathy. Spine (Phila Pa 1976), 2011, 36(23):1940-1947.
6.	Pal D, Bayley E, Magaji SA, et al. Freehand determination of the trajectory angle for cervical lateral mass screws:how accurate is it? Eur Spine J, 2011, 20(6):972-976.
7.	Chen GD, Lu Q, Sun JJ, et al. Effect and prognostic factors of laminoplasty for cervical myelopathy with an occupying ratio greater than 50%. Spine, 2016, 41(5):378-383.
8.	Tamai K, Suzuki A, Terai H, et al. Laminar closure after expansive open-door laminoplasty:fixation methods and cervical alignments impact on the laminar closure and surgical outcomes. Spine J, 2016.[Epub ahead of print].
9.	Hosono N, Miwa T, Mukai Y, et al. Potential risk of thermal damage to cervical roots by a high-speed drill. J Bone Joint Surg (Br), 2009, 91(11):1541-1544.
10.	Xia Y, Shen Q, Li H, et al. Influence of hinge position on the effectiveness of expansive open-door laminoplasty for cervical spondylotic myelopathy. J Spinal Disord Tech, 2011, 24(8):514-520.
11.	Iizuka H, Shimizu T, Tateno K, et al. Extensor musculature of the cervical spine after laminoplasty:morphologic evaluation by coronal view of the magnetic resonance image. Spine (Phila Pa 1976), 2001, 26(20):2220-2226.
12.	Imagama S, Matsuyama Y, Yukawa Y, et al. C5 palsy after cervical laminoplasty:a multicentre study. J Bone Joint Surg (Br), 2010, 92(3):393-400.
13.	Ahmed SH, El-Shaarawy EA, Ishaq MF, et al. Morphological and radiometrical study of the human intervertebral foramina of the cervical spine. Folia Morphol (Warsz), 2014, 73(1):7-18.
14.	Koshu K, Tominaga T, Yoshimoto T. Spinous process-splitting laminoplasty with an extended foraminotomy for cervical myelopathy. Neurosurgery, 1995, 37(3):430-435.
15.	Kim SD, Ha HG, Lee CY, et al. Cervical cord decompression using extended anterior cervical foraminotomy technique. J Korean Neurosurg Soc, 2014, 56(2):114-120.
16.	Ohashi M, Yamazaki A, Watanabe K, et al. Two-year clinical and radiological outcomes of open-door cervical laminoplasty with prophylactic bilateral C4-C5 foraminotomy in a prospective study. Spine (Phila Pa 1976), 2014, 39(9):721-727.
17.	Masaki Y, Yamazaki M, Okawa A, et al. An analysis of factors causing poor surgical outcome in patients with cervical myelopathy due to ossification of the posterior longitudinal ligament:anterior decompression with spinal fusion versus laminoplasty. Spinal Disord Tech, 2007, 20(1):7-13.
18.	Katsumi K, Yamazaki A, Watanabe K, et al. Can prophylactic bilateral C4/C5 foraminotomy prevent postoperative C5 palsy after open-door laminoplasty?:a prospective study. Spine (Phila Pa 1976), 2012, 37(9):748-754.
19.	Komagata M, Nishiyama M, Endo K, et al. Prophylaxis of C5 palsy after cervical expansive laminoplasty by bilateral partial foraminotomy. Spine J, 2004, 4(6):650-655.
20.	Henderson C, Geddes JF, Vaccaro AR, et al. Stretch-associated injury in cervical spondylotic myelopathy:new concept and review. Neurosurgery, 2005, 56(5):1101-1113.
21.	Kong Q, Zhang L, Liu L, et al. Effect of the decompressive extent on the magnitude of the spinal cord shift after expansive open-door laminoplasty. Spine (Phila Pa 1976), 2011, 36(13):1030-1036.
22.	Miyamoto H, Maeno K, Uno K, et al. Outcomes of surgical intervention for cervical pondylotics myelopathy ccompanying local kyphosis (comparison between laminoplasty alone and posterior reconstruction surgery using the screw-rod system). Eur Spine J, 2014, 23(2):341-346.
23.	Duan Y, Zhang H, Min SX, et al. Posterior cervical fixation following laminectomy:a stress analysis of three techniques. Eur Spine J, 2011, 20(9):1552-1559.
24.	Pateder DB, Carbone JJ. Lateral mass screw fixation for cervical spine trauma:associated complications and efficacy in maintaining alignment. Spine J, 2006, 6(1):40-43.
