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1.
BMC Musculoskelet Disord ; 22(1): 881, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34654410

RESUMO

OBJECTIVES: To explore the factors associated with the increased spinal cord area in single-door cervical laminoplasty (SDCL) with miniplate fixation. METHODS: A retrospective study enrolled 83 patients underwent SDCL with miniplate fixation and the patient characteristics such as age, gender, tobacco use, alcohol use, diabetes mellitus, hypertension, diagnosis, operative level, etc., were obtained. The opening angle, door shaft position and spinal canal area of the patients were measured after surgery. The sagittal canal diameter (SCD), the C2-7 Cobb angle, the cervical curvature index (CCI), the range of motion (ROM) and the spinal canal area were measured before and after operation. The increased cervical spinal cord area was also measured before and after surgery, and the correlation between the above indicators and the increased cervical spinal cord area was studied through Pearson's correlation analysis and multivariate logistic regression analysis. RESULTS: There were 34 patients in small spinal cord area increment group (SAI group), 29 patients in middle spinal cord area increment group (MAI group) and 20 patients in large spinal cord area increment group (LAI group). The preoperative diagnosis(P = 0.001), door shaft position (P = 0.008), preoperative spinal canal area (P = 0.004) and postoperative spinal canal area (P = 0.015) were significant different among the 3 groups. The multivariate analysis showed that the preoperative diagnosis (OR = 2.076, P = 0.035), door shaft position (OR = 3.425, P = 0.020) and preoperative spinal canal area (OR = 10.217, P = 0.009) were related to increased spinal cord area. CONCLUSIONS: The preoperative diagnosis, door shaft position and preoperative spinal canal area might be associated with increased spinal cord area after cervical laminoplasty with miniplate fixation. Preoperative symptoms are mostly caused by compression of the spinal cord, so spinal cord area enlargement can bring a better recovery in patients alongside long-term. Spine surgeons should pay more attention to the accuracy of the preoperative diagnosis, the preoperative measurement of spinal canal area and the door shaft position during the operation.


Assuntos
Laminoplastia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Laminectomia , Laminoplastia/efeitos adversos , Análise Multivariada , Estudos Retrospectivos , Medula Espinal , Resultado do Tratamento
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(10): 1318-1322, 2021 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-34651487

RESUMO

Objective: To investigate the effect of prophylactic C 4, 5 foraminal dilatation in posterior cervical open-door surgery on postoperative C 5 nerve root palsy syndrome. Methods: The clinical data of patients with cervical spondylotic myelopathy (cervical spinal cord compression segments were more than 3) who met the selection criteria between March 2016 and March 2019 were retrospectively analyzed. Among them, 40 patients underwent prophylactic C 4, 5 foraminal dilatation in posterior cervical open-door surgery (observation group) and 40 patients underwent simple posterior cervical open-door surgery (control group). There was no significant difference between the two groups ( P>0.05) in gender, age, disease duration, Nurick grade of spinal cord symptoms, and preoperative diameter of C 4, 5 intervertebral foramen, Japanese Orthopaedic Association (JOA) score, and visual analogue scale (VAS) score. The occurrence of C 5 nerve root paralysis syndrome was recorded and compared between the two groups, including incidence, paralysis time, recovery time, and spinal cord drift. VAS and JOA scores were used to evaluate the improvement of pain and function before operation and at 12 months after operation. Results: The incisions of the two groups healed by first intention, and there was no early postoperative complications such as cerebrospinal fluid leakage. Patients of both groups were followed up 12-23 months, with an average of 17.97 months. C 5 nerve root paralysis syndrome occurred in 8 cases in the observation group (3 cases on the right and 5 cases on the left) and 2 cases in the control group (both on the right). There was significant difference of the incidence (20% vs. 5%) between the two groups ( χ 2=4.114, P=0.043). Except for 1 case in the observation group who developed C 5 nerve root palsy syndrome at 5 days after operation, the rest patients all developed at 1 day after operation; the recovery time of the observation group and the control group were (3.87±2.85) months and (2.50±0.70) months respectively, showing no significant difference between the two groups ( t=-0.649, P=0.104). At 12 months after operation, the JOA score and VAS score of cervical spine in the two groups significantly improved when compared with those before operation ( P<0.05); there was no significant difference in the difference of the cervical spine JOA score and VAS score between at 12 months after operation and before operation and the degree of spinal cord drift between the two groups ( P>0.05). Conclusion: Prophylactic C 4, 5 foraminal dilatation can not effectively prevent and reduce the occurrence of postoperative C 5 root palsy, on the contrary, it may increase its incidence, so the clinical application of this procedure requires caution.


