Selective laminoplasty after the preoperative diagnosis of the responsible level using spinal cord evoked potentials in elderly patients with cervical spondylotic myelopathy: a preliminary report.
METHODS
A preliminary report of a new operative method termed selective laminoplasty after the preoperative diagnosis of the responsible level using spinal cord evoked potentials (SCEPs) in elderly patients with cervical spondylotic myelopathy.


OBJECTIVE
To introduce the method and clinical results for selective laminoplasty.


BACKGROUND
Clinical results for conventional laminoplasty and anterior decompression and fusion guided by SCEPs have been reported. However, there have been no reports that consider SCEP results for selecting the optimal level in lamioplasty for cervical spondylotic myelopathy.


METHODS
Seven elderly patients who underwent selective laminoplasty were followed for a minimum of 12 months. The T2-high-intensity area on magnetic resonance imaging, the responsible level detected by SCEPs, and the laminoplasty level were recorded. The operative time, intraoperative bleeding, clinical results including the Japanese Orthopaedic Association score, recovery rate, Nurick grading scale, and visual analog scale of axial pain were investigated preoperatively and postoperatively.


RESULTS
The responsible intervertebral levels were at C3-C4 in 3 patients and at C4-C5 in 4 patients. These were identical for SCEP recorded after median nerve stimulation and transcranial electric stimulation. High-intensity area on T2-weighted magnetic resonance imaging was seen in 6 patients (3 at C3-C4 and 3 at C4-C5). The average operative time was 106 minutes and the average amount of bleeding was 20 mL. Neurologic recovery was achieved in all patients except 1 who had severe myelopathy. Visual analog scales of axial pain were 41.3 + or - 33.9 before surgery and 18.0 + or - 19.4 at final follow-up. The Japanese Orthopaedic Association score and the Nurick grade improved in 6 patients but did not change in 1 patient.


CONCLUSIONS
Preliminary clinical results for selective laminoplasty were satisfactory in all but 1 case. Although long-term results are not yet available, we consider this method to be less invasive and capable of giving satisfactory clinical results and benefits for elderly patients.
Kato
Yoshihiko
Y
Department of Orthopedic Surgery Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, Japan. kato-yo@yamaguchi-uac.jp
Kojima
Takanori
T
Kataoka
Hideo
H
Imajo
Yasuaki
Y
Yara
Takahiro
T
Yoshida
Yuichiro
Y
Imagama
Takashi
T
Taguchi
Toshihiko
T
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D019299:Decompression, Surgical; D004558:Electric Stimulation / Q000379:methods; D004568:Electrodiagnosis / Q000379:methods*; D004594:Electrophysiology / Q000379:methods; D005071:Evoked Potentials / Q000502:physiology*; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008475:Median Nerve / Q000502:physiology; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D055009:Spondylosis / Q000150:complications / Q000601:surgery*; D054854:Vertebroplasty / Q000379:methods