Volumetric analysis of bilateral spinal canal decompression via hemilaminectomy versus laminoplasty in cervical spondylotic myelopathy.
Cervical spondylotic myelopathy
Laminoplasty
Laminotomy
Volume gain
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
28
04
2020
accepted:
08
06
2020
pubmed:
26
6
2020
medline:
5
2
2021
entrez:
26
6
2020
Statut:
ppublish
Résumé
Cervical spondylotic myelopathy (CSM) is a degenerative process of the cervical spine requiring surgical decompression to prevent neurological deterioration. While both anterior and posterior approaches yield satisfactory results, posterior decompression is preferred in cases of the multilevel disease. In 2015, we described a muscle-sparing, novel technique of bilateral osteoligamentous decompression via hemilaminectomy (OLD) for CSM. In this study, we investigate whether this technique offers comparable volumetric results to laminoplasty in terms of spinal canal enlargement and whether this technique can yield significant clinical improvement. Patients undergoing OLD due to CSM were prospectively enrolled in this study and then matched to and compared with a historic cohort of patients with CSM treated by laminoplasty. An independent sample t test was performed to analyze whether the volumetric gain in the two separate groups was statistically significant. Patients in the OLD cohort were clinically evaluated with the mJOA score preoperatively and 3 months postoperatively. To assess clinical improvement, a paired sample t test was performed. A total of 38 patients were included in the analysis: 19 underwent OLD and 19 underwent laminoplasty. Both groups were well matched in terms of sex, age, preoperative spinal canal volume, and involved levels. Both surgical methods yielded statistically significant volumetric gain in the cervical spinal canal, but a trend towards a greater volume gain was seen in the OLD group. In the OLD group, a statistically significant clinical improvement was also demonstrated. Our study reveals that OLD can yield a comparable extent of decompression to laminoplasty in CSM while also delivering statistically significant clinical improvement.
Sections du résumé
BACKGROUND
Cervical spondylotic myelopathy (CSM) is a degenerative process of the cervical spine requiring surgical decompression to prevent neurological deterioration. While both anterior and posterior approaches yield satisfactory results, posterior decompression is preferred in cases of the multilevel disease. In 2015, we described a muscle-sparing, novel technique of bilateral osteoligamentous decompression via hemilaminectomy (OLD) for CSM. In this study, we investigate whether this technique offers comparable volumetric results to laminoplasty in terms of spinal canal enlargement and whether this technique can yield significant clinical improvement.
METHODS
Patients undergoing OLD due to CSM were prospectively enrolled in this study and then matched to and compared with a historic cohort of patients with CSM treated by laminoplasty. An independent sample t test was performed to analyze whether the volumetric gain in the two separate groups was statistically significant. Patients in the OLD cohort were clinically evaluated with the mJOA score preoperatively and 3 months postoperatively. To assess clinical improvement, a paired sample t test was performed.
RESULTS
A total of 38 patients were included in the analysis: 19 underwent OLD and 19 underwent laminoplasty. Both groups were well matched in terms of sex, age, preoperative spinal canal volume, and involved levels. Both surgical methods yielded statistically significant volumetric gain in the cervical spinal canal, but a trend towards a greater volume gain was seen in the OLD group. In the OLD group, a statistically significant clinical improvement was also demonstrated.
CONCLUSIONS
Our study reveals that OLD can yield a comparable extent of decompression to laminoplasty in CSM while also delivering statistically significant clinical improvement.
Identifiants
pubmed: 32583084
doi: 10.1007/s00701-020-04453-z
pii: 10.1007/s00701-020-04453-z
pmc: PMC7415020
doi:
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2069-2074Références
Baba H, Uchida K, Maezawa Y, Furusawa N, Azuchi M, Imura S (1996) Lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy: a magnetic resonance imaging study. J Neurol 243:626–632
doi: 10.1007/BF00878657
Boden S, McCowin P, Davis D, Dina T, Mark A, Wiesel S (1990) Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 72(8):1178–1184
doi: 10.2106/00004623-199072080-00008
Chen C, Yang C, Yang S, Gao Y, Zhang Y, Wu X, Hua W, Shao Z (2019) Clinical and radiographic outcomes of modified unilateral open-door laminoplasty with posterior muscle-ligament complex preservation for cervical spondylotic myelopathy. Spine 44(24):1697–1704
doi: 10.1097/BRS.0000000000003158
Denaro V, Longo U, Berton A, Salvatore G, Denaro L (2015) Cervical spondylotic myelopathy: the relevance of the spinal cord back shift after posterior multilevel decompression. A systematic review. Eur Spine J 24(7):S832–S841
doi: 10.1007/s00586-015-4299-x
Fehlings M, Smith J, Kopjar B, Arnold P, Yoon S, Vaccaro A, Brodke DS, Janssen ME, Chapman JR, Sasso RC, Woodard EJ, Banco RJ, Massicotte EM, Dekutoski MB, Gokaslan ZL, Bono CM, Shaffrey CI (2012) Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSPine North America cervical spondylotic myelopathy study. J Neurosurg Spine 16:425–432
doi: 10.3171/2012.1.SPINE11467
Hirabayashi K, Watanabe K, Wakano K, Suzuki N, Satomi K, Ishii Y (1983) Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine 8:693–699
doi: 10.1097/00007632-198310000-00003
Itoh T, Tsuji H (1985) Technical improvements and results of laminoplasty for compressive myelopathy in the cervical spine. Spine 10(8):729–736
doi: 10.1097/00007632-198510000-00007
Karadimas S, Erwin W, Ely C, Dettori J, Fehlings M (2013) Pathophysiology and natural history of cervical spondylotic myelopathy. Spine (Phila Pa 1976) 38(22):S21–S36
doi: 10.1097/BRS.0b013e3182a7f2c3
Kim P, Murata H, Kurokawa R, Takaishi Y, Asakuno K, Kawamoto T (2007) Myoarchitectonic spinolaminoplasty: efficacy in reconstituting the cervical musculature and preserving biomechanical function. J Neurosurg Spine 7(3):293–304
doi: 10.3171/SPI-07/09/293
Kumar V, Rea G, Mervis LJ, McGregor JM (1999) Cervical spondylotic myelopathy: functional and radiographic long-germ outcome after laminectomy and posterior fusion. Neurosurgery 44:771–777
doi: 10.1097/00006123-199904000-00046
Kurokawa R, Kim P (2015) Cervical laminoplasty: the history and the future. Neurol Med Chir (Tokyo) 55(7):529–539
doi: 10.2176/nmc.ra.2014-0387
Liu F, Yang S, Huo L, Wang T, Yang D, Ding W (2016) Laminoplasty versus laminectomy and fusion for multilevel cervical compressive myelopathy. Medicine(Baltimore) 95(23):e3588
Mielke D, Rohde V (2015) Bilateral spinal canal decompression via hemilaminectomy in cervical spondylotic myelopathy. Acta Neurochir 157:1813–1817
doi: 10.1007/s00701-015-2549-7
Nolan J, Sherk H (1988) Biomechanical evaluation of the extensor musculature of the cervical spine. Spine (Phila Pa 1976) 13(1):9–11
doi: 10.1097/00007632-198801000-00003
Ryken TC, Heary RF, Matz PG, Anderson PA, Groff MW, Holly LT, Kaiser MG, Mummaneni PV, Choudhri TF, Vresilovic EJ, Resnick DK, Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons (2009) Cervical laminectomy for the treatment of cervical degenerative myelopathy. J Neurosurg Spine 11:142–149
doi: 10.3171/2009.1.SPINE08725
Sodeyama T, Goto S, Mochizuki M, Takahashi J, Moriya H (1999) Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord. Spine 24:1527–1531
doi: 10.1097/00007632-199908010-00005
Wang M, Luo X, Deng Q, Li J, Wang N (2016) Prevalence of axial symptoms after posterior cervical decompression: a meta-analysis. Eur Spine J 25:2302–2310
doi: 10.1007/s00586-016-4524-2
Wu C, Wang ZY, Lin GZ, Yu T, Liu B, Si Y, Zhang YB, Li YC (2019) Biomechanical changes of sheep cervical spine after unilateral hemilaminectomy and different degrees of facetectomy. Beijing Da Xue Xue Bao 51(4):728–732
pubmed: 31420630
Xiao S, Jiang H, Yang L, Xiao ZM (2015) Anterior cervical discectomy versus corpectomy for multilevel cervical spondylotic myelopathy: a meta-analysis. Eur Spine J 24:31–39
doi: 10.1007/s00586-014-3607-1
Xie T, Qian J, Lu Y, Chen B, Jiang Y, Luo C (2013) Biomechanical comparison of laminectomy, hemilaminectomy and a new minimally invasive approach in the surgical treatment of multilevel cervical intradural tumour: a finite element analysis. Eur Spine J 22:2719–2730
doi: 10.1007/s00586-013-2992-1
Yang XJ, Tian RJ, Su X, Hu SB, Lei W, Zhang Y (2015) Relationship of actual laminoplasty opening size and increment of the cross-sectional area based on single-door cervical laminoplasty. Medicine (Baltimore) 97(12):e0216
doi: 10.1097/MD.0000000000010216