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1.
Medicine (Baltimore) ; 100(9): e24900, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655951

RESUMO

OBJECTIVE: We designed and performed a network meta-analysis to compare the clinical outcomes among the 5 surgeries-anterior cervical corpectomy and fusion (ACCF), anterior controllable antedisplacement fusion (ACAF), laminoplasty (LP), laminectomy (LC), and posterior decompression with instrumented fusion (PDF)-for patients with cervical spondylosis related to the ossification of the posterior longitudinal ligament (OPLL). METHODS: Databases, including PubMed, EMBASE, Cochrane Library, Google Scholar, and Web of Science (firstly available-2019) were selected for literature search. We performed a network meta-analysis with the included studies. A Newcastle-Ottawa scale was employed to assess the study quality of the included studies. RESULTS: Total 23 studies with 1516 patients were included in our analysis. We found that ACCF achieved the most improvement in the Japanese Orthopaedic Association Scores and excellent and good recovery rate, ACAF achieved the best improvement of the improvement rate and lordosis. LP got the best operative time and blood loss. CONCLUSIONS: Our results suggested that both anterior (ACCF and ACAF) and posterior (LP, LC, and PDF) procedures have their strengths and weaknesses. Clinicians need to select the most appropriate surgery with a comprehensive consideration of the clinical condition of each patient with OPLL-related cervical spondylosis.


Assuntos
Descompressão Cirúrgica/métodos , Ligamentos Longitudinais/cirurgia , Metanálise em Rede , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Cooperação do Paciente , Espondilose/cirurgia , Vértebras Cervicais , Humanos , Laminectomia/métodos , Laminoplastia/métodos , Ossificação do Ligamento Longitudinal Posterior/complicações , Fusão Vertebral/métodos , Espondilose/etiologia
2.
BMC Surg ; 21(1): 141, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33740933

RESUMO

BACKGROUND: The open-door laminoplasty is an effective procedure for the treatment of cervical spondylotic myelopathy. However, little information is available about the surgical results of open-door laminoplasty in the treatment of intraspinal tumors. In the present study, we aimed to investigate the clinical effect of open-door laminoplasty with ARCH plate fixation in the treatment of cervical intraspinal tumors. METHODS: This was a retrospective study. From January 2013 to May 2018, 38 patients (13 males and 25 females, the average age of 44 ± 17 years) with cervical intraspinal tumors underwent open-door laminoplasty with ARCH plate fixation in our hospital. The operation time, blood loss, pre- and postoperative visual analog scale (VAS), and Japanese Orthopedic Association (JOA) scores were determined. To determine the radiographic outcomes, cervical X-ray film and magnetic resonance imaging (MRI) were performed before and after the operation, and cervical X-ray sagittal film was used to measure Cobb angle. The clinical data before and after the operation were compared by t-test. RESULTS: A total of 38 patients underwent a successful operation and demonstrated primary healing. The average operation time was 113 ± 12 min. The average blood loss was 120 ± 19 mL. All patients were followed up for 26.1 ± 2.8 months, and the final follow-up time was more than 24 months. VAS scores were much better at 24 months after operation compared with those before the operation, which were decreased from 6.1 ± 1.1 to 1.4 ± 0.7 (t = 32.63, P < 0.01). The JOA score was improved from 9.9 ± 1.5 to 15.5 ± 0.6 (t = - 18.36, P < 0.01), and the mean JOA recovery rate was 79% ± 11% at 24 months after the operation. There was no significant difference in Cobb angle between pre-operation and 24 months after the operation, which was 9.8 ± 2.6 and 10.3 ± 3.1 respectively (t = - 0.61, P > 0.05). Neither spinal malalignment on the coronal plane nor displacement of the laminoplasty flap was observed on postoperative cervical X-ray and MRI examinations at the final follow-up. CONCLUSIONS: Open-door laminoplasty with ARCH plate fixation was a safe and effective surgical approach for the treatment of cervical intraspinal tumors.


Assuntos
Vértebras Cervicais , Laminoplastia , Neoplasias da Coluna Vertebral , Adulto , Placas Ósseas , Vértebras Cervicais/cirurgia , Feminino , Humanos , Laminoplastia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/cirurgia , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(33): e20955, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871974

