Preservation of C7 spinous process does not influence the long-term outcome after laminoplasty for cervical spondylotic myelopathy

K. Higashino1, S. Katoh1, K. Sairyo1, T. Sakai1, H. Kosaka1, N. Yasui1
1Department of Orthopedics, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan

Tóm tắt

Axial pain is one of the major complications after laminoplasty, and preservation of C7 spinous process during the procedure can reduce the axial pain. However, it has not been elucidated whether laminoplasty preserving the C7 spinous process can maintain neurological improvement for a long time. The purpose of our retrospective study was to investigate the long-term neurological outcome after open-door laminoplasty preserving the C7 spinous process for cervical spondylotic myelopathy (CSM). Clinical and radiological outcomes were analysed in 42 patients who underwent open-door laminoplasty preserving C7 spinous process and followed up for more than 5 years. Neurological function was evaluated by means of the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. Axial pain was assessed using a visual analog scale (VAS) at the last examination. Alignment and motion of the cervical spine were measured from radiographs, and magnetic resonance imaging (MRI) was used to evaluate postoperative compression at C7. The mean JOA score was 9.4 before surgery and 12.0 at the latest follow-up. The mean VAS score in 26 patients score was 9.7/100. No compression of the spinal cord was observed in any MRI at the latest follow-up. Preservation of the C7 spinous process does not influence the long-term outcome of CSM after laminoplasty. Although we did not have a comparative group, the procedure described here should be considered as the solution.

Từ khóa


Tài liệu tham khảo

Wada E et al (2001) Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy: a long-term follow-up study over 10 years. Spine 26:1443–1447, discussion 1448

Wang MY, Green BA (2004) Open-door cervical expansile laminoplasty. Neurosurgery 54:119–123, discussion 123–124

Hosono N, Yonenobu K, Ono K (1996) Neck and shoulder pain after laminoplasty. A noticeable complication. Spine 21:1969–1973

Kawaguchi Y, Matsui H, Ishihara H, Gejo R, Yoshino O (1999) Axial symptoms after en bloc cervical laminoplasty. J Spinal Disord 12:392–395

Yoshida M et al (2002) Does reconstruction of posterior ligamentous complex with extensor musculature decrease axial symptoms after cervical laminoplasty? Spine 27:1414–1418

Katoh S, Ikata T, Hirai N, Okada Y, Nakauchi K (1995) Influence of minor trauma to the neck on the neurological outcome in patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. Paraplegia 33:330–333

Okada Y, Ikata T, Katoh S, Yamada H (1994) Morphologic analysis of the cervical spinal cord, dural tube, and spinal canal by magnetic resonance imaging in normal adults and patients with cervical spondylotic myelopathy. Spine 19:2331–2335

Wang MY, Shah S, Green BA (2004) Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy. Surg Neurol 62:487–492

Fukui K, Kataoka O, Sho T, Sumi M (1990) Pathomechanism, pathogenesis, and results of treatment in cervical spondylotic myelopathy caused by dynamic canal stenosis. Spine 15:1148–1152

Suda K et al (2003) Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy. Spine 28:1258–1262

Kawakami M, Tamaki T, Ando M, Yamada H, Yoshida M (2002) Relationships between sagittal alignment of the cervical spine and morphology of the spinal cord and clinical outcomes in patients with cervical spondylotic myelopathy treated with expansive laminoplasty. J Spinal Disord Tech 15:391–397