Assuntos
Laminoplastia , Vértebras Cervicais/cirurgia , Dilatação , Humanos , Laminectomia , Paralisia/etiologia , Paralisia/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento
3.
Orphanet J Rare Dis ; 16(1): 401, 2021 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-34583711

RESUMO

BACKGROUND: Although the clinical efficacy of laminoplasty in adult cervical spondylotic myelopathy or ossification of posterior longitudinal ligament has been frequently reported, there are only few reports of laminoplasty for patients with lysosome storage diseases (LSDs). Therefore, this study aimed to report the midterm clinical and radiological outcomes of patients with LSDs after cervical laminoplasty. METHODS: Six patients with LSD who underwent laminoplasty with/without C1 laminectomy for cervical myelopathy were enrolled. Clinical evaluations, including the cervical Japanese Orthopedic Association (cJOA) score and visual analog scale (VAS) scores for upper extremity numbness, and radiographic parameters, including C2-C7 lordotic angle, atlanto-dens interval (ADI), and ⊿ADI, were evaluated preoperatively, at 2 years postoperatively, and at the final follow-up. RESULTS: Five patients had mucopolysaccharidoses (type I: n = 1, II: n = 3, VII: n = 1) and one patient had mucolipidoses type III. The mean age of patients at surgery was 27.5 years, and the mean postoperative follow-up period was 61 months. All mucopolysaccharidoses cases required C1 posterior arch resection with C2-C7 laminoplasty. No critical complications were observed postoperatively. There were no significant differences in C2-C7 angle (p = 0.724) and ⊿ADI (p = 0.592) between the preoperative and final follow-ups. The cJOA score and VAS for numbness significantly improved at the final follow-up (p = 0.004 and p = 0.007, respectively). CONCLUSIONS: The cervical myelopathy in patients with LSD could be safely and effectively treated with laminoplasty with/without C1 posterior arch resection after excluding patients with atlantoaxial instability. Atlantoaxial stability and symptom improvement could be maintained at an average of 5 years postoperatively.


Assuntos
Laminoplastia , Doenças por Armazenamento dos Lisossomos , Mucolipidoses , Mucopolissacaridoses , Doenças da Medula Espinal , Adulto , Vértebras Cervicais/cirurgia , Humanos , Estudos Retrospectivos , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento
6.
BMC Musculoskelet Disord ; 22(1): 765, 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496821

RESUMO

BACKGROUND: In treating patients with cervical ossification of the posterior longitudinal ligament (COPLL), a novel surgery technique - anterior controllable antedisplacement and fusion (ACAF) suggested promising clinical benefits in recent exploratory studies. METHODS: This is a multicentre, randomized, open-label, parallel-group, active controlled trial that will compare the clinical benefits of ACAF versus conventional posterior laminoplasty (LAMP) in severe COPLL patients. A total of 164 patients will be enrolled and randomized in a 1:1 ratio to either ACAF or LAMP group. The primary efficacy measure is cervical- Japanese Orthopaedic Association (C-JOA) recovery rate at 12 months post operation, which is to be derived by Hirabayashi's method from JOA data (range, 0 [worst] to 17 [normal condition]). Other important secondary efficacy endpoints include visual analogue scale (VAS) pain score (range, 0 [no pain] to 10 [most severe]), 10-item neck disability index (NDI, a total range of 0 to 50 points, the highest index the worst) and 6-level Nurick disability grade (range, 0 [mild] to 5 [severe]). Safety endpoints including adverse events, perioperative complications, and adverse events of special interest will also be assessed in this study. Full analysis set for baseline and efficacy data analyses according to the intention-to-treat principle will be established as the primary analysis population. Analysis of covariance (ANCOVA) will be used to analyze the C-JOA recovery rate, with random stratification factors (if appropriate) and the treatment group as fixed factors, and the baseline level of C-JOA score as covariate. DISCUSSION: This study is designed to demonstrate the clinical benefits of ACAF as compared to conventional LAMP in COPLL patients. It will provide clinical evidence that the novel surgery technique - ACAF might be more favorable in treating patients with severe cervical ossification of the posterior longitudinal ligament. (Words: 290). TRIAL REGISTRATION: ClinicalTrials.gov number, NCT04968028 .


