title: Laminoplasty and laminectomy hybrid decompression for the treatment of cervical spondylotic myelopathy with hypertrophic ligamentum flavum: a retrospective study.
abstract: OBJECTIVE
  To report the outcomes of a posterior hybrid decompression protocol for the treatment of cervical spondylotic myelopathy (CSM) associated with hypertrophic ligamentum flavum (HLF).
  
  
  BACKGROUND
  Laminoplasty is widely used in patients with CSM; however, for CSM patients with HLF, traditional laminoplasty does not include resection of a pathological ligamentum flavum.
  
  
  METHODS
  This study retrospectively reviewed 116 CSM patients with HLF who underwent hybrid decompression with a minimum of 12 months of follow-up. The procedure consisted of reconstruction of the C4 and C6 laminae using CENTERPIECE plates with spinous process autografts, and resection of the C3, C5, and C7 laminae. Surgical outcomes were assessed using Japanese Orthopedic Association (JOA) score, recovery rate, cervical lordotic angle, cervical range of motion, spinal canal sagittal diameter, bone healing rates on both the hinge and open sides, dural sac expansion at the level of maximum compression, drift-back distance of the spinal cord, and postoperative neck pain assessed by visual analog scale.
  
  
  RESULTS
  No hardware failure or restenosis was noted. Postoperative JOA score improved significantly, with a mean recovery rate of 65.3 ± 15.5%. Mean cervical lordotic angle had decreased 4.9 degrees by 1 year after surgery (P<0.05). Preservation of cervical range of motion was satisfactory postoperatively. Bone healing rates 6 months after surgery were 100% on the hinge side and 92.2% on the open side. Satisfactory decompression was demonstrated by a significantly increased sagittal canal diameter and cross-sectional area of the dural sac together with a significant drift-back distance of the spinal cord. The dural sac was also adequately expanded at the time of the final follow-up visit.
  
