Laminoplasty with adjunct anterior short segment fusion for multilevel cervical myelopathy associated with local kyphosis.
BACKGROUND
When treating patients who have multilevel cervical spondylotic myelopathy (MCSM) with short-segment kyphosis, instability, or major anterior foci, long-level anterior decompression with fusion is often a standard method but can cause obvious loss of range of motion and usually needs further posterior stabilization. For MCSM with correctable kyphosis or simple instability, laminectomy with lateral-mass instrumented fusion is also a treatment of choice, but all the involved segments are immobilized. Combining expansive open-door laminoplasty (EOLP) and anterior short-segment fusion may be an alternative treatment to save more motion segments.


METHODS
This study included 109 patients who exhibited MCSM with combined local kyphosis, instability, and anterior pathology, and received EOLP and concomitant anterior short-segment fusion. The patients were enrolled from August 2005 to July 2012. Nurick scores and Japanese Orthopedics Association cervical myelopathy scores were used to evaluate the functional outcomes. Follow-up plain films were collected and magnetic resonance imaging was conducted to assess the radiographic outcomes.


RESULTS
One year after the operation, the Japanese Orthopedics Association recovery rate was 83.4 ± 16.6%. The improvement in the functional scores and decrease in neck pain were significant. The canal width improved without further collapse at 12 months. The preservation of range of motion was approximately 57% at 1 year.


CONCLUSIONS
EOLP with adjunct anterior short-segment decompression fusion yields an excellent outcome for MCSM patients who exhibit concomitant short-segment kyphosis, instability or major anterior pathology. Performing laminoplasty first is safer for the spinal cord due to its posterior shifting while anterior procedures are being done.
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, ROC; Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, ROC.
Kuang-Ting
KT
Yeh
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, ROC.
Ru-Ping
RP
Lee
Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, ROC; School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC.
Ing-Ho
IH
Chen
Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, ROC; School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC.
Tzai-Chiu
TC
Yu
Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, ROC.
Cheng-Huan
CH
Peng
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, ROC; Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, ROC.
Kuan-Lin
KL
Liu
Department of Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, ROC.
Jen-Hung
JH
Wang
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, ROC; Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, ROC; School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC. Electronic address: wentien2003@yahoo.com.tw.
Wen-Tien
WT
Wu
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D065406:Laminoplasty / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D013123:Spinal Fusion / Q000379:methods*
anterior cervical decompression fusion; expansive open-door laminoplasty; major anterior pathology; multilevel cervical spondylotic myelopathy