25.	Liu Y, Hou Y, Yang L, et al. Comparison of 3 reconstructive techniques in the surgical management of multilevel cervical spondylotic myelopathy. Spine, 2012, 37(23):E1450-1458.
26.	Seichi A, Hoshino Y, Kimura A, et al. Neurological complications of cervical laminoplasty for patients with ossification of the posterior longitudinal ligament-a multi-institutional retrospective study. Spine (Phila Pa 1976), 2011, 36(15):E998-E1003.
27.	连鸿凯, 黄金承, 刘纪恩.多节段脊髓型颈椎病不同手术方法早期临床疗效探讨.中国修复重建外科杂志, 2014, 28(10):1231-1235.
28.	梁丙寅.颈椎后路全椎板减压侧块螺钉内固定术影像学参数和脊髓后移的相关性研究.石家庄:河北医科大学, 2012.
29.	Takeuchi K, Yokoyama T, Ono A, et al. Cervical range of motion and alignment after laminoplasty preserving or reattaching the semispinalis cervicis inserted into axis. J Spinal Disord Tech, 2007, 20(8):571-576.
30.	Mori E, Ueta T, Maeda T, et al. Effect of preservation of the C₆ spinous process and its paraspinal muscular attachment on the prevention of postoperative axial neck pain in C3-6 laminoplasty. J Neurosurg Spine, 2015, 22(3):221-229.
31.	Fujibayashi S, Neo M, Yoshida M, et al. Neck muscle strength before and after cervical laminoplasty:relation to axial symptoms. J Spinal Disord Tech, 2010, 23(3):197-202.

1. Du W, Zhang P, Shen Y, et al. Enlarged laminectomy and lateral mass screw fixation for multilevel cervical degenerative myelopathy associated with kyphosis. Spine J, 2014, 14(1):57-64.
2. Fraser J, Härtl R. Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine, 2007, 6(4):298-303.
3. De la Garza-Ramos R, Xu R, Ramhmdani S, et al. Long-term clinical outcomes following 3-and 4-level anterior cervical discectomy and fusion. J Neurosurg Spine, 2016, 24(6):885-891.
4. Goffin J, Geusens E, Vantomme N, et al. Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech, 2004, 17(2):79-85.
5. Hirai T, Okawa A, Arai Y, et al. Middle-term results of a prospective comparative study of anterior decompression with fusion and posterior decompression with laminoplasty for the treatment of cervical spondylotic myelopathy. Spine (Phila Pa 1976), 2011, 36(23):1940-1947.
6. Pal D, Bayley E, Magaji SA, et al. Freehand determination of the trajectory angle for cervical lateral mass screws:how accurate is it? Eur Spine J, 2011, 20(6):972-976.
7. Chen GD, Lu Q, Sun JJ, et al. Effect and prognostic factors of laminoplasty for cervical myelopathy with an occupying ratio greater than 50%. Spine, 2016, 41(5):378-383.
8. Tamai K, Suzuki A, Terai H, et al. Laminar closure after expansive open-door laminoplasty:fixation methods and cervical alignments impact on the laminar closure and surgical outcomes. Spine J, 2016.[Epub ahead of print].
9. Hosono N, Miwa T, Mukai Y, et al. Potential risk of thermal damage to cervical roots by a high-speed drill. J Bone Joint Surg (Br), 2009, 91(11):1541-1544.
10. Xia Y, Shen Q, Li H, et al. Influence of hinge position on the effectiveness of expansive open-door laminoplasty for cervical spondylotic myelopathy. J Spinal Disord Tech, 2011, 24(8):514-520.
11. Iizuka H, Shimizu T, Tateno K, et al. Extensor musculature of the cervical spine after laminoplasty:morphologic evaluation by coronal view of the magnetic resonance image. Spine (Phila Pa 1976), 2001, 26(20):2220-2226.
12. Imagama S, Matsuyama Y, Yukawa Y, et al. C5 palsy after cervical laminoplasty:a multicentre study. J Bone Joint Surg (Br), 2010, 92(3):393-400.
13. Ahmed SH, El-Shaarawy EA, Ishaq MF, et al. Morphological and radiometrical study of the human intervertebral foramina of the cervical spine. Folia Morphol (Warsz), 2014, 73(1):7-18.
