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Extensive laminectomy for multilevel cervical stenosis with ligamentum flavum hypertrophy: more than 10 years follow-up

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Abstract

Purpose

The aim of this research was to evaluate the long-term results of extensive laminectomy for the treatment of cervical spondylotic myelopathy due to multilevel cervical stenosis (MCS) with ligamentum flavum hypertrophy (LFH).

Methods

From January 2000 to December 2002, a total of 91 patients who underwent extensive laminectomy for MCS with LFH were included in this study to investigate the long-term outcome of this surgical option. All patients were presenting moderate-to-severe preoperative cervical myelopathy. The patients with cervical lordosis, without cervical kyphosis and instability, were included in our study through preoperative radiological examination. Clinical outcomes were evaluated by the Japanese Orthopedic Association (JOA) scoring system and by recovery rate (RR). The changes in curvature of cervical spine were determined by cervical curvature index (CCI). Range of motion (ROM) of the cervical spine was assessed by measuring the C2–7 Cobb angle on flexion and extension. The anteroposterior diameters and the drift-back distance of the spinal cord were calculated using the MRI image. The axial pain was measured by a visual analogue scale (VAS). Statistical analysis was performed using paired t test with significance set at P < 0.05.

Results

Ninety-one (83 %) of the 109 patients completed the follow-up in this study. The mean duration of follow-up was 12.1 years. The preoperative JOA scores in these patients averaged 6.8, and the postoperative scores at the final follow-up averaged 14.5 (average RR 68.4 %). The CCI decreased significantly from 20.8 ± 2.1 preoperatively to 11.5 ± 1.8 at last follow-up (t = 15.31, P < 0.01). The cervical ROM at C2–7 decreased from 42.7° before surgery to 20.4° at the final follow-up (t = 21.16, P < 0.01). The increased anteroposterior diameters at the level of maximum compression together with the significant drift-back distance of the spinal cord suggested that decompression was complete. The postoperative VAS score suggested that the axial pain was mild (1.4 ± 0.8).

Conclusions

A series of clinical results were obtained after the extensive laminectomy for a long-term follow-up period exceeding 10 years. The extensive laminectomy may be an option for an alternative procedure for treatment of MCS with LFH.

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References

  1. Rao RD, Gourab K, David KS (2006) Operative treatment of cervical spondylotic myelopathy. J Bone Joint Surg Am 88:1619–1640

    Article  PubMed  Google Scholar 

  2. Mitsunaga LK, Klineberg EO, Gupta MC (2012) Laminoplasty techniques for the treatment of multilevel cervical stenosis. Adv Orthop 2012:307916

    PubMed Central  PubMed  Google Scholar 

  3. Hsu W, Dorsi MJ, Witham TF (2009) Surgical management of cervical spondylotic myelopathy. Neurosurg Q 19:302–307

    Article  PubMed Central  PubMed  Google Scholar 

  4. Papadopoulos EC, Huang RC, Girardi FP, Synnott K, Cammisa FP Jr (2006) Three-level anterior cervical discectomy and fusion with plate fixation: radiographic and clinical results. Spine (Phila Pa 1976) 31:897–902

    Article  Google Scholar 

  5. Stewart TJ, Schlenk RP, Benzel EC (2007) Multiple level discectomy and fusion. Neurosurgery 60:S143–S148

    Article  PubMed  Google Scholar 

  6. Gok B, Sciubba DM, McLoughlin GS, McGirt M, Ayhan S, Wolinsky JP, Bydon A, Gokaslan ZL, Witham TF (2008) Surgical treatment of cervical spondylotic myelopathy with anterior compression: a review of 67 cases. J Neurosurg Spine 9:152–157

    Article  PubMed  Google Scholar 

  7. Hale JJ, Gruson KI, Spivak JM (2006) Laminoplasty: a review of its role in compressive cervical myelopathy. Spine J 6:289S–298S

    Article  PubMed  Google Scholar 

  8. Li KK, Chung OM, Chang YP, So YC (2002) Myelopathy caused by ossification of ligamentum flavum. Spine (Phila Pa 1976) 27:E308–E312

    Article  Google Scholar 

  9. Rhee JM, Basra S (2008) Posterior surgery for cervical myelopathy: laminectomy, laminectomy with fusion, and laminoplasty. Asian Spine J 2:114–126

    Article  PubMed Central  PubMed  Google Scholar 

  10. Sodeyama T, Goto S, Mochizuki M, Takahashi J, Moriya H (1999) Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord. Spine (Phila Pa 1976) 24:1527–1531 (discussion 1531–1532)

    Article  CAS  Google Scholar 

  11. Zhao X, Xue Y, Pan F, Zhao H, Li P, Wang P, Ma X (2012) Extensive laminectomy for the treatment of ossification of the posterior longitudinal ligament in the cervical spine. Arch Orthop Trauma Surg 132:203–209