Assuntos
Laminoplastia , Ossificação do Ligamento Longitudinal Posterior , Fusão Vertebral , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Humanos , Laminoplastia/efeitos adversos , Ligamentos Longitudinais/cirurgia , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Osteogênese , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
7.
Neurol Med Chir (Tokyo) ; 61(11): 667-673, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34483199

RESUMO

A lateral mass screw (LMS) is one of the standard anchor screws in posterior cervical fixation. Although the advantage of cervical LMS is that it is easier and safer to place than pedicle screw, it is sometimes difficult for surgeons to confirm the exact point for screw entry and accurate angle in cases of revision surgery. When LMS fixation is performed as revision surgery after cervical laminoplasty or laminectomy, it might be complicated to secure safe placement of the LMSs. We present a simple but practical technique involving a caliper and angle device for revision surgery after cervical laminoplasty for ossification of the posterior longitudinal ligament. In this technique, the distance between the bilateral entry points is ascertained using preoperative CT. Insertion of the screw is guided using the angle device set to 25 degrees. The technique presented here is easy and allows accurate placement of the LMSs in the posterior cervical spine, and is practical even for revision surgery.


Assuntos
Laminoplastia , Parafusos Pediculares , Fusão Vertebral , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Ligamentos Longitudinais , Osteogênese , Reoperação
8.
Medicine (Baltimore) ; 100(31): e26807, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397837

RESUMO

ABSTRACT: Several studies have demonstrated that the dynamic factor at the mobile segment affects the severity of myelopathy in patients with cervical ossification of the posterior longitudinal ligament (C-OPLL), and posterior decompression supplemented with posterior instrumented fusion at the mobile segment provides good neurological improvement. However, there have been few reports of changes in range of motion at the mobile segment (segmental ROM) after laminoplasty (LP). The aim of this study was thus to retrospectively investigate changes in segmental ROM after LP and the impacts of these changes on neurological improvement in patients with C-OPLL.A total of 51 consecutive patients who underwent LP for C-OPLL since May 2010 and were followed for at least 2 years after surgery were included in this study. Neurological status was assessed using the Japanese Orthopaedic Association (JOA) score before surgery and at 2-year follow-up. Segmental ROM at the responsible level for myelopathy was measured preoperatively and at 2-year follow-up using lateral flexion-extension radiographs of the cervical spine.The mean JOA score improved significantly from 10.7 points preoperatively to 13.5 points at 2 years after surgery (mean recovery rate, 45.0%). The mean segmental ROM decreased significantly from 6.5 degrees before surgery to 3.2 degrees at 2 years after surgery. In the good clinical outcome group (recovery rate of the JOA score ≥50%; n = 22), the mean segmental ROM decreased significantly from 5.8 degrees preoperatively to 3.0 degrees postoperatively. It also decreased significantly from 7.1 degrees to 3.4 degrees in the poor clinical outcome group (recovery rate of the JOA score <50%; n = 29).This study showed that segmental ROM was stabilized after LP in most patients with C-OPLL. Neither preoperative nor postoperative segmental ROM showed significant differences between the good and poor clinical outcome groups and neither a postoperative increase nor decrease of segmental ROM significantly affected the recovery rate of the JOA score.


Assuntos
Vértebras Cervicais , Laminoplastia , Exame Neurológico , Ossificação do Ligamento Longitudinal Posterior , Amplitude de Movimento Articular , Fusão Vertebral , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/fisiopatologia , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Feminino , Humanos , Japão/epidemiologia , Laminoplastia/efeitos adversos , Laminoplastia/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Exame Neurológico/métodos , Exame Neurológico/estatística & dados numéricos , Ossificação do Ligamento Longitudinal Posterior/diagnóstico , Ossificação do Ligamento Longitudinal Posterior/fisiopatologia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Avaliação de Resultados em Cuidados de Saúde/métodos , Período Perioperatório/métodos , Período Perioperatório/estatística & dados numéricos , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
9.
Zhonghua Yi Xue Za Zhi ; 101(25): 1978-1984, 2021 Jul 06.
Artigo em Chinês | MEDLINE | ID: mdl-34225419