14. Koshu K, Tominaga T, Yoshimoto T. Spinous process-splitting laminoplasty with an extended foraminotomy for cervical myelopathy. Neurosurgery, 1995, 37(3):430-435.
15. Kim SD, Ha HG, Lee CY, et al. Cervical cord decompression using extended anterior cervical foraminotomy technique. J Korean Neurosurg Soc, 2014, 56(2):114-120.
16. Ohashi M, Yamazaki A, Watanabe K, et al. Two-year clinical and radiological outcomes of open-door cervical laminoplasty with prophylactic bilateral C4-C5 foraminotomy in a prospective study. Spine (Phila Pa 1976), 2014, 39(9):721-727.
17. Masaki Y, Yamazaki M, Okawa A, et al. An analysis of factors causing poor surgical outcome in patients with cervical myelopathy due to ossification of the posterior longitudinal ligament:anterior decompression with spinal fusion versus laminoplasty. Spinal Disord Tech, 2007, 20(1):7-13.
18. Katsumi K, Yamazaki A, Watanabe K, et al. Can prophylactic bilateral C4/C5 foraminotomy prevent postoperative C5 palsy after open-door laminoplasty?:a prospective study. Spine (Phila Pa 1976), 2012, 37(9):748-754.
19. Komagata M, Nishiyama M, Endo K, et al. Prophylaxis of C5 palsy after cervical expansive laminoplasty by bilateral partial foraminotomy. Spine J, 2004, 4(6):650-655.
20. Henderson C, Geddes JF, Vaccaro AR, et al. Stretch-associated injury in cervical spondylotic myelopathy:new concept and review. Neurosurgery, 2005, 56(5):1101-1113.
21. Kong Q, Zhang L, Liu L, et al. Effect of the decompressive extent on the magnitude of the spinal cord shift after expansive open-door laminoplasty. Spine (Phila Pa 1976), 2011, 36(13):1030-1036.
22. Miyamoto H, Maeno K, Uno K, et al. Outcomes of surgical intervention for cervical pondylotics myelopathy ccompanying local kyphosis (comparison between laminoplasty alone and posterior reconstruction surgery using the screw-rod system). Eur Spine J, 2014, 23(2):341-346.
23. Duan Y, Zhang H, Min SX, et al. Posterior cervical fixation following laminectomy:a stress analysis of three techniques. Eur Spine J, 2011, 20(9):1552-1559.
24. Pateder DB, Carbone JJ. Lateral mass screw fixation for cervical spine trauma:associated complications and efficacy in maintaining alignment. Spine J, 2006, 6(1):40-43.
25. Liu Y, Hou Y, Yang L, et al. Comparison of 3 reconstructive techniques in the surgical management of multilevel cervical spondylotic myelopathy. Spine, 2012, 37(23):E1450-1458.
26. Seichi A, Hoshino Y, Kimura A, et al. Neurological complications of cervical laminoplasty for patients with ossification of the posterior longitudinal ligament-a multi-institutional retrospective study. Spine (Phila Pa 1976), 2011, 36(15):E998-E1003.
27. 连鸿凯, 黄金承, 刘纪恩.多节段脊髓型颈椎病不同手术方法早期临床疗效探讨.中国修复重建外科杂志, 2014, 28(10):1231-1235.
28. 梁丙寅.颈椎后路全椎板减压侧块螺钉内固定术影像学参数和脊髓后移的相关性研究.石家庄:河北医科大学, 2012.
29. Takeuchi K, Yokoyama T, Ono A, et al. Cervical range of motion and alignment after laminoplasty preserving or reattaching the semispinalis cervicis inserted into axis. J Spinal Disord Tech, 2007, 20(8):571-576.
30. Mori E, Ueta T, Maeda T, et al. Effect of preservation of the C₆ spinous process and its paraspinal muscular attachment on the prevention of postoperative axial neck pain in C3-6 laminoplasty. J Neurosurg Spine, 2015, 22(3):221-229.
31. Fujibayashi S, Neo M, Yoshida M, et al. Neck muscle strength before and after cervical laminoplasty:relation to axial symptoms. J Spinal Disord Tech, 2010, 23(3):197-202.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL OBSERVATION OF POSTERIOR CERVICAL DECOMPRESSIVE LAMINECTOMY AND LATERAL MASS SCREW FIXATION COMBINED WITH FORAMINOTOMY FOR CERVICAL RADICULO-MYELOPATHY

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