RESUMO

We conducted a retrospective study to compare the clinical and radiological results of anterior cervical discectomy and fusion (ACDF) and posterior laminoplasty for two-level localized ossification of the posterior longitudinal ligament (OPLL).ACDF and posterior laminoplasty are performed for localized OPLL at the disc and vertebral body levels, respectively.Eighty six patients with two-level localized OPLL who underwent surgery from January 2011 to December 2016 were retrospectively investigated (41, ACDF group; 45, laminoplasty group). Clinical outcomes were reviewed, and radiologic results such as occupying ratio (OR), space available in the spinal cord, cranial and caudal OPLL-to-disc distance (ODD)/posterior body height (PBH) ratios, segmental angle, C2-C7 Cobb angle, T1 slope, C2-C7 sagittal vertical axis (SVA), and range of motion were investigated.Patients were followed-up for an average of 42.7 ±â€Š10.5 months. Clinical outcomes, postoperative OR, and space available in the spinal cord were significantly improved at the final follow-up in both groups. Preoperatively, the OR and cranial and caudal ODD/PBH ratios were not significantly different between the groups. Compared to pre-operative values, differences in the segmental and C2-C7 Cobb angles at the final follow-up were statistically significant for the ACDF group (P < .05). The mean operative time, bleeding volume, and the duration of hospitalization were significantly lower in the ACDF group than in the laminoplasty group (P < .05). Complications occurred in 1 ACDF case and in 5 laminoplasty cases.Both ACDF and laminoplasty provided satisfactory clinical and radiologic outcomes for two-level localized OPLL. However, ACDF was associated with a lower operation time, bleeding loss, duration of hospitalization, and complications.


Assuntos
Discotomia , Laminoplastia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/cirurgia , Fusão Vertebral , Adulto , Idoso , Perda Sanguínea Cirúrgica , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Laminoplastia/métodos , Tempo de Internação , Ligamentos Longitudinais/diagnóstico por imagem , Ligamentos Longitudinais/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Ossificação do Ligamento Longitudinal Posterior/complicações , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Complicações Pós-Operatórias , Amplitude de Movimento Articular , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Fusão Vertebral/métodos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(25): e20538, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569174

RESUMO

OBJECTIVE: We undertook a meta-analysis to compare the efficacy and safety of single versus double door posterior cervical laminoplasty for cervical spondylotic myelopathy. METHODS: PubMed, Embase, and Cochrane Central Register of controlled trials were searched for randomized controlled trials investigating single and double door posterior cervical laminoplasty for cervical spondylotic myelopathy. The Mantel-Haenszel method with the fixed-effects or random-effects model was used to calculate relative risks and 95% confidence intervals (CIs). RESULTS: Seven studies with 224 patients met the eligibility criteria and were included. There was a significant difference in Japanese Orthopedic Association score (MD = 0.79, 95%CI [0.09, 1.49], P = .03; P for heterogeneity = .09, I = 45%), and adverse events (OR = 0.32, 95%CI [0.11, 0.95], P = .04; P for heterogeneity = 1.00, I = 0%) between the double door posterior cervical laminoplasty group and the single door posterior cervical laminoplasty group. There was no significance in operative time (MD = 0.56, 95%CI [-11.86, 12.98], P = .93; P for heterogeneity = 0.001, I = 73%) and length of hospital stay (OR = -0.75, 95%CI [-1.78, 0.27], P = .15; P for heterogeneity = 1.00, I = 0%) between the 2 groups. CONCLUSION: Double door posterior cervical laminoplasty is more effective and safer than single door laminoplasty in the treatment of cervical spondylotic myelopathy.


Assuntos
Vértebras Cervicais/cirurgia , Laminoplastia/métodos , Espondilose/cirurgia , Adulto , Idoso , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
5.
J Clin Neurosci ; 78: 371-375, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32386863

RESUMO

In this study, the stabilities of the hinge sides of plate-augmented open-door laminoplasties based on cutting in a curved or straight line were compared using a finite element (FE) model and an experimental assessment. Using FE models generated from CT scans of a human subject, straight and curved techniques for cutting the hinge side were evaluated. Compressive forces were applied to both simulated models, and the stress distributions on the respective hinge sites were evaluated by comparing the maximum von Mises stresses. Biomechanical testing procedures were then carried out on porcine cervical vertebrae, with straight- and curved-cut groups loaded to failure, and the corresponding reaction forces on the hinge sites were recorded using a loading cell. The FE analysis results revealed no significant differences between the straight- and curved-cut groups in terms of maximum stress forces on the superior, middle, or inferior portions of the hinge sites. In the experimental study, the curved-cut group withstood higher loads to failure at the hinge site than the straight-cut group. The ability of the curved-cut laminoplasty hinges to withstand higher compressive loading to failure than straight-cut hinges suggests the potential of the proposed technique to reduce the risk of hinge fracture and displacement.


Assuntos
Fenômenos Biomecânicos , Análise de Elementos Finitos , Laminoplastia/métodos , Animais , Placas Ósseas , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Fraturas Ósseas/prevenção & controle , Fraturas Ósseas/cirurgia , Humanos , Suínos , Tomografia Computadorizada por Raios X
6.
World Neurosurg ; 138: 200, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32156597

RESUMO

This Video 1 presents the surgical management of a 36-year-old woman who presented with progressive weakness in her right arm associated with a pins-and-needles sensation. Magnetic resonance imaging of the cervical spine revealed a likely hemorrhagic cavernous malformation of the spinal cord at the C3-4 level. The lesion was wholly intramedullary with no presentation to the surface of the spinal cord. It was located in the spinal cord centrally with some right-side predominance. Treatment options were presented to the patient, who agreed to surgery. A resection was performed after a hemilaminotomy at C3 and C4 levels. A biportal technique was used, demonstrating resection of the malformation through 2 small myelotomies made between the entering rootlets at the dorsal root entry zone. This was intended to preserve all roots at the entry zone while enabling visualization of the entire cavernous malformation and its cavity from 2 different portals of entry, essentially providing the same field of access while preserving all roots. After successful resection, the cavity was carefully inspected and closure of the dura was performed, followed by fixation of the osteotomy sites of the laminae at C3 and C4. The patient awoke with no new neurologic deficits and has had no evidence of lesion recurrence or symptoms in 3-year follow-up. The patient provided consent for publication.


Assuntos
Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Laminoplastia/métodos , Neoplasias da Medula Espinal/cirurgia , Adulto , Medula Cervical/cirurgia , Feminino , Humanos
7.
BMC Musculoskelet Disord ; 21(1): 75, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32024507

RESUMO

BACKGROUND: For patients with spinal canal stenosis in the upper cervical spine who undergo C3-7 laminoplasty alone, it remains impossible to achieve full decompression due to its limited range. This study explores the extension of expansive open-door laminoplasty (EODL) to C1 and C2 for the treatment of cervical spinal stenosis of the upper cervical spine and its effects on cervical sagittal parameters. METHODS: A retrospective analysis of 33 patients presenting with symptoms of cervical spondylosis myelopathy (CSM) and ossification in the posterior longitudinal ligament (OPLL) of the upper cervical spine from February 2013 to December 2015 was performed. Furthermore, the changes in the C0-2 Cobb angle, C1-2 Cobb angle, C2-7 Cobb angle, C2-7 SVA, and T1-Slope in lateral X-rays of the cervical spine were measured before, immediately after, and 1 year after the operation. JOA and NDI scores were used to evaluate spinal cord function. RESULTS: The C0-2 and C1-2 Cobb angles did not significantly increase (P = 0.190 and P = 0.081), but the C2-7 Cobb angle (P = 0.001), C2-7 SVA (P < 0.001), and T1-Slope (P < 0.001) significantly increased from preoperative to 1 year postoperative. In addition, C2-7 SVA was significantly correlated with the T1-Slope (Pearson = 0.376, P < 0.001) and C0-2 Cobb angle (Pearson = 0.287, P = 0.004), and the C2-7 SVA was negatively correlated with the C2-7 Cobb angle (Pearson = - 0.295, P < 0.001). The average preoperative and postoperative JOA scores were 8.3 ± 1.6 and 14.6 ± 1.4 points, respectively, indicating in a postoperative neurological improvement rate of approximately 91.6%. The average preoperative and final follow-up NDI scores were 12.62 ± 2.34 and 7.61 ± 1.23. CONCLUSIONS: The sagittal parameters of patients who underwent EODL extended to C1 and C2 included loss of cervical curvature, increased cervical anteversion and compensatory posterior extension of the upper cervical spine to maintain visual balance in the field of vision. However, the changes in cervical spine parameters were far less substantial than the alarm thresholds reported in previous studies. We believe that EODL extended to C1 and C2 for the treatment of patients with spinal canal stenosis in the upper cervical spine is a feasible and safe procedure with excellent outcomes.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Descompressão Cirúrgica/métodos , Laminoplastia/métodos , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Compressão da Medula Espinal/cirurgia , Espondilose/cirurgia , Idoso , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Laminoplastia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/complicações , Período Pós-Operatório , Radiografia , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Espondilose/complicações , Resultado do Tratamento
8.
World Neurosurg ; 137: e321-e327, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32018050

RESUMO

OBJECTIVE: To investigate the noninferiority of facet joint- and nuchal ligament-sparing laminectomy (FNL) compared with conventional open-door laminoplasty. METHODS: This retrospective study analyzed 31 patients who underwent FNL (7 women; median age, 71 years) and 29 patients who underwent laminoplasty (9 women; median age, 61 years) with cervical myelopathy due to degenerative cervical spine diseases. The surgical concept in laminectomy was to spare the facet joints and nuchal ligament, providing laminectomy with deviation to the side of dominant symptoms. In both groups, recovery rate of Japanese Orthopaedic Association (JOA) score, mean decompression ratio (decompressed width/distance between outermost edges of the lateral mass on computed tomography ×100) at decompressed laminas, and pre- and postoperative final cervical Cobb angle and cervical sagittal vertical axis were mainly examined. RESULTS: Clinical and radiologic median data with interquartile range for patients who underwent FNL and laminoplasty were as follows: postoperative follow-up, 783.0 days (535.0-1128.0 days) and 731.0 days (524.0-1213.5 days); preoperative JOA score (full score 17), 13.0 (9.5-15.0) and 13.0 (10.0-14.0); recovery rate of JOA score, 72.2% (33.3-100.0%) and 50.0% (31.0-75.0%); and mean decompression ratio, 41.9% (40.0-43.6%) and 51.6% (48.9-55.4%), respectively. The FNL group showed a comparable recovery rate of JOA score to the laminoplasty group, despite the significantly smaller mean decompression ratio (P < 0.001). Furthermore, no significant differences in pre- or postoperative median cervical Cobb angle or sagittal vertical axis were observed between groups. CONCLUSIONS: FNL was not inferior to conventional open-door laminoplasty in terms of clinical or radiologic outcomes, reducing the detachment of muscle from each lamina.