RESUMO

Objectives: To compare the clinical effect of alternative-level and all-level Arch mini-plate fixation in patients undergoing unilateral open-door laminoplasty. Methods: Clinical data of 134 patients administrated in the Peking University International Hospital for multistage cervical spondylotic myelopathy from March 2015 to March 2019 were reviewed retrospectively. There were 63 males and 71 females with an average age of (62±8) years and a mean disease course of (18±7) months (3-37 months). All the patients underwent posterior cervical unilateral open-door laminoplasty with Arch titanium plate fixation. All the patients were divided into two groups according to the different amount of titanium plates used during operation as follow: group A, Arch plates were fixed at the door sides of C3, C5 and C7 (n=68) and group B, Arch plates were fixed at the door sides of C3, C4, C5, C6 and C7 (n=66). Operation time, intraoperative blood loss, postoperative hospitalization days and the cost of consumables, the Japanese orthopaedic association (JOA) score, cervical dysfunction index (NDI), the rates of improved JOA score, cervical curvature index, C2-7 Cobb angle, cervical range of motion, sagittal diameter of vertebral canal, opening angle of laminar, hinges bone healing and surgery related complications (axial symptoms, C5 nerve root palsy, screw loosening, laminar re-closing, cervical kyphosis, etc.) were recorded and compared between the two groups. Results: There was no complications during the operation, and the mean follow-up was (20±8) months (14-48 months). There was no statistically significant difference between the two groups in terms of gender, age, course of disease and compression segments (all P>0.05). There was no statistically significant differences between the two groups in operation time, intraoperative blood loss and postoperative hospital stay too (all P>0.05). The cost of consumables in group A was (34 970±1 325) yuan, and it was (57 450±2 161) yuan in group B, the difference between the two groups was statistically significant (P<0.01). The JOA and NDI score were significantly improved 3 months and 1 year after operation in both groups (both P<0.05). The sagittal diameter of each segment of the spinal canal at C3, C4, C5, C6 and C7 were all significantly increased in both groups 3 months and 1 year after surgery (all P<0.05). The C2-7 Cobb angle and cervical curvature index were all significantly reduced in both groups 3 months and 1 year after surgery (all P<0.05). The cervical range of motion in both groups was significantly reduced 3 months and 1 year after surgery compared with that before surgery (both P<0.05). The range of motion of the cervical spine in group A was significantly higher than that in group B (P<0.05). The opening angles of C4 and C6 segment lamina in group A 3 months and 1 year after operation were significantly lower than those in group B (all P<0.05). At 3 months after the operation, the hinges healing rate of C4 and C6 in group B was significantly better than that of group A (both P<0.05). At 1 year after the operation, there was no difference in the hinges healing rate of C4 and C6 in the two groups (both P>0.05). There was no statistically significant difference in postoperative complications between the two groups (P>0.05). Conclusions: The safety and early clinical efficacy of alternative-level and all-level Arch titanium plate fixation in posterior cervical unilateral open-door laminoplasty are comparable, alternative-level fixation can effectively reduce the cost of hospitalization. The open Angle loss and lower early hinges healing rate of the non-fixed segment in the alternative-level fixed group does not lead to laminar re-closing in early period of post operation.


Assuntos
Laminoplastia , Idoso , Placas Ósseas , Vértebras Cervicais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
10.
World Neurosurg ; 152: e738-e744, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34153482

RESUMO

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is effective for the treatment of single-level cervical spondylotic myelopathy (CSM). However, the data surrounding multilevel CSM have remained controversial. One alternative is laminoplasty, although evidence comparing these strategies has remained sparse. In the present report, we retrospectively reviewed the readmission and reoperation rates for patients who had undergone ACDF or laminoplasty for multilevel CSM from a national longitudinal administrative claims database. METHODS: We queried the MarketScan Commercial Claims and Encounters database to identify patients who had undergone ACDF or laminoplasty for multilevel CSM from 2007 to 2016. The patients were stratified by operation type. Patients aged <18 years, patients with a history of tumor or trauma, and patients who had undergone anteroposterior approach were excluded from the present study. RESULTS: A total of 5445 patients were included, of whom 1521 had undergone laminoplasty. A matched cohort who had undergone ACDF was identified. The overall 90-day postoperative complication rate was greater in the laminoplasty cohort (odds ratio, 1.48; 95% confidence interval, 1.18-1.86; P < 0.0001). The mean length of stay and 90-day readmission rates were greater in the laminoplasty cohort. The hospital and total payments of the index hospitalization were greater in the ACDF cohort, as were the total payments for ≤2 years after the index hospitalization. CONCLUSIONS: In the present administrative claims database study, no difference was found in the reoperation rate between ACDF and laminoplasty. ACDF resulted in fewer complications and readmissions compared with laminoplasty but was associated with greater costs. Additional prospective research is required to investigate the factors driving the higher costs of ACDF in this population and the long-term clinical outcomes.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Laminoplastia/métodos , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Espondilose/cirurgia , Estudos de Coortes , Custos e Análise de Custo , Bases de Dados Factuais , Discotomia/economia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Resultado do Tratamento
11.
Neurocirugia (Astur : Engl Ed) ; 32(5): 224-230, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34148852

RESUMO

OBJECTIVE: The open-door laminoplasty technique is widely used in the treatment of multilevel cervical myelopathy. Despite the satisfactory functional and radiological results of this technique, postoperative C5 palsy is still a severe and disabling complication with a variable incidence in the literature. The objective of this article is to describe and demonstrate the surgical technique step by step with the addition of unilateral C4-5 foraminotomy and to evaluate the results obtained to date, with special emphasis on C5 palsy. MATERIAL AND METHODS: Retrospective study of 20 patients operated on for cervical myelopathy using the "extended" laminoplasty technique, which is described step by step. RESULTS: Between January 2013 and April 2019, 20 patients were operated on using the extended laminoplasty technique. Only one patient (5%) presented postoperative C5 palsy. The postoperative recovery rate of the modified JOA (Japanese Orthopaedic Association) score was 54.5%, similar to that observed in other series. CONCLUSION: The extended cervical laminoplasty technique with unilateral C4-5 foraminotomy was developed and demonstrated for the prevention of C5 palsy. The results were analysed and an incidence of C5 palsy coinciding with the lowest percentage reported in the literature was obtained. A prospective randomised study would be useful to assess the role of preventive unilateral C4-5 foraminotomy.


Assuntos
Foraminotomia , Laminoplastia , Vértebras Cervicais/diagnóstico por imagem , Humanos , Laminoplastia/efeitos adversos , Estudos Prospectivos , Estudos Retrospectivos
12.
Orthop Surg ; 13(5): 1673-1681, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34109741

RESUMO

OBJECTIVE: This study is to introduce lift-open laminoplasty and verify the increase of the spinal canal area following this surgical technique according to the preoperative anatomical measurement. METHODS: There are 82 patients (43 male and 39 female) analyzed in our study from January 2019 to December 2020. The average age was 63.2 ± 3.21 years (from 41 to 84 years). All of them were treated with open-door laminoplasty, with a decompression segment range from C3 to C6. The increase of the spinal canal area after open-door laminoplasty was measured on postoperative CT images of the patients, and the distances between both lamina-facet junctions and lamina length was measured on preoperative CT images. Using the Pythagorean theorem for the equation of calculation area after the expansile open-door laminoplasty. Based on previous measurement parameters, spinous process length, lateral mass width, distance between osteotomy line and lamina-facet junctions line were additionally measured on preoperative CT images. Pythagorean theorem was used for calculating the area after the expansile lift-open laminoplasty. The results were recorded and a statistical analysis was undertaken. Then, there were six patients (five male and one female) treated with lift-open laminoplasty on C6, open-door on C3-C5, who suffer from cervical spondylotic myelopathy from December 2020 to January 2021. The average age was 60.3 ± 1.7 years (from 56 to 71 years). Operation time, blood loss, and Japanese Orthopaedic Association (JOA) score recovery rate were recorded. Intraoperative and postoperative complications were observed. RESULTS: The increase of the spinal canal area after open-door laminoplasty measured on postoperative CT images was 123.01 ± 17.06 mm2 and the calculation of the increase of the spinal canal areausing the Pythagorean theorem after open-door laminoplasty was 122.86 ± 15.86 mm2 . A comparison of the actual value with calculative value showed no significant difference (T value = 0.057, P value = 0.955). The calculation of the increase of the spinal canal area after lift-open laminoplasty was 183.57 ± 62.99 mm2 , which was larger than that after open-door laminoplasty (T value = 8.462, P value < 0.001). Mean operation time was 153.3 min and operative blood loss was 600 mL of the six patients treated with lift-open laminoplasty. At 1 month follow-up, all patients had recovered well. JOA score recovery rate was 37.6% and no intraoperative and postoperative complications occurred. CONCLUSION: Lift-open laminoplasty could preserve nearly 100% of extensor muscle, avoid damaging C7 paraspinal muscles and C6-7 posterior muscle-ligament complex, reconstruct the spinous process firmly in the midline, and expand adequate spinal canal area after operation. These advantages could reduce the incidence rate of complications and bring better clinical results than traditional laminoplasty.


Assuntos
Vértebras Cervicais/cirurgia , Laminoplastia/métodos , Canal Medular/cirurgia , Doenças da Medula Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Canal Medular/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X
14.
BMC Surg ; 21(1): 291, 2021 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-34118924

RESUMO

BACKGROUND: To explore the relationship between spino cranial angle (SCA) and loss of cervical lordosis (LOCL), and to determine whether SCA has the ability to predict LOCL for patients with cervical myelopathy. METHODS: A total of 68 consecutive patients with cervical myelopathy who received laminoplasty (LAMP) were selected to the current study. C2-C7 lordosis was defined as a representation of the cervical alignment. Alignment change > 0° was considered LOCL. Multiple linear regression analysis was applied to evaluate the association between LOCL and various sagittal parameters at preoperative, such as SCA, CL, T1s and cSVA. Linear regression analysis was applied to evaluate the relationships between LOCL and preoperative SCA in each subgroup. RESULTS: Patients were assigned to three groups depending on the quartile of preoperative SCA. The first quarter of patients were defined as the low SCA group, the last quarter were defined as the high SCA group and the middle half were defined as the middle SCA group. There was no statistically significant difference in age, sex and the type of OPLL among the three groups. Patients in the low SCA group showed more cervical lordosis before surgery and more LOCL after LAMP (p < 0.001). After linear regression analysis for SCA and LOCL, preoperative SCA was negatively correlated with LOCL in the low SCA group (r = - 0.857, p < 0.001) and high SCA group (r = - 0.515, p = 0.034). However, there was no significant correlation between preoperative SCA and LOCL in the middle SCA group (r = 0.027, p = 0.881). CONCLUSIONS: Patients with lower SCA had more lordosis preoperatively and performed more LOCL after LAMP at 2 years of follow-up. Both too high or low preoperative SCA were negatively correlated with the degree of LOCL, while when the SCA fluctuates in a suitable range, it is easier to compensate for the changes of cervical sagittal alignment.


Assuntos
Laminoplastia , Lordose , Doenças da Medula Espinal , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Lordose/diagnóstico por imagem , Lordose/cirurgia , Crânio , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia
15.
Turk Neurosurg ; 31(3): 432-440, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33978209

RESUMO

AIM: To compare the radiological and functional changes after multi-level laminoplasty between patients with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL). MATERIAL AND METHODS: This study included 75 patients consisted with 32 of CSM (group A) and 43 of OPLL (group B) presenting a preserved cervical sagittal balance who underwent multi-level laminoplasty for cervical myelopathy. The radiological outcomes were analyzed with the following radiological parameters: C2?C7 Cobb angle in neutral (C2-7AN), flexed (C2-7AF), and extended (C2-7AE) neck postures; C2?C7 range of motion (C2-7ROM); T1 slope (T1S); and C2?C7 sagittal vertical axis (C2-7SVA). The functional outcomes were analyzed with the modified Japanese Orthopedic Association (mJOA) score, Nurick grade, and recovery rate. The radiological and functional outcomes between the two groups were evaluated at 12-month postoperatively. RESULTS: There were statistically significance increase of C2-7SVA in group A; and decrease of C2-7AF and C2-7ROM in group A and C2-7ROM in group B postoperatively (p < 0.05). However, C2-7AN showed no statistically significant inter-group differences and postoperative intra-group changes in both groups (p > 0.05). There were no statistically significant differences in the postoperative functional outcomes including mJOA score (p=0.251), Nurick grade (p=0.316), and recovery rate (p=0.435) between the two groups. CONCLUSION: Although there were no statistically significant differences in functional outcomes between the two groups, the group A showed a greater deterioration in sagittal balance with an increase of C2-7SVA than the group B after multi-level laminoplasty.


Assuntos
Vértebras Cervicais/cirurgia , Laminoplastia , Ligamentos Longitudinais/cirurgia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Espondilose/cirurgia , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Período Pós-Operatório , Radiografia , Amplitude de Movimento Articular , Espondilose/diagnóstico por imagem , Resultado do Tratamento
16.
Spine (Phila Pa 1976) ; 46(23): E1238-E1245, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33958538

RESUMO

STUDY DESIGN: A prospective multicenter study. OBJECTIVE: To evaluate and compare the surgical outcomes after open-door (OD) and double-door (DD) laminoplasties in subjects with cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA: Although previous studies compared clinical results after OD and DD laminoplasties, they were performed at a single institution with a relatively small sample size targeting mixed pathologies, including cervical spondylotic myelopathy. METHODS: This study was performed by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. A total of 478 patients with myelopathy caused by cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for 2 years. Of these, 41 and 164 patients received OD and DD laminoplasties, respectively. Demographic information, medical history, and imaging findings were collected. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association, Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, and visual analog scale scores. RESULTS: Age, sex, symptom duration, and comorbidities were not significantly different between the groups. Segmental ossification was the most frequent in both the groups. No significant differences in K-line type, canal occupying ratio, C2 to C7 angles, and range of motion were found. Both the procedures reduced the cervical range of motion postoperatively. A comparable frequency of perioperative complications was observed between the groups. The cervical Japanese Orthopaedic Association scores showed a similar improvement at 2 years postopera- tively. The reduction in visual analog scale score for neck pain was favorable in the OD group (P = 0.02), while other pain assessments did not show any significant differences between the groups. The functional outcomes assessed using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire presented equivalent effective rates. CONCLUSION: The results demonstrated almost comparable surgical outcomes between OD and DD laminoplasties. Lamino- plasty is a valuable technique as a therapeutic option for cervical OPLL.Level of Evidence: 2.


