Skip to main content

Advertisement

SpringerLink
Log in

Cervical Laminectomy with Lateral Mass Screw Fixation in Cervical Spondylotic Myelopathy

  • Neurological and Sagittal Alignment Outcome: Do We Need Lateral Mass Screws at each Segment?
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Anterior cervical decompression and fusion is the standard procedure used for treating patients with cervical myelopathy. However, these procedures are associated with complications such as pseudarthrosis, construct failure, and neurological complications. Posterior cervical laminectomy and instrumentation is an alternative procedure to treat multilevel cervical myelopathy. In this study, we raised questions whether instrumentation is required at all levels and whether stabilizing the spine in neutral or lordotic contour with indirect decompression leads to neurological improvement with radiological evidence of anterior decompression. The results of posterior cervical laminectomy and instrumentation with lateral mass screw in terms of radiological and functional outcome in patients with multilevel cervical myelopathy are prospectively evaluated.

Materials and Methods

In this prospective study conducted between June 2006 and December 2015, we have evaluated 112 patients with multilevel cervical myelopathy who underwent multilevel cervical laminectomy and instrumentation with lateral mass screw. All patients were evaluated preoperatively and postoperatively with Nurick’s grading and Modified Japanese Orthopaedic Association (mJOA) scale for neurological function. Cooper scale and British Medical Research Council grading system for motor function. Curvature index was used to measure the alignment of cervical spine preoperatively and postoperatively. Alignment of the cervical spine was done preoperatively and postoperatively by calculating the curvature index. Axial MRI was used to calculate the severity of compression preoperatively which was calculated as per Singh’s criteria and postoperatively to assess the adequacy of decompression at the operated level.

Results

In our study, there were 112 patients including 99 males and 13 females, with mean age of 59.53 years. The mean duration of followup of patients was 33.24 months. In total, cervical laminectomy was performed at 342 levels in 112 patients with an average of 3.05 laminectomies, and in total, 112 lateral mass screws were inserted. On postoperative followup, the mJOA and Nurick’s grading showed improvement in all cases as compared to preoperative findings. The mean mJOA improved significantly from 8.56 preoperatively to 13.57 postoperatively (P < 0.001). The mean Nurick’s grading also improved significantly from 2.59 preoperatively to 0.66 postoperatively (P < 0.001). The mean Cooper scale also showed significant improvement in both upper and lower limbs postoperatively (P < 0.001). The mean preoperative Cooper scale was 1.75 and postoperative was 0.31 for upper limbs, and the mean Cooper scale was 2.14 preoperatively and 0.56 postoperatively for lower limbs. X-rays done on routine followups showed good alignment of the cervical spine with maintenance of curvature index in all patients. The mean grade of compression as seen on preoperative MRI was 2.46 which reduced significantly postoperatively to 0.16 (P < 0.001).

Conclusion

The multilevel cervical laminectomy and instrumentation with lateral mass screw for multilevel cervical myelopathy is a safe technique that provides decompression of the spinal cord, prevents the development of kyphotic spinal deformity and posterior tension band of the spinal cord as associated with laminoplasty or uninstrumented laminectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Miyazaki M, Kodera R, Yoshiiwa T, Kawano M, Kaku N, Tsumura H. Prevalence and distribution of thoracic and lumbar compressive lesions in cervical spondylotic myelopathy. Asian Spine J 2015;9:218–24.

    Article  Google Scholar 

  2. Edwards CC 2nd, Riew KD, Anderson PA, Hilibrand AS, Vaccaro AF. Cervical myelopathy. Current diagnostic and treatment strategies. Spine J 2003;3:68–81.

    PubMed  Google Scholar 

  3. Ellingson BM, Salamon N, Hardy AJ, Holly LT. Prediction of neurological impairment in cervical spondylotic myelopathy using a combination of diffusion MRI and proton MR spectroscopy. PLoS One 2015;10:e0139451.

  4. Fei Q, Li J, Su N, Wang B, Li D, Meng H, et al. Comparison between anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion for the treatment of cervical spondylotic myelopathy: A meta-analysis. Ther Clin Risk Manag 2015;11:1707–18.

    PubMed  PubMed Central  Google Scholar 

  5. Liu T, Xu W, Cheng T, Yang HL. Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review. Eur Spine J 2011;20:224–35.

    Article  Google Scholar 

  6. Lao L, Zhong G, Li X, Qian L, Liu Z. Laminoplasty versus laminectomy for multi-level cervical spondylotic myelopathy: A systematic review of the literature. J Orthop Surg Res 2013;8:45.

    Article  Google Scholar 

  7. Song M, Zhang Z, Lu M, Zong J, Dong C, Ma K, et al. Four lateral mass screw fixation techniques in lower cervical spine following laminectomy: A finite element analysis study of stress distribution. Biomed Eng Online 2014;13:115.

    Article  Google Scholar 

  8. Chang V, Lu DC, Hoffman H, Buchanan C, Holly LT. Clinical results of cervical laminectomy and fusion for the treatment of cervical spondylotic myelopathy in 58 consecutive patients. Surg Neurol Int 2014;5 Suppl 3:S133–7.

    PubMed  PubMed Central  Google Scholar 

  9. Zhu B, Xu Y, Liu X, Liu Z, Dang G. Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: A systemic review and meta-analysis. Eur Spine J 2013;22:1583–93.

    Article  Google Scholar 

  10. Komotar RJ, Mocco J, Kaiser MG. Surgical management of cervical myelopathy: Indications and techniques for laminectomy and fusion. Spine J 2006;6 6 Suppl:252S–67S.

    Article  Google Scholar 

  11. Fehlings MG, Barry S, Kopjar B, Yoon ST, Arnold P, Massicotte EM, et al. Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: Outcomes of the prospective multicenter AOSpine North America CSM study in 264 patient. Spine (Phila Pa 1976) 2013;38:2247–52.

    Article  Google Scholar 

  12. Tian P, Fu X, Li ZJ, Sun XL, Ma XL. Hybrid surgery versus anterior cervical discectomy and fusion for multilevel cervical degenerative disc diseases: A meta-analysis. Sci Rep 2015;5:13454.

    Article  CAS  Google Scholar 

  13. Shriver MF, Lewis DJ, Kshettry VR, Rosenbaum BP, Benzel EC, Mroz TE. Pseudarthrosis rates in anterior cervical discectomy and fusion: A meta-analysis. Spine J 2015;15:2016–27.

    Article  Google Scholar 

  14. McAnany SJ, Baird EO, Overley SC, Kim JS, Qureshi SA, Anderson PA. A meta-analysis of the clinical and fusion results following treatment of symptomatic cervical pseudarthrosis. Global Spine J 2015;5:148–55.

    Article  Google Scholar 

  15. Feng NL, Zhong HL, Xuan H, Zhi C, Fang Z, Hong XS, et al. Comparison of two reconstructive techniques in the surgical management of four level cervical spondylotic myelopathy. Biomed Res Int 2015;20 15:513906.

    Google Scholar 

  16. Du W, Wang L, Shen Y, Zhang Y, Ding W, Ren L. Long term impacts of different posterior operations on curvature, neurological recovery and axial symptoms for multilevel cervical degenerative myelopathy. Eur Spine J 2013;22:1594–602.

    Article  Google Scholar 

  17. McAllister BD, Rebholz BJ, Wang JC. Is posterior fusion necessary with laminectomy in the cervical spine? Surg Neurol Int 2012;3 Suppl 3:S225–31.

    Article  Google Scholar 

  18. Kaptain GJ, Simmons NE, Replogle RE, Pobereskin L. Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg 2000;93 2 Suppl:199–204.

    CAS  PubMed  Google Scholar 

  19. Liu X, Min S, Zhang H, Zhou Z, Wang H, Jin A. Anterior corpectomy versus posterior laminoplasty for multilevel cervical myelopathy: A systematic review and meta-analysis. Eur Spine J 2014;23:362–72.

    Article  Google Scholar 

  20. Epstein NE, Hollingsworth R. C5 nerve root palsies following cervical spine surgery: A review. Surg Neurol Int 2015;6 Suppl 4:S154–63.

    Article  Google Scholar 

  21. Du W, Zhang P, Shen Y, Zhang YZ, Ding WY, Ren LX. Enlarged laminectomy and lateral mass screw fixation for multilevel cervical degenerative myelopathy associated with kyphosis. Spine J 2014;14:57–64.

    Article  Google Scholar 

  22. Anderson PA, Matz PG, Groff MW, Heary RF, Holly LT, Kaiser MG, et al. Laminectomy and fusion for the treatment of cervical degenerative myelopathy. J Neurosurg Spine 2009;11:150–6.

    Article  Google Scholar 

  23. Houten JK, Cooper PR. Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossifcation of the posterior longitudinal ligament: Effects on cervical alignment, spinal cord compression, and neurological outcome. Neurosurgery 2003;52:1081–7.

    PubMed  Google Scholar 

  24. Revanappa KK, Rajshekhar V. Comparison of nurick grading system and modifed Japanese Orthopaedic Association scoring system in evaluation of patients with cervical spondylotic myelopathy. Eur Spine J 2011;20:1545–51.

    Article  Google Scholar 

  25. Liu K, Shi J, Jia L, Yuan W. Surgical technique: Hemilaminectomy and unilateral lateral mass fxation for cervical ossification of the posterior longitudinal ligament. Clin Orthop Relat Res 2013;471:2219–24.

    Article  Google Scholar 

  26. Chen Y, Chen D, Wang X, Lu X, Guo Y, He Z, et al. Anterior corpectomy and fusion for severe ossification of posterior longitudinal ligament in the cervical spine. Int Orthop 2009;33:477–82.

    Article  Google Scholar 

  27. Uchida K, Nakajima H, Sato R, Yayama T, Mwaka ES, Kobayashi S, et al. Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: Outcome after anterior or posterior decompression. J Neurosurg Spine 2009;11:521–8.

    Article  Google Scholar 

  28. Ito M, Nagahama K. Laminoplasty for cervical myelopathy. Global Spine J 2012;2:187–94.

    Article  Google Scholar 

  29. Cho WS, Chung CK, Jahng TA, Kim HJ. Post-laminectomy kyphosis in patients with cervical ossification of the posterior longitudinal ligament: Does it cause neurological deterioration? J Korean Neurosurg Soc 2008;43:259–64.

    Article  Google Scholar 

  30. Kumar VG, Rea GL, Mervis LJ, McGregor JM. Cervical spondylotic myelopathy: Functional and radiographic long term outcome after laminectomy and posterior fusion. Neurosurgery 1999;44:771–7.

    Article  CAS  Google Scholar 

  31. Huang RC, Girardi FP, Poynton AR, Cammisa FP Jr. Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decompression and fusion with lateral mass plate fixation and local bone graft. J Spinal Disord Tech 2003;16:123–9.

    Article  Google Scholar 

  32. Geck MJ, Eismont FJ. Surgical options for the treatment of cervical spondylotic myelopathy. Orthop Clin North Am 2002;33:329–48.

    Article  Google Scholar 

  33. Blizzard DJ, Gallizzi MA, Sheets C, Klement MR, Kleeman LT, Caputo AM, et al. The role of iatrogenic foraminal stenosis from lordotic correction in the development of C5 palsy after posterior laminectomy and fusion. J Orthop Surg Res 2015;10:160.

    Article  Google Scholar 

  34. Yi S, Yoon DH, Kim KN, Kim SH, Shin HC. Postoperative spinal epidural hematoma: Risk factor and clinical outcome. Yonsei Med J 2006;47:326–32.

    Article  Google Scholar 

  35. Takahashi Y, Sato T, Hyodo H, Kawamata T, Takahashi E. Symptomatic epidural haematoma after cervical laminoplasty: A report of three cases. J Orthop Surg (Hong Kong) 2016;24:121–4.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anaesthesia, Shanta Spine Institute, Shanta Spine Institute, 1st Floor, Ashirvad Complex, 440 010, Ramdaspeth, Nagpur, Maharashtra, India

    Sonal Manoj Singrakhia & Shivaji Subhash Deshmukh

  2. Department of Spine Surgery, Shanta Spine Institute, Nagpur, Maharashtra, India

    Manoj Dayalal Singrakhia & Nikhil Ramdas Malewar

Authors
  1. Manoj Dayalal Singrakhia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikhil Ramdas Malewar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sonal Manoj Singrakhia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shivaji Subhash Deshmukh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Manoj Dayalal Singrakhia.

Additional information

This is an open access artcle distributed under the terms of the Creatve Commons Atributon-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creatons are licensed under the identcal terms.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singrakhia, M.D., Malewar, N.R., Singrakhia, S.M. et al. Cervical Laminectomy with Lateral Mass Screw Fixation in Cervical Spondylotic Myelopathy. IJOO 51, 658–665 (2017). https://doi.org/10.4103/ortho.IJOrtho_266_16

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ortho.IJOrtho_266_16

Keywords

MeSH terms

Search

Navigation