Assuntos
Laminectomia/métodos , Laminoplastia/métodos , Ligamentos Articulares/cirurgia , Articulação Zigapofisária/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Medula Espinal/cirurgia
9.
J Clin Neurosci ; 73: 140-143, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31987631

RESUMO

OBJECT: Cervical laminoplasty, which is well described in the Japanese literature, is the gold standard for decompressing multilevel spinal cord compression. Several spacers have been introduced to provide enough decompression of the spinal canal and reconstruct the stable posterior elements. The purpose of this study was to retrospectively evaluate radiological outcomes after open door laminoplasty using the titanium spacer (Laminoplasty Basket: L-Basket; Ammtec, Tokyo). METHODS: Between July 2014 and June 2016, 31 patients with cervical spondylotic disease, including OPLL, were underwent open door laminoplasty with this device. All patients were clinically assessed by JOA score. The average follow-up period was 48.9 months with a range of 37-60 months. Postoperative radiological evaluation revealed bone union on both the open side and the gutter side from 12 months to 36 months after surgery on computed tomography. RESULTS: The clinical outcome improved from 10.9 points on the Japanese Orthopaedic Association scale to 15.8 points at 3 months after surgery and there were no significant major complications such as the implant failure. The bone union rate of the gutter side was 85.9% (85/99) at 1 year, 96.0% (95/99) at 3 years after surgery and of the open side was 57.6% (57/99) at 1 year, 89.9% (89/99) at 3 years after surgery. Circumferential fusion was confirmed 85.9% (85/99) of the time. CONCLUSION: This titanium spacer seemed to have the potential of promoting bone union between the spacer and both lamina, and lateral mass in cervical laminoplasty which is a safe procedure with satisfactory clinical results.


Assuntos
Laminoplastia/instrumentação , Laminoplastia/métodos , Próteses e Implantes , Espondilose/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais , Descompressão Cirúrgica/instrumentação , Descompressão Cirúrgica/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Espondilose/complicações , Titânio , Resultado do Tratamento
10.
Spine (Phila Pa 1976) ; 45(11): 741-746, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31923132

RESUMO

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.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Laminoplastia/métodos , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Resultado do Tratamento
11.
World Neurosurg ; 135: 80-86, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31759152

RESUMO

BACKGROUND: Cervical laminoplasty is a motion-preserving procedure that addresses spinal cord compression and avoids postlaminectomy kyphosis associated with cervical laminectomy. The most common complications include C5 nerve palsy, axial neck pain, hinge nonunion, and premature closure. Plating is a relatively newer method of laminoplasty fixation that may provide greater stabilization postoperatively and reduce the risk of laminoplasty closure compared with less rigid (e.g., suture) fixation techniques. Although prior studies have reported low rates of laminar/lateral mass screw back out, plate breakage and migration have not been previously described in the literature. The purpose of this paper is to present a case of multilevel hinge nonunion, plate breakage, and plate fragment migration. Although rare, plate failure may result in a dural tear and spinal cord injury/compression. CASE DESCRIPTION: In this case, a 61-year-old man with a history of cervical spondylotic myelopathy treated with C3-7 laminoplasty 7 years prior presented to our hospital with severe headaches and electrical-type pain through the left upper and lower extremities. Imaging studies revealed several broken laminoplasty plates and intradural migration of a fragment of the C7 plate. CONCLUSIONS: We provide recommendations for preventing hinge nonunion because resultant micromotion likely contributed to the plate breakages observed in this patient.


Assuntos
Placas Ósseas , Vértebras Cervicais/cirurgia , Falha de Equipamento , Laminoplastia/métodos , Migração de Corpo Estranho , Humanos , Masculino , Pessoa de Meia-Idade , Espondilose/cirurgia
12.
J Clin Neurosci ; 71: 76-83, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31708404

