Laminoplasty and corporectomy in the treatment of cervical spondylotic myelopathy

Abstract

Introduction: Cervical Spondylotic myelopathy (CSM) is a disabling manifestation of extended cervical stenosis characterized by pronounced neurological dysfunction. Decompressive interventions contribute to significant regression of symptoms and, in some cases, complete recovery can be achieved.

Objective: To explore the potential of laminoplasty in patients with extended cervical spondylotic stenoses complicated by myelopathy, and to develop approaches for surgical intervention in these patients.

Material and methods: 56 patients were included in the study. Laminoplasty was performed in 34 patients (average age, 59.4 ± 12.8 years, women/men ratio, 9:25); 28 patients had compression on 3 levels of, 4 patients had compression on 4 levels and 2 patients had compression over 5 levels. Corporectomy was performed in 22 patients who made up the comparison group (average age, 43.8 ± 16.4 years, women/men ratio, 7:15). The frequency and initial severity of concomitant non-neurological disorders in both groups were comparable.

Results: Indications for laminoplasty were determined. They include: symptoms of spondylotic myelopathy, three or more levels of compression, preservation of lordosis, absence of segmental instability signs, inability to perform anterior decompression, and age over 55 years. The presence of segmental instability signs, kyphotic deformation and history of mental disorders may be considered as contraindications for this surgery. Early and late (> 3 years) clinical outcomes (evolution of pyramidal and sensory symptoms) and X-ray and neuroimaging postoperative parameters (spine canal width, preservation of lordosis, etc.) were evaluated.

Conclusions: Due to a number of advantages, lamynoplasty is the treatment of choice for extended cervical spondylotic stenosis. Adequate selection of patients based on the evaluation of clinical symptoms, extension of stenosis, neurological signs and neuroimaging features make possible to achieve excellent results. This type of surgery is preferable for elderly patients (>55–60 years).

About the authors

Maksim D. Dreval'

Research Center of Neurology

Author for correspondence.
Email: center@test.ru
Russian Federation

Sergey О. Arestov

Research Center of Neurology

Email: center@test.ru
Russian Federation

David V. Petrosyan

Research Center of Neurology

Email: center@test.ru
Russian Federation

Аleksey А. Kasheev

Research Center of Neurology

Email: center@test.ru
Russian Federation

Аndrey V. Vershinin

Research Center of Neurology

Email: center@test.ru
Russian Federation

Еkaterina N. Poltorako

Research Center of Neurology

Email: center@test.ru
Russian Federation

Аrtem О. Guscha

Research Center of Neurology

Email: center@test.ru
Russian Federation

References

  1. Belova A.N. Neyroreabilitatsiya: rukovodstvo dlya vrachey. 2-e izd. [Neurorehabilitation: guide for doctors. 2nd edition]. 2002; Moscow: Antidor. 736 p. (In Russ.)
  2. Uotkins R.G. [Predicting the outcomes of surgical treatment in patients with chronic disability due to pain in the lumbar spine]. Vestnik travmatologii i ortopedii im. NN Priorova. 2002; 3: 58-65. (In Russ.)
  3. Matz P.G., Anderson P.A., Holly L.T. et al. The natural history of cervical spondylotic myelopathy. J Neurosurg Spine 2009; 11: 104-111. PMID: 19769489 doi: 10.3171/2009.1.SPINE08716.
  4. Dreval' M.D., Gushcha A.O. [Surgical treatment of cervical spondylotic myelopathy using laminoplasty: review]. Khirurgiya pozvonochnika. 2015; 12: 44-50. doi: 10.14531/ss2015.2.44-50. (In Russ.)
  5. Yusupov, M.N. [Comparative analysis of structural and functional manifestations of cervical spondylotic myelopathy before and after decompressive surgeries]. Avtoreferat dis.... kand. med. nauk. Saint-Petersburg, 2011: 6-24. (In Russ.)
  6. Clarke E., Robinson P.K. Cervical myelopathy: a complication of cervical spondylosis. Brain. 1956; 79: 483-510. PMID: 13364095
  7. Lees F., Turner J.W. Natural History and Prognosis of Cervical Spondylosis. Br Med J. 1963 2: 1607-1610. PMID: 14066179
  8. Bohm P.E., Fehlings M.G., Kopjar B. et al. Psychometric properties of the 30-m walking test in patients with degenerative cervical myelopathy: results from two prospective multicenter cohort studies. Spine J. 2017; 17: 211-217. PMID: 27592193 doi: 10.1016/j.spinee.2016.08.033
  9. Chung J.Y., Kim S.K., Jung S.T., Lee K.B. Clinical adjacent-segment pathology after anterior cervical discectomy and fusion: results after a minimum of 10-year follow-up. Spine J. 2014; 14: 2290-2298. PMID: 24462531 doi: 10.1016/j.spinee.2014.01.027
  10. Heller J.G., Edwards C.C. 2nd, Murakami H., Rodts G.E. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis. Spine (Phila Pa 1976). 2001; 26: 1330-1336 PMID: 11426147
  11. Gushcha A.O., Dreval' M.D., Kireeva N.S., Korepina O.S. [Treatment of spondylotic cervical myelopathy]. Annals of clinical and experimental neurology. 2015; 9: 34-41. (In Russ.)
  12. Hale J.J., Gruson K.I., Spivak J.M. Laminoplasty: a review of its role in compressive cervical myelopathy. Spine J. 2006; 6: 289S-298S. PMID: 17097549 doi: 10.1016/j.spinee.2005.12.032
  13. Klement M.R., Kleeman L.T., Blizzard D.J. et al. C5 palsy after cervical laminectomy and fusion: does width of laminectomy matter? Spine J. 2016; 16: 462-467. PMID: 26208880 doi: 10.1016/j.spinee.2015.07.437
  14. Haddas R., Ju K.L., Patel S. