Objective To evaluate the effectiveness of combined posterior decompression with laminoplasty and anterior decompression with fusion for the treatment of cervical spinal canal stenosis with reverse arch. Methods Between May 2009 and February 2012, 13 cases of cervical spinal canal stenosis with reverse arch underwent posterior decompression with laminoplasty surgery in prone position and then anterior decompression with fusion surgery in supine position. There were 7 males and 6 females with an average age of 43.5 years (range, 38-62 years) and an average disease duration of 25 months (range, 18-60 months). All the patients had neck axial symptoms and spinal cord compressed symptoms, and lateral computer radiology (CR) of the neck showed reverse arch of cervical vertebrae. Segments of intervertebral disc protrusion included C3-6 in 4 cases, C4-7 in 4 cases, and C3-7 in 5 cases. After operation, anteroposterior and lateral CR was used to observe the cervical curvature change and fixation loosening, MRI to observe the change of the compression on spinal cord, visual analogue scale (VAS) score to evaluate the improvement of axial symptom, and Japanese Orthopaedic Association (JOA) score to assess the nerve function improvement. Results All incisions healed by first intention. All patients were followed up 9-32 months (mean, 15.4 months). Internal fixator had good position without loosening or breaking and the compression on spinal cord improved significantly after operation. All the patients obtained bony fusion at 6 months after operation. The axial symptoms and the nerve function at last follow-up were improved. VAS score at last follow-up (3.25 ± 1.54) was significantly lower than that at preoperation (6.55 ± 1.52) (P lt; 0.05); JOA score at last follow-up (10.45 ± 4.23) was significantly higher than that at preoperation (7.05 ± 1.32) (P lt; 0.05); and cervical curvature value at last follow-up [(6.53 ± 3.12) mm] was significantly higher than that at preoperation [(3.22 ± 5.15) mm] (P lt; 0.05). Conclusion Combined posterior decompression with laminoplasty and anterior decompression with fusion for the treatment of cervical spinal canal stenosis with reverse arch is a safe and effective surgical method.
ObjectiveTo compare the clinical and radiographic outcomes between laminoplasty and laminectomy compression and fusion with internal fixation to treat cervical spondylotic myelopathy. MethodsBetween September 2006 and September 2009, 143 cases of multilevel cervical myelopathy (the affected segments were more than 3) were treated by laminoplasty in 87 cases (group A) and by laminectomy decompression and fusion with lateral mass screw fixation in 56 cases (group B). There was no significant difference in gender, age, disease duration, pathological type, and affected segments between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, improvement of neurological function [Japanese Orthopaedic Association (JOA) 17 score], and the incidences of complications were observed; the cervical curvature index (CCI), range of motion (ROM), and symptoms of neck and shoulder pain [visual analogue scale (VAS) and neck disability index (NDI) scores] were recorded and compared. ResultsThere was no significant difference in operation time and intraoperative blood loss between 2 groups (P gt; 0.05). All patients were followed up 18-30 months (mean, 24 months). C5 nerve root palsy occurred in 4 cases (4.60%) of group A and in 5 cases (8.93%) of group B, showing no significant difference (χ2=0.475, P=0.482). No complication of deep infection, pseudarthrosis, or screw loosening occurred. No closure of opened laminae was observed in group A; and no screw extrusion, breakage, or nerve injury was observed in group B. At last follow-up, neck axial symptoms appeared in 35 cases (40.23%) of group A and in 11 cases (19.64%) of group B, showing significant difference (χ2=6.612, P=0.009). No significant difference was found in JOA score, CCI, ROM, or VAS scores between 2 groups at preoperation (P gt; 0.05); the JOA score, ROM, and VAS scores of groups A and B and CCI of group A at last follow-up were significantly improved when compared with preoperative ones (P lt; 0.05). No significant difference was found in the JOA score, improvement rate, and VAS score between 2 groups (P gt; 0.05); however, significant differences were found in ROM and CCI between 2 groups (P lt; 0.05). There were significant differences (P lt; 0.05) in pain intensity, lifting, work, reaction, driving, and total score between 2 groups at last follow-up. ConclusionLaminectomy decompression and fusion with internal fixation can effectively relieve pain, but it will greatly reduce the ROM; laminoplasty has less complications and satisfactory outcome. The two methods have similar effectiveness in the improvement of neurological function.
Objective To investigate the operational method of cervical vertebral flavectomy and its cl inical appl ication in the management of cervical canal stenosis. Methods From June 1997 to June 2007, 25 patients suffering from cervical spinal canal stenosis caused by obvious flaval l igament hypertrophy were given flavectomy. There were 22 males and 3 females, with an age range of 32 to 68 years (average 54 years). The course of disease was from 3 weeks to 7 years, with an average of 3 years and 7 months. All patients had degenerative cervical canal stenosis; of them, 5 cases had a history of cervical injury 2 to 3 weeks before operation (3 cases of fall ing injury and 2 cases of traffic accident injury). The X-ray film, CT, and MRI examinations showed that the compression locations were C4-7 in 12 cases, C3-7 in 9 cases, C5-7 in 3 cases, and C6,7 in 1 case. Spinous process and vertebral lamella were exposed by central posterior approach. The insertions of flaval l igaments were cut off at the superior vertebral lamella border, then the starting points of which were cut down from the anterior side of the upper vertebral lamella at their inferior border after l ifting up the flaval l igaments. The residual flaval l igaments in front of the vertebral lamella were scraped off by slope rongeur, the dura mater then could be seen to inflate from the intervertebral lamella space, showing the compression having been rel ieved. Twenty-five cases were all given posterior flavectomy. At 1 week to 3 months after operation, 12 patients received anterior cervical discectomy or vertebral gaining decompression with fusion by bone graft. Results The time for flavectomy was from 60 to 180 minutes, with an average of 95 minutes. The blood loss during operation was from 90 to 360 mL, with an average of 210 mL. The dura maters were lacerated by knife tips during operation with the cervical vertebrae in hyperflexion in 2 cases. Immediate suture and repair were performed and there were no postoperative cerebrospinal fluid leakage. All the incisions healed by first intension after operation. All of the 25 cases were followed up from 2 to 10 years, with an average of 3 years and 9 months. All patients had no compl ication of axial symptoms, and no restenosis at their operation site of cervical canal stenosis. The section area ratios of functional spinal canal to spinal cord were 1.12 ± 0.07 before operation and 2.11 ± 0.19 at 24 months after operation, showing significant difference (P lt; 0.05). The range of motion of cervical vertebrae was (39.4 ± 3.2)º befeore operation and (42.1 ± 2.9)° at 24 months after operation in 13 cases without anterior cervical discectomy fusion, showing no significant difference (P gt; 0.05); was (34.3 ± 3.4)° before operation and (29.2 ± 3.6)° at 24 months after operation in 12 cases with anterior cervical discectomy fusion, showing significant difference (P lt; 0.05). The bone graft achieved bony union 3-5 months after operation (average 3.8 months). The Japanese Orthopaedic Association (JOA) scores were 7.9 ± 2.2 before operation and 15.6 ± 1.4 at 24 months after operation, showing significant difference (P lt; 0.05), with an average improvement rate of 86.3%. Conclusion Cervical flavectomy could rel ieve compression to spinal cord and nerves caused by the flaval l igament hypertrophy without damaging the normal integral ity of bony canal, thus avoiding the compl ication of axial symptoms and so on which are encountered in open-door expansile cervical laminoplasty.
Objective To explore if the modified unilaterally-open expansive laminoplasty using bridge grafting and reconstructing posterior ligamentous complex methods is effective in preventing persisting axial symptoms, restriction of neck motion, and loss of cervical curvature. Methods From June 2000 to October 2005, 138 patients with cervical spondylotic myelopathy underwent this procedure. Of them, 78 who were followed for more than 2 years (group A) were included in this study. Another 69 patients who underwent conventional unilaterally opendoor laminoplasty served as controls(groupB). The JOA scores and the incidence of newly developed or deteriorated axial symptoms were recorded. Preoperative and postoperative ranges of neck motion were measured on lateral flexion and extension radiographs. Preoperative and postoperative cervical curvature indices were calculated according to Ishihara’s method. Results The patients of group A were followed 24-44 months (mean 33 months), and the patients of group B were followed 2453 months(mean 35 months). The operative time was 114±20 min in group A and 70±25 min in group B,showing statistically significant difference(P＜0.05). The operative blood loss was 280±72 ml in group A and 210±80 ml in group B(P＞0.05). Accordingto JOA scoring, the average recovery rates were 67.0%±17.3% in group A and 65.0%±21.4% in group B(P＞0.05). Postoperative development or deterioration of axial symptoms occurred in 12% of patients in group A and 51% of patients in group B, showing statistically significant difference(P＜0.05). Postoperative range of neck motion was 88.0%±10.1% of the preoperative one in group A and 64.0%±16.3% in group B(P＜0.05). There was no significant difference between preoperative(15.3±8.2) and postoperative(13.5±9.3) cervical curvature index in group A, whereas the mean value of postoperative index (11.1±5.7) was significantly smaller than that of preoperative one (17.2±13.5) in group B (Plt;0.05). Conclusion This new procedure was less invasive to the posterior extensor mechanism than the conventional unilaterally-open laminoplasty and was effective in preventing postoperative morbidities.
Objective To introduce a new operative technique of the expansive laminoplasty with reattachment of the spinous process and theextensor musculature for treatment of a tumor in the cervical vertebral channeland evaluate the clinical outcome of the technique. Methods From July 2003 to June 2006, this technique was applied to 26 patients (14 males,12 females; age, 25-57 years; illness course, 3 months-2 years) in our hospital. The four limbs had a muscle force of ⅢⅣ degrees, and with a high musculartension. The tendon reflex was sthenic and 2 patients had patellar clonus and ankle clonus. MRI was used to measure the tumor size (from 1.5 cm ×0.8 cm to 2.8 cm×2.0 cm, at the C3-6 levels) before and after operation.There were 8 cases at the C3,4levels, 9 cases at the C4,5 levels, 9 casesat the C5,6 levles. Results The result of the follow-up (average,8months; range, 6-12 months) showed that all the patients achieved a recovery at different degrees,with no death or complication. Although 10 of the patients felt a pain in the neck, but the pain was relieved after the functional exercise; the cervical active scope was changed a little with no cervical intervertrbal instability. The postoperative MRI and CT showed that the posterior column was maintained, and the “close-door” phenomenon did not happen. The degree of latitule of the cervical vertebra after operation was measured. The antecollis was 28.43°(37.9° onaverage). The hyposokinesis was 3244°(41° on average), the left antecollis was 25.45°(23° on average), and the right antecollis was 35.45°(36.2° on overage).Conclusion The expansive laminoplasty with reattachment of the spinous process and the extensor musculature can provide enough operative space and reserve the normal posterior column of the cervical vertebra. The intervertebral stability can beobtained after conglutination between the spinous process and the vertebral lamina.
Objective To evaluate the results of laminoplasty and foraminotomy in treatment of cervical radiculopathy. Methods Of 29 patients, there were 16 males and 13 females,aged 38 to 72 years with an average of 59 years. The reasons of intervertebral foramen stenosis were：prolapse of intervertebral disc, osteophyte formation of Luschka joint, spinal canal stenosis combined with thicknessof flavum ligmentum and facet joint hypertrophy. The most frequently affected intervertebral foramen were C5,6 and C6,7. The mostsignifcant symptoms after impairment of nerve root were reduced sensation, muscle weakness and diminished reflexes. On the basis of laminoplasty, theforaminotomy was performed on the stenotic foramen, including grade Ⅰ decompression on 13 occasions, degree Ⅱ on 21 occasions; and double level decompressions were performed on 5 patients.Results After operation, reduced sensation was recovered most significantly andquickly, and the recovery of muscle weakness followed, while the recovery of diminished reflexes was the slowest and worst. In the followed-up patients, the percentage of excellent and good results was 97%.Conclusion In the cervical spondylotic patients who also have foraminar stenosis, performing laminoplasty with foraminotomy can getgood results. If the indication are chosen properly, it can be used widely in clinic.
ObjectiveTo apply H-shaped allogeneic bone graft combined with spinous process replantation for posterior spinal canal reconstruction after removal of intraspinal tumors,and observe its effectiveness. MethodsA total of 48 cases of thoracic and lumbar intraspinal tumors were recruited between February 2006 and May 2012,including 35 males and 13 females with a mean age of 29.5 years (range,17-48 years).The disease duration was 3-16 months (mean,10.5 months).Intraspinal tumors located at T5,6 in 3 cases,at T10 in 7 cases,at T12,L1 in 13 cases,at L3 in 10 cases,and at L4-S1 in 15 cases.There were 18 cases of epidural meningioma,2 cases of epidural lipoma,3 cases of extramedullary neurological tumors,10 cases of extramedullary meningioma,6 cases of extramedullary schwannoma,6 cases of intramedullary ependymoma,and 3 cases of intramedullary astrocytoma.All patients underwent H-shaped allogeneic bone graft combined with spinous process replantation for posterior spinal canal reconstruction after removal of intraspinal tumor by posterior laminectomy.The Oswestry disability index (ODI) was used to assess postoperative symptom improvement,and the Frankel grade of spinal cord injury to evaluate the extent of nerve damage and recovery. ResultsAfter operation,8 cases had cerebrospinal fluid leakage,and 4 cases had yellowish exudate,and they were all cured after appropriate treatment; primary healing of wound was obtained in the other cases,without postoperative complication.Forty-eight patients were followed up 18-72 months (mean,38 months).CT showed all the graft bones healed and posterior spinal canal was well reconstructed without iatrogenic spinal stenosis formation.X-ray film showed no vertebral instability or spondylolisthesis,and no shifting of reconstructed vertebrae.MRI showed no recurrence except 1 case.The symptoms were improved significantly after operation; the ODI score at last follow-up (16.69±2.53) was significantly lower (t=0.89,P=0.00) than that at preoperation (47.83±7.25).The results of symptom improvement were excellent in 36 cases,good in 10 cases,fair in 1 case,and poor in 1 case; the excellent and good rate was 95.83%.At last follow-up,Frankel grade was improved significantly (Z=13.32,P=0.00) when compared with preoperative grade except 1 recurrent patient. ConclusionThe application of the H-shaped allogeneic bone graft combined with spinous process replantation can well reconstruct the posterior spinal canal,and also can effectively avoid iatrogenic spinal stenosis,so it is worthy of promoting in the clinical treatment of intraspinal tumor surgery.