    Article  PubMed  Google Scholar 

  12. Al-Tamimi YZ, Guilfoyle M, Seeley H, Laing RJ (2013) Measurement of long-term outcome in patients with cervical spondylotic myelopathy treated surgically. Eur Spine J 22:2552–2557

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Du W, Wang L, Shen Y, Zhang Y, Ding W, Ren L (2013) Long-term impacts of different posterior operations on curvature, neurological recovery and axial symptoms for multilevel cervical degenerative myelopathy. Eur Spine J 22:1594–1602

    Article  PubMed Central  PubMed  Google Scholar 

  14. Fujimori T, Iwasak M, Okuda S, Takenaka S, Kashii M, Kaito T, Yoshikawa H (2014) Long-term results of cervical myelopathy due to ossification of the posterior longitudinal ligament with an occupying ratio of 60 % or more. Spine (Phila Pa 1976) 39(1):58–67

    Article  Google Scholar 

  15. van Geest S, de Vormer AM, Arts MP, Peul WC, Vleggeert-Lankamp CL (2013) Long-term follow-up of clinical and radiological outcome after cervical laminectomy. Eur Spine J. doi:10.1007/s00586-013-3089-6 (Epub ahead of print)

    PubMed  Google Scholar 

  16. Nurick S (1972) The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95:87–100

    Article  CAS  PubMed  Google Scholar 

  17. Takeshita K, Murakami M, Kobayashi A, Nakamura C (2001) Relationship between cervical curvature index (Ishihara) and cervical spine angle (C2–7). J Orthop Sci 6:223–226

    Article  CAS  PubMed  Google Scholar 

  18. Grossman CB (1995) Degenerative and traumatic conditions of the spine. In: Magnetic resonance imaging and computed tomography of the head and spine, 2nd edn, pp 730–734

  19. Chokshi FH, Quencer RM, Smoker WR (2010) The “thickened” ligamentum flavum: is it buckling or enlargement? Am J Neuroradiol 31:1813–1816

    Article  CAS  PubMed  Google Scholar 

  20. Ahn DK, Lee S, Moon SH, Boo KH, Chang BK, Lee JI (2014) Ossification of the ligamentum flavum. Asian Spine J 8:89–96

    Article  PubMed Central  PubMed  Google Scholar 

  21. Batzdorf U, Batzdorff A (1988) Analysis of cervical spine curvature in patients with cervical spondylosis. Neurosurgery 22:827–836

    Article  CAS  PubMed  Google Scholar 

  22. Hosono N, Yonenobu K, Ono K (1996) Neck and shoulder pain after laminoplasty. A noticeable complication. Spine (Phila Pa 1976) 21:1969–1973

    Article  CAS  Google Scholar 

  23. Kato M, Nakamura H, Konishi S, Dohzono S, Toyoda H, Fukushima W, Kondo K, Matsuda H (2008) Effect of preserving paraspinal muscles on postoperative axial pain in the selective cervical laminoplasty. Spine (Phila Pa 1976) 33:E455–E459

    Article  Google Scholar 

  24. Kotani Y, Abumi K, Ito M, Sudo H, Takahata M, Ohshima S, Hojo Y, Minami A (2009) Minimum 2-year outcome of cervical laminoplasty with deep extensor muscle-preserving approach: impact on cervical spine function and quality of life. Eur Spine J 18:663–671

    Article  PubMed Central  PubMed  Google Scholar 

  25. Edwards CC 2nd, Heller JG, Murakami H (2002) Corpectomy versus laminoplasty for multilevel cervical myelopathy: an independent matched-cohort analysis. Spine (Phila Pa 1976) 27:1168–1175

    Article  Google Scholar 

  26. Edwards CC 2nd, Heller JG, Silcox DH 3rd (2000) T-Saw laminoplasty for the management of cervical spondylotic myelopathy: clinical and radiographic outcome. Spine (Phila Pa 1976) 25:1788–1794

    Article  Google Scholar 

  27. Nakama S, Nitanai K, Oohashi Y, Endo T, Hoshino Y (2003) Cervical muscle strength after laminoplasty. J Orthop Sci 8:36–40

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China

    Zhiyang Li, Yuan Xue, Dong He, Yanming Tang, Huairong Ding, Yi Wang, Yaqi Zong & Ying Zhao

  2. Department of Orthopedic Surgery, Tianjin Geriatrics Institute, Tianjin Medical University General Hospital, Tianjin, 300052, China

    Yuan Xue

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  1. Zhiyang Li
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Correspondence to Yuan Xue.

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Li, Z., Xue, Y., He, D. et al. Extensive laminectomy for multilevel cervical stenosis with ligamentum flavum hypertrophy: more than 10 years follow-up. Eur Spine J 24, 1605–1612 (2015). https://doi.org/10.1007/s00586-014-3459-8

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  • DOI: https://doi.org/10.1007/s00586-014-3459-8

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