RESUMO

Surgical decompression using laminoplasty is commonly performed for multilevel stenosis with cervical spondylotic myelopathy. However, the long-term effects on the craniocervical range of motion (ROM) after surgery are not well understood. This study represents the first entry into the literature of photogrammetric analysis for clinical measurement of craniocervical ROM. All patients underwent a French-door laminoplasty from 1995 to 2016 and were evaluated radiologically and with postoperative photographs (photogrammetric analysis) to measure craniocervical ROM and axial rotation. Radiographic parameters were occiput to C2 angle, C1-2 angle, C2-7 angle/cervical lordosis (CL), T1-slope (T1S), and TS-CL were measured. Chin-brow vertical angle (CBVA) was utilized for flexion and extension, while nose-turn angle (NTA) was used to assess axial rotation. Forty-four patients (mean age: 65.7 years, 50% female) had a mean follow-up of 37.9 months. Mean values in neutral, flexion, and extension were occiput to C2 = 30°, 15°, and 43°; C1-C2 = -32°, -25°, -32°; and C2-C7 = -4°, 11°, -20°, respectively. Mean CL was within 1 SD of the established -17° (±13.86°). Mean T1S and TS-CL were 33° and 30° in the neutral position, respectively. Mean radiographic full range of motion from flexion to extension was 53°. NTA towards patients' left was 48° and the right side was 45°. Mean CBVA, was -4°, mean flexion 37°, and extension -45°; full range was 81°. Global craniocervical ROM has proven to be well preserved for many years following cervical laminoplasty. Photogrammetric analysis is a cost-effective and radiation-free method, accurate for quantitative assessment of craniocervical and cervical ROM.


Assuntos
Vértebras Cervicais/cirurgia , Laminoplastia/métodos , Fotogrametria/métodos , Amplitude de Movimento Articular , Doenças da Medula Espinal/cirurgia , Idoso , Vértebras Cervicais/diagnóstico por imagem , Descompressão Cirúrgica/métodos , Feminino , Humanos , Lordose , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Rotação , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/fisiopatologia , Osteofitose Vertebral/cirurgia
13.
World Neurosurg ; 134: e581-e588, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31678439

RESUMO

OBJECTIVE: Upper extremity sensory disturbances are primary symptoms that affect the quality of life (QOL) of patients with cervical spondylotic myelopathy. Although laminoplasty is 1 of the surgical options, its effects on sensory disturbances have remained unclear. We aimed to determine whether surgical intervention would improve the sensory disturbances of patients with cervical spondylotic myelopathy. METHODS: We conducted a prospective clinical trial of 101 patients who had undergone open door laminoplasty. For an objective sensory assessment, we measured the current perception thresholds (CPTs) in the patients' forearms and palms using PainVision PS-2100. For a subjective sensory assessment, numbness in the upper extremities was rated using a visual analog scale (VAS). Using the VAS scores, the patients were divided into those with improvement and without improvement. Their self-reported 36-item short-form health survey and Japanese Orthopaedic Association cervical myelopathy evaluation questionnaire scores were compared. RESULTS: The postoperative CPTs in relationship to the preoperative CPTs at 3, 6, and 12 months was 99.3%, 98.1%, and 93.8% in the forearm and 93.6%, 90.6%, and 87.8% in the palm, respectively. The corresponding postoperative numbness VAS scores were 63.8%, 50.5%, and 48.0%. At 12 months postoperatively, the 36-item short-form health survey physical and role component summary scores, cervical spine function effectiveness rates, upper and lower extremity function, and QOL items in the Japanese Orthopaedic Association cervical myelopathy evaluation questionnaire were significantly higher in the improvement group. CONCLUSIONS: Our findings have indicated that improvement in postoperative subjective sensory disturbances will occur relatively earlier and will be significantly greater than the improvement in objective sensory disturbances. Furthermore, improvement in the subjective sensory disturbances contributes to functional spinal cord recovery and patients' health-related QOL.


Assuntos
Vértebras Cervicais/cirurgia , Laminoplastia , Transtornos das Sensações/cirurgia , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Idoso , Feminino , Humanos , Laminoplastia/métodos , Masculino , Transtornos das Sensações/etiologia , Transtornos das Sensações/fisiopatologia , Limiar Sensorial , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/fisiopatologia , Espondilose/complicações , Espondilose/fisiopatologia , Resultado do Tratamento , Extremidade Superior
14.
Asian J Surg ; 43(5): 613-624, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31481282

RESUMO

BACKGROUND/OBJECTIVE: The selection of surgical technique in patients with cervical spondylotic myelopathy relies on the surgeon(s) and patients' conditions. The objectives of the study were to test the hypotheses that French-door laminoplasty recovers faster than laminectomy and has good outcome measures. METHODS: Data regarding surgical, radiological, and clinical outcome measures of 330 patients with cervical spondylotic myelopathy operated under French-door laminoplasty (fdLP group, n = 110), open-door laminoplasty (odLP group, n = 110), or laminectomy (LC group, n = 110) were collected from the records of institute and analyzed. RESULTS: Patients of fdLP group (p < 0.0001, q = 11.65) and odLP group (p < 0.0001, q = 11.27) both had significantly improved modified Rankin scale score than those of LC group. In addition, patients of fdLP group had minimum blood loss during operations and that was maximum for patients of the LC group. Unlike patients of fdLP group (p < 0.0001, q = 80) and LC group (p < 0.0001, q =122), those of odLP group had lost more amount of cervical lordotic after surgery. Open-door laminoplasty had significantly reduced cervical range of motion than laminectomy (p < 0.0001, q = 15.45) and French-door laminoplasty (p < 0.0001, q = 13.45). After 12-months, fdLP group had higher bone union rate than odLP group (p = 0.007, q = 3.395) and LC group (p = 0.007, q = 4.243). French door laminoplasty had a better postoperative quality of life. CONCLUSIONS: Among the posterior decompression spine surgeries, French-door laminoplasty is superior surgical procedure than laminectomy and could be superior surgical technique than open-door laminoplasty.


Assuntos
Vértebras Cervicais/cirurgia , Laminectomia/métodos , Laminoplastia/métodos , Doenças da Medula Espinal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
15.
J Orthop Sci ; 25(1): 58-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30905611

RESUMO

BACKGROUND: The optimal surgical procedure for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) remains controversial because there are few comprehensive studies investigating the surgical methods. Therefore, we conducted a systematic review and meta-analysis to evaluate evidence in the literature and compare the surgical outcomes of anterior decompression with fusion (ADF) and laminoplasty (LAMP), which are representative procedures for cervical OPLL. METHODS: An extensive literature search was performed using PubMed, Embase, and the Cochrane Library to identify comparative studies of ADF and LAMP for cervical OPLL. The language was restricted to English, and the year of publication was from January 1980 to December 2018. We extracted outcomes from the studies, such as preoperative and postoperative Japanese Orthopaedic Association (JOA) score, cervical alignment, surgical complications and reoperation rate. Then, meta-analysis was performed for these surgical outcomes. RESULTS: Twelve studies were obtained, including 1 prospective cohort study and 11 retrospective cohort studies. In the meta-analysis, neurological recovery rate in JOA score was greater in ADF than in LAMP, especially in patients with a large canal occupying ratio (≥60%) and preoperative kyphotic alignment. ADF also exhibited more favorable results in postoperative cervical alignment. In contrast, operating time and intraoperative blood loss were greater in ADF. Surgical complications were more frequently seen in ADF, leading to higher rates of reoperation. CONCLUSIONS: This systematic review and meta-analysis showed both the merits and shortcomings of ADF and LAMP. ADF resulted in more favorable neurological recovery compared to LAMP, especially for patients with massive OPLL and kyphotic alignment. Postoperative cervical lordosis was also better preserved in ADF. However, ADF was associated with greater surgical invasion and higher incidences of surgical complications.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Laminoplastia/métodos , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Fusão Vertebral/métodos , Humanos
16.
Neurosurgery ; 86(6): 825-834, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31435653

RESUMO

BACKGROUND: In cervical open-door laminoplasty for cervical myelopathy, a high-speed rotatory drill and rongeurs are used to make unicortical troughs and bicortical openings in the laminae. The lamina is reflected at the trough to enlarge the spinal canal, followed by bone healing on the hinge side to stabilize laminoplasty. The ultrasonic bone scalpel (UBS) has been used due to theoretical advantages including a better hinge union rate, less soft tissue trauma, less neurological injury, and shorter operative time. OBJECTIVE: To assess the superiority of UBS for hinge union compared to the drill through randomized controlled trial. METHODS: In 190 randomly allocated cervical myelopathy patients, the trough and opening at the lamina were made using either the drill (n = 95) or UBS (n = 95) during 2015 to 2018. The primary outcome was the hinge union rate on 6-mo postoperative computed tomography. Secondary outcomes included the hinge union rate at 12 mo, the operative time, intraoperative/postoperative bleeding, neurological injury, complications, and clinical outcomes over a 24-mo follow-up. RESULTS: Hinge union in all laminae was achieved in 60.0% (drill) and 43.9% (UBS) of patients at 6 mo (intention-to-treat analysis; P = .02; odds ratio, 2.1) and in 91.9% (drill) and 86.5% (UBS) at 12 mo. Dural injury only occurred in the drill group (2.1%), and the UBS group showed significantly less intraoperative bleeding (P < .01). The other secondary outcomes did not differ between groups. CONCLUSION: The hinge union rate was inferior in the UBS group at 6 mo postoperatively, but UBS was efficacious in reducing dural injuries and bleeding.


Assuntos
Vértebras Cervicais/cirurgia , Laminoplastia/métodos , Doenças da Medula Espinal/cirurgia , Terapia por Ultrassom/métodos , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Laminoplastia/instrumentação , Laminoplastia/tendências , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Terapia por Ultrassom/instrumentação
17.
Spine (Phila Pa 1976) ; 44(24): 1697-1704, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31794507

RESUMO

MINI: The surgical results of modified and traditional open-door laminoplasties were retrospectively compared. There were no differences in neurological outcomes and postoperative complications. However, compared with traditional laminoplasty, modified laminoplasty was associated with better maintenance of cervical curvature and ROM, as well as a lower incidence of postoperative axial symptoms. STUDY DESIGN: A retrospective comparative study. OBJECTIVE: The aim of this study was to evaluate the efficacy of modified unilateral open-door laminoplasty with posterior muscle-ligament complex preservation in treating cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA: The prevalence of axial symptoms after open-door laminoplasty ranges from 5% to 86%. Current modified laminoplasty techniques cannot satisfactorily reduce postoperative axial symptoms. METHODS: From June 2014 to July 2016, 36 patients with CSM underwent modified laminoplasty with posterior muscle-ligament complex preservation (modified group) and 27 patients underwent traditional laminoplasty (control group). The demographics, operation duration, blood loss volume, cervical curvature, cervical curvature index (CCI), range of motion (ROM), cervical posterior muscle volume on magnetic resonance imaging (MRI), axial symptoms, visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score, neck disability index (NDI), and complications were recorded and analyzed before operation, after operation, and at the final follow-up. RESULTS: Cervical flexion curvature, cervical curvature, ROM, and CCI were better in the modified group than in controls at the final follow-up (P < 0.01). Postoperative VAS and NDI scores were significantly reduced in the modified group compared with controls (1.15 ±â€Š0.76 vs. 2.63 ±â€Š1.06, 5.67 ±â€Š2.57 vs. 8.89 ±â€Š5.37, respectively) (P < 0.01). Posterior muscle volume at the hinge side in the modified group was not different at final follow-up relative to that before the operation, whereas it was reduced in controls (P < 0.01). Finally, the incidence of axial symptoms was significantly lower in the modified group than in controls (6% vs. 22%) (P = 0.03). CONCLUSION: Modified unilateral open-door laminoplasty with posterior muscle-ligament complex preservation is effective for treating CSM with good recovery of neurological functions and satisfactory maintenance of cervical curvature and ROM. Furthermore, it reduces the incidence of postoperative axial symptoms compared with conventional open-door laminoplasty. LEVEL OF EVIDENCE: 3.


Assuntos
Músculos do Dorso , Laminoplastia/métodos , Ligamentos , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Adulto , Idoso , Músculos do Dorso/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pescoço , Tratamentos com Preservação do Órgão , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Amplitude de Movimento Articular , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/fisiopatologia , Espondilose/complicações , Espondilose/diagnóstico por imagem , Espondilose/fisiopatologia , Resultado do Tratamento
18.
J Orthop Surg Res ; 14(1): 401, 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31779644

RESUMO

OBJECTIVE: Posterior open-door laminoplasty (PODL) is a common procedure for treating multilevel cervical spondylotic myelopathy (MCSM). Little information is available regarding the cervical sagittal balance and surgical efficacy of PODL when securing with different methods. Therefore, this study aims to investigate the clinical outcomes and the changes in cervical sagittal parameters and balance associated with PODL secured with titanium miniplates vs anchors. METHOD: A retrospective analysis was performed on the clinical data of 79 patients with MCSM who were treated in our institution from January 2015 to December 2016. Among them, 42 patients were treated by PODL secured with titanium miniplates (group A) and 37 patients by PODL secured with anchors (group B). Surgical time, intraoperative blood loss, hospital stay, hospitalized cost, VAS scores of neck pain, JOA scores, neck disability index (NDI), and improvement rate of spinal neurological function (IRNF) were recorded before surgery and at 12 months after surgery. Before surgery, at 1 month and 2 years after surgery, the following radiological parameters were recorded and compared on the lateral cervical X-ray images: the distance from the vertical axis of C2 sagittal plane to the posterior superior edge of C7 (C2-7 SVA), the inclusion angle of tangent between C2 and C7 trailing edge (C2-7 Cobb angle), and the intersection angle between the upper edge of T1 and the horizontal line (T1 Slope). RESULT: Comparing the two groups, there were no significant differences in surgical time, intraoperative blood loss, hospital stay, VAS, JOA, and NDI scores before surgery (P > 0.05); however, the hospitalized cost of group A were much higher than those of the group B (P < 0.05). At 2 years after surgery in the two groups, there was a significant reduction in VAS and NDI scores (P < 0.05), and JOA scores increased significantly (P < 0.05). In addition, there were no significant differences in VAS, JOA and IRNF between the two groups (P > 0.05); however, NDI scores of group A were better than those of group B (P < 0.05). In radiological parameters, before surgery, the two groups showed no significant differences in C2-7 SVA, C2-7 Cobb angle, and T1 slope (P > 0.05); however, after surgery, C2-7 SVA and T1 slope increased (P < 0.05), while C2-7 Cobb angle decreased (P < 0.05). At 2 years after surgery, the two groups did not differ significantly in C2-7 Cobb angle and T1 slope (P > 0.05), while C2-7 SVA of group A was superior to that of group B (P < 0.05). The difference value of C2-7 SVA measured before and after surgery was correlated negatively with that of NDI scores (P < 0.05). CONCLUSION: PODL secured with titanium miniplates or anchors achieved good clinical efficacy in the treatment of MCSM. However, the patients with miniplates feel a better cervical functional status, while those with anchors spend less on hospitalization. Both methods lead to anteversion of cervical spine, but cervical sagittal balance after miniplates is better than that of anchors.


Assuntos
Placas Ósseas , Vértebras Cervicais/cirurgia , Laminoplastia/métodos , Espondilose/cirurgia , Idoso , Prótese Ancorada no Osso , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Espondilose/diagnóstico por imagem , Resultado do Tratamento
19.
Medicine (Baltimore) ; 98(38): e16655, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567931

RESUMO

In this study, we first reported of a modified hybrid fixation method in expansive open-door laminoplasty (EOLP) in order to reduce medical costs. The purpose of the present study is to compare the surgical outcomes and cost-effectiveness of the modified fixation with all levels miniplate fixation in EOLP for multilevel cervical spondylotic myelopathy.Data of 67 patients who underwent EOLP from July 2015 to June 2016 were retrospectively analyzed, with 33 in the modified group and 34 in the all miniplate group based on their surgical approaches. Laminae were kept open with alternate levels miniplate and anchor fixation in the modified group, while with all levels miniplate fixation in the all miniplate group. Medical costs and clinical results including Japanese Orthopedic Association (JOA) scores, Visual Analogue Scale (VAS) scores and occurrences of complications were investigated and compared between the 2 groups. After evaluation on X-ray, CT, and MRI, radiographic data reflecting cervical alignments, spinal canal enlargement and spinal cord decompression were collected and compared within each group and between the 2 groups.After a follow-up period of about 18 months, no significant differences in operation time, intraoperative blood loss, complication rates, VAS scores, neurological recovery rates and postoperative hospital stays were observed between the 2 groups. However, EOLP with the modified fixation costed less. When comparing the 2 groups, cervical curvature index (CCIs) which reflected cervical alignments and anteroposterior diameters (APDs) reflecting spinal canal enlargement at all the follow-ups had no significant differences. Postoperative open angles which reflected spinal cord decompression of C4 and C6 were significantly smaller in the modified group. However, that difference was no longer detected at the final follow-up. Within each group, APDs increased significantly after surgery. However, no significant differences in CCIs and open angles at different follow-ups were observed in each group.Compared with all miniplate fixation, the modified hybrid fixation in EOLP showed almost the same clinical and radiographic results. However, the modified hybrid fixation method could reduce costs.


Assuntos
Placas Ósseas , Vértebras Cervicais/cirurgia , Laminoplastia/métodos , Espondilose/cirurgia , Adulto , Idoso , Desenho de Equipamento , Feminino , Humanos , Laminoplastia/economia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espondilose/diagnóstico por imagem , Resultado do Tratamento , Escala Visual Analógica
20.
Clin Spine Surg ; 32(9): 351-356, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31577615

RESUMO

STUDY DESIGN: Prospective observational single-center study. OBJECTIVE: To evaluate anterior decompression and fusion (ADF) or posterior surgery (PS) for patients with cervical spondylotic myelopathy (CSM) using the modified K-line (mK-line) and to compare clinical and radiologic outcomes between these 2 techniques. SUMMARY OF BACKGROUND DATA: The authors have previously reported that insufficient posterior decompression is often seen after laminoplasty for CSM in patients with preoperative anterior clearance of the spinal cord <4 mm on the basis of the mK-line. However, to our knowledge, no study has investigated the role, if any, of the mK-line in surgical decision making for patients with CSM. METHODS: A total of 87 patients were enrolled who underwent surgery for treatment of CSM between 2011 and 2015 at our hospital and who could be followed up for at least 2 years. ADF was selected as a more favorable procedure than PS in patients with anterior spinal clearance of <4 mm on preoperative midsagittal magnetic resonance imaging. On the basis of the Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy, the rate of recovery of the JOA scores at 2 years after surgery was investigated as a clinical outcome to compare these 2 groups. RESULTS: Mean age was 65.1 (±12.9) years in the ADF group (n=26) and 70.5 (±8.6) years in the PS group (n=61). In the PS group, 10 patients underwent posterior decompression with fusion. Mean preoperative and postoperative JOA scores were 10.5 and 14.1 points in the ADF group and 9.8 and 13.1 points in the PS group, respectively, showing no significant difference in recovery rate of JOA score between the ADF (58.9%) and PS (47.1%) groups. However, patients with a minimum interval between the mK-line and the anterior compression factor on the midsagittal image (minimum interval of the spinal cord) <4 mm tended to have unsatisfactory outcomes (recovery rate 29.6%) compared with patients with minimum interval of the spinal cord >4 mm (53.6%, P=0.07) in the PS group. CONCLUSION: Preoperative intervention using the mK-line is useful to predict residual cord compression and might homogenize postoperative clinical outcomes in both anterior surgery and PS.


Assuntos
Vértebras Cervicais/cirurgia , Tomada de Decisão Clínica , Descompressão Cirúrgica/métodos , Fusão Vertebral/métodos , Espondilose/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Laminoplastia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
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