title: Enlarged laminectomy and lateral mass screw fixation for multilevel cervical degenerative myelopathy associated with kyphosis.
abstract: BACKGROUND
  Either an anterior approach or a posterior approach, which aims to decompress the spinal cord and restore the sagittal alignment, has been adopted to treat multilevel cervical degenerative myelopathy (CDM) associated with kyphosis. However, there is controversy on the optimal surgical strategy for the treatment of multilevel CDM with kyphotic deformity because of the complications of each surgical approach.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the surgical efficacy of enlarged laminectomy (removing the inside edge of facet joints and decompressing the nerve foramina) and lateral mass screw fixation for the treatment of multilevel CDM associated with kyphosis.
  
  
  METHODS
  A retrospective radiographic and clinical study to access the efficacy of enlarged laminectomy with lateral mass screw fixation in the treatment of multilevel CDM related to kyphosis.
  
  
  METHODS
  A total of 43 patients (28 men and 15 women; average age, 59.6 years) with multilevel CDM correlated to kyphosis were obtained in the study.
  
  
  METHODS
  All radiological data were recorded on computer-based measurement from preoperative or postoperative X-ray, magnetic resonance imaging (MRI), and computed tomography. All neurological parameters were accessed in each patient.
  
  
  METHODS
  Analysis consisted of: Japanese Orthopedic Association (JOA) score, recovery rate, curvature index (CI), the expansion degree and drift-back distance of the spinal cord, axial symptom severity, and C5 root palsy. The recovery rate based on the JOA score was calculated for each patient. Cervical CI as well as the expansion degree and drift-back distance of the spinal cord was measured using MRI. Axial symptom severity was quantified by a visual analog scale (VAS). Statistical analysis was performed using paired t test with significance set at p<.05.
  
  
  RESULTS
  Enlarged laminectomy was performed over a mean of 3.97 levels (range, 3-5 levels). Follow-up information was obtained at a mean of 2.8 years (range, 1.5-5 years) after surgery. Analysis of the final follow-up data showed significant differences before and after surgery in the JOA score (t=24.17, p<.001), CI improvement (t=21.89, p<.001), the anteroposterior diameter at the level of maximum compression of the spinal cord (t=9.54, p<.001), and VAS score (t=13.30, p<.001). The mean spinal cord posterior shift was 4.72±1.10 mm (range, 0-6.71 mm). X-rays confirmed that bone grafts were completely fused at a mean of 3 months after surgery. During the follow-up period, only two patients (4.7%) did not obtain complete recovery, four patients (9.3%) experienced axial symptoms; there were no C5 root palsy and instrument failures noted in this series.
  
  
  CONCLUSIONS
  Enlarged laminectomy with fixation for the management of multilevel CDM is demonstrated to be an effective strategy for improving neurological function, restoring the normal cervical lordosis, and decreasing the incidence of axial symptoms and C5 root palsy, but there is a need for randomized controlled studies with long-term follow-up to confirm and clarify these results.
authors: Department of Spine Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Rd, Shijiazhuang 050051, China.
authors: Wei
authors: W
authors: Du
authors: Department of Spine Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Rd, Shijiazhuang 050051, China.
authors: Peng
authors: P
authors: Zhang
authors: Department of Spine Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Rd, Shijiazhuang 050051, China. Electronic address: shenyongspine@163.com.
authors: Yong
authors: Y
authors: Shen
authors: Department of Spine Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Rd, Shijiazhuang 050051, China.
authors: Ying-ze
authors: YZ
authors: Zhang
authors: Department of Spine Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Rd, Shijiazhuang 050051, China.
authors: Wen-yuan
authors: WY
authors: Ding
authors: Department of Orthopaedic Surgery, Beijing Chuiyangliu Hospital, No.2, Chuiyangliu South St. Chaoyang District, Beijing 100022, China.
authors: Long-xi
authors: LX
authors: Ren
mesh_terms: D000328:Adult; D000368:Aged; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000150:complications / Q000601:surgery*; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000150:complications / Q000601:surgery*; D013118:Spinal Cord Diseases / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cervical degenerative myelopathy; Enlarged laminectomy; Kyphotic deformity; Lateral mass screw fixation