Assuntos
Laminoplastia , Ossificação do Ligamento Longitudinal Posterior , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Laminoplastia/efeitos adversos , Ligamentos Longitudinais , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Osteogênese , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
17.
Orthop Surg ; 13(4): 1351-1358, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33998781

RESUMO

OBJECTIVE: To investigate whether the modified K-line can be used to predict the clinical outcome and to determine the surgical approach for K-line (-) patients with cervical ossification of the posterior longitudinal ligament (OPLL). METHODS: A new modified K-line was defined as the line connecting the midpoints of the spinal cord at C4 and C6 on the lateral cervical radiographs. A total of four consecutive patients (three men and one woman) with cervical myelopathy due to OPLL were included in this research. The patients were diagnosed with OPLL with K-line (-) while they were also classified as modified K-line (+). Preoperative modified K-line was used to predict the surgical outcome in K-line (-) patients with OPLL according to the original K-line. And a modified laminoplasty with C3 laminectomy and C4-6 bilateral open-door laminoplasty was adopted to perform on all the patients. The Japanese Orthopaedic Association scores before surgery and at 1-year follow-up after surgery were evaluated and the recovery rate was calculated. The visual analogue scale (VAS) scores were also evaluated before surgery and after surgery. Furthermore, cervical plain radiographs in neutral position before surgery and after surgery were obtained to measure C2 -C7 angles for assessing the cervical sagittal alignment. RESULTS: The results showed that good neurological improvement could be achieved in all K-line (-) patients who underwent C3 laminectomy with C4 -C6 bilateral open-door laminoplasty. The Postoperative JOA scores improved from 13.5 to 16.5, from 11 to 16.5, from 13 to 16, and from 12.5 to 13, respectively. The mean recovery rate was 65.4% in the K-line (-) patients. And the VAS scores dropped from 3 to 1, 5 to 2, 5 to 3, and 4 to 2, respectively. The JOA and VAS scores showed satisfaction in all patients at the 1-year follow-up. Relatively satisfactory and stable cervical sagittal alignment was observed on postoperative lateral radiography in all patients at the 3-month follow-up period. There were no postoperative complications associated with this technique found in all the patients. CONCLUSIONS: Modified K-line may predict the clinical outcome of this modified laminoplasty and offer guidance regarding the choice of surgical method for K-line (-) patients with OPLL. Additionally, C3 laminectomy with C4 -C6 bilateral open-door laminoplasty should be recommended for the use in patients with K-line (-) OPLL, who were also classified as modified K-line (+). However, further studies with more cases will be required to reveal its generalizability and availability.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Tomada de Decisão Clínica , Laminectomia/métodos , Laminoplastia/métodos , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Feminino , Humanos , Masculino , Medição da Dor , Radiografia , Inquéritos e Questionários
18.
Orthop Surg ; 13(5): 1496-1504, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34056862

RESUMO

PURPOSE: To provide imaging evidence of the feasibility and clinical efficacy of a new full lamina back shift spinal canal enlargement technique. METHODS: A retrospective analysis was conducted on 64 patients with multisegment cervical spondylotic myelopathy caused by cervical stenosis. Of these, 32 patients underwent the new full lamina back shift spinal canal enlargement technique (as observation group) and 32 patients underwent single open-door miniature titanium plate internal fixation (as control group). The computed tomography (CT) data of both groups were imported into Mimics 17.0 software to measure the median sagittal diameter and cross-sectional area of the spinal canal. Photoshop CS5 was employed to measure the drift distance of the spinal cord on MR images to perform a comparative study of the imaging parameters from the two groups. RESULTS: The T2-weighted MR images in both groups showed continuous recovery of the cerebrospinal fluid signal in the C3 -C7 range. The enlarged spinal canal cross-sectional area (mm2 ) of each segment after the new full lamina back shift spinal canal enlargement technique was 130.90 ± 20.52 (C3 ), 180.81 ± 18.86 (C4 ), 240.48 ± 35.43 (C5 ), 145.93 ± 36.94 (C6 ), and 153.16 ± 36.28 (C7 ), and the enlarged median sagittal diameter (mm) was 5.31 ± 1.13 (C3 ), 8.8 ± 1.28 (C4 ), 10.28 ± 1.68 (C5 ), 9.46 ± 1.48 (C6 ), and 9.22 ± 1.12 (C7 ). Both parameters were significantly superior to single open-door miniature titanium plate internal fixation (P < 0.05). No significant difference was detected in the drift distance of the spinal cord between the two groups (P > 0.05). CONCLUSION: The new full lamina back shift spinal canal enlargement technique achieved a thorough spinal canal decompression effect on imaging while ensuring a reasonable spinal drift distance and few surgical complications. The clinical curative effect of the new technique was precise.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Laminoplastia/métodos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Idoso , Diagnóstico por Imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Biomed Res Int ; 2021: 8410317, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33997042

RESUMO

Objective: (1) To propose a novel technique named thoracic extensive laminoplasty (TELP) in curing severe thoracic ligamentum flavum ossification (STOLF) and (2) to compare outcomes between TELP and laminectomy in curing STOLF. Methods: Cases with fused or tuberous STOLF (Sato classification) treated from Jan 2015 to Jan 2017 were reviewed and divided into the TELP group (G1) and laminectomy group (G2) according to their surgical management. Data on demographics, complications, pre- and postoperative symptoms, residual spinal canal area (RSCA-1), residual spinal cord area (RSCA-2), modified Japanese Orthopedic Association score (mJOA), and health-related quality of life (HRQOL, based on the SF-36) were collected. Results: Fifty-nine G1 and sixty-two G2 patients were enrolled. No significant differences in demographic data or preoperative data of RSCA-1, RSCA-2, mJOA, or HRQOL were observed between the two groups (p > 0.05). Patients in G1 and G2 showed similar postoperative improvements in RSCA-1 and RSCA-2 at the final follow-up (p > 0.05). However, patients in G1 showed higher postoperative improvements in mJOA (OR = 2.706, 95% CI: 1.279~5.727, p = 0.008) at the final follow-up. Patients in G1 also showed higher postoperative improvements in HRQOL than patients in G2 (p < 0.05) at the final follow-up, and patients with more severe STOLF presented with better improvements in HRQOL in G1 (p < 0.05). Dural laceration and cerebrospinal fluid leakage were observed in seven G2 patients, and no complications were found in G1 patients after surgery. Conclusion: TELP is a novel, effective, and safer surgical technique in treating STOLF and could be a substitute for traditional laminectomy.


Assuntos
Laminectomia , Laminoplastia , Ligamento Amarelo/cirurgia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Doenças da Coluna Vertebral/cirurgia , Estudos de Casos e Controles , Feminino , Humanos , Laminectomia/efeitos adversos , Laminectomia/métodos , Laminoplastia/efeitos adversos , Laminoplastia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Qualidade de Vida
20.
BMC Musculoskelet Disord ; 22(1): 426, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33962588

RESUMO

BACKGROUND: Segmental cervical instability is a risk factor for the progression of osteophytic bone spurs and development of myelopathy, and is treated as a relative contraindication of cervical laminoplasty. The aim of this study was to compare laminoplasty with selective fixation (LPSF) versus laminectomy with fusion (LCF) in patients with multilevel cervical myelopathy accompanied by segmental instability. METHODS: A case-control study was conducted by reviewing data from 63 patients who underwent LPSF (n = 30) or LCF (n = 33). Cervical alignment, range of motion (ROM), neurologic status and axial symptom severity pre-operation, 3-days after operation, and at the final follow-up (minimum 24 months) were measured and compared between groups. RESULTS: Postoperation, patients in the LPSF group lost 31.1 ± 17.3 % of cervical lordosis and 43.2 ± 10.9 % cervical ROM while patients in the LCF group lost 5.7 ± 8.2 % and 67.9 ± 15.5 %, respectively. Both LPSF and LCF groups significantly improved neurologic status and axial symptom severity at the final follow-up with similar between-group results(P > 0.05). Blood loss, operation time, hospital stay, and medical cost in the LPSF group were significantly less than in the LCF group(P < 0.05). CONCLUSIONS: In 2 years of clinical observation, LPSF was effective in maintaining the stability of the cervical spine with less sacrifice of mobility and surgical trauma for multilevel myelopathy with segmental instability compared to LCF.


Assuntos
Laminoplastia , Doenças da Medula Espinal , Fusão Vertebral , Estudos de Casos e Controles , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Laminectomia/efeitos adversos , Laminoplastia/efeitos adversos , Estudos Retrospectivos , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
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