  
  CONCLUSIONS
  Hybrid laminectomy and autograft laminoplasty decompression using Centerpiece plates may facilitate bone healing and produce a comparatively satisfactory prognosis for CSM patients with HLF.
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China.
authors.forename: Huairong
authors.initials: H
authors.lastname: Ding
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Xue
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China.
authors.forename: Yanming
authors.initials: Y
authors.lastname: Tang
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China.
authors.forename: Dong
authors.initials: D
authors.lastname: He
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China.
authors.forename: Zhiyang
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China.
authors.forename: Yaqi
authors.initials: Y
authors.lastname: Zong
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China.
authors.forename: Pei
authors.initials: P
authors.lastname: Wang
mesh_terms: D000368:Aged; D001860:Bone Plates; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D007796:Laminectomy / Q000379:methods*; D065406:Laminoplasty / Q000379:methods*; D017843:Ligamentum Flavum / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000517:prevention & control; D011379:Prognosis; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D013115:Spinal Canal / Q000473:pathology / Q000601:surgery; D013117:Spinal Cord Compression / Q000473:pathology / Q000601:surgery; D055009:Spondylosis / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
references.citation: Spine (Phila Pa 1976). 2011 Mar 1;36(5):399-403
references.pmid: 20890264
references.citation: Orthopedics. 2012 Feb 17;35(2):e225-31
references.pmid: 22310411
references.citation: Evid Based Spine Care J. 2010 Dec;1(3):27-33
references.pmid: 22956925
references.citation: J Clin Neurosci. 2012 Jun;19(6):804-9
references.pmid: 22475766
references.citation: Neurol India. 2012 Mar-Apr;60(2):210-6
references.pmid: 22626706
references.citation: Orthopedics. 2012 Apr;35(4):e543-8
references.pmid: 22495857
references.citation: J Neurosurg Spine. 2009 Aug;11(2):130-41
references.pmid: 19769492
references.citation: Eur Spine J. 2007 Dec;16(12):2072-7
references.pmid: 17726618
references.citation: Spine (Phila Pa 1976). 1985 Oct;10(8):729-36
references.pmid: 3909451
references.citation: Orthop Clin North Am. 2002 Apr;33(2):329-48
references.pmid: 12389279
references.citation: Hand Clin. 2013 Nov;29(4):473-81
references.pmid: 24209946
references.citation: Spine J. 2001 Jan-Feb;1(1):26-30
references.pmid: 14588365
references.citation: Spine (Phila Pa 1976). 1994 Mar 1;19(5):507-10
references.pmid: 8184342
references.citation: Spine (Phila Pa 1976). 1999 Aug 1;24(15):1527-31; discussion 1531-2
references.pmid: 10457571
references.citation: Neurosurgery. 1998 Jul;43(1):43-9; discussion 49-50
references.pmid: 9657187
references.citation: J Spinal Disord Tech. 2004 Aug;17(4):317-20
references.pmid: 15280762
references.citation: Spinal Cord. 1999 Jan;37(1):20-4
references.pmid: 10025690
references.citation: Neurol Clin. 2013 Feb;31(1):287-305
references.pmid: 23186905
references.citation: Spine (Phila Pa 1976). 1996 Feb 15;21(4):474-83; discussion 484
references.pmid: 8658252
references.citation: Acta Orthop. 2008 Feb;79(1):62-6
references.pmid: 18283574
references.citation: Spine J. 2006 Nov-Dec;6(6 Suppl):274S-281S
references.pmid: 17097547
references.citation: Spine (Phila Pa 1976). 2011 Jan 1;36(1):9-14
references.pmid: 21192219
references.citation: Spine (Phila Pa 1976). 1981 Jul-Aug;6(4):354-64
references.pmid: 6792717
references.citation: Neurol India. 2012 Mar-Apr;60(2):201-9
references.pmid: 22626705
references.citation: Indian J Orthop. 2009 Jul;43(3):305-8
references.pmid: 19838355
references.citation: Clin Orthop Relat Res. 2003 Jun;(411):129-39
references.pmid: 12782868
references.citation: Neurosurgery. 2002 Jan;50(1):97-101; discussion 101-2
references.pmid: 11844239
references.citation: No Shinkei Geka. 1999 Jun;27(6):525-31
references.pmid: 10396735
references.citation: J Clin Neurosci. 2009 Mar;16(3):404-9
references.pmid: 19153044
references.citation: Spine (Phila Pa 1976). 1998 Dec 15;23(24):2730-7
references.pmid: 9879098
references.citation: Eur Spine J. 2011 Feb;20(2):185-94
references.pmid: 20941514
references.citation: Neurosurgery. 2007 Jan;60(1 Supp1 1):S149-53
references.pmid: 17204877
references.citation: J Spinal Disord Tech. 2007 Oct;20(7):492-8
references.pmid: 17912125
references.citation: Spine (Phila Pa 1976). 2002 Jul 1;27(13):1414-8
references.pmid: 12131738
references.citation: Spine (Phila Pa 1976). 2003 Nov 1;28(21):2447-51
references.pmid: 14595162
references.citation: Conn Med. 1996 Jul;60(7):395-8
references.pmid: 8758657
references.citation: J Neurosurg Spine. 2008 Dec;9(6):530-7
references.pmid: 19035744
references.citation: J Neurosurg. 2003 Apr;98(3 Suppl):230-8
references.pmid: 12691377
references.citation: Neurologist. 2010 May;16(3):176-87
references.pmid: 20445427
references.citation: Asian Spine J. 2008 Dec;2(2):114-26
references.pmid: 20404967
references.citation: J Spinal Disord Tech. 2004 Aug;17(4):265-71
references.pmid: 15280753
references.citation: Neurol Res. 2009 Dec;31(10):1097-101
references.pmid: 19215639
references.citation: Spine J. 2002 Mar-Apr;2(2):108-15
references.pmid: 14588269
references.citation: Spine (Phila Pa 1976). 1983 Oct;8(7):693-9
references.pmid: 6420895
references.citation: Spine (Phila Pa 1976). 2007 Aug 15;32(18):1980-5
references.pmid: 17700444