Retrospective cohort study between selective and standard C3-7 laminoplasty. Minimum 2-year follow-up study.
A total of 64 patients with cervical spondylotic myelopathy (CSM) were assessed in this study. Forty-two patients underwent selective expansive open-door laminoplasty (ELAP). Twenty-two patients who underwent conventional C3-7 ELAP served as controls. There were no significant differences in recovery rate of JOA scores, C2-C7 angle or cervical range of motion between two groups. Incidence of axial symptoms and segmental motor paralysis in selective ELAP was significantly lower than those in the C3-7 ELAP. Size of anterior compression mass, postoperative spinal cord positions and decompression conditions were evaluated using preoperative or postoperative MRI in 50 of 64 patients. There was a positive correlation between number of expanded laminae and maximum anterior spaces of spinal cord. Incomplete decompression was developed in three of 37 patients in selective ELAP and in two of 13 patients in C3-7ELAP. Mean size of anterior compression mass at incomplete decompression levels was significantly greater than that at complete decompression levels. Since, there was less posterior movement of the spinal cord in selective ELAP than that in C3-7ELAP, minute concerns about size of anterior compression mass is necessary to decide the number of expanded laminae. Overall, selective ELAP was less invasive and useful in reducing axial symptoms and segmental motor paralysis. This new surgical strategy was effective in improving the surgical outcomes of CSM, and short-term results were satisfactory.
Tsuji
Takashi
T
Department of Orthopaedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan. tsujit@sc.itc.keio.sc.jp
Asazuma
Takashi
T
Masuoka
Kazunori
K
Yasuoka
Hiroki
H
Motosuneya
Takao
T
Sakai
Tsubasa
T
Nemoto
Koichi
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology / Q000601:surgery; D013117:Spinal Cord Compression / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D013128:Spinal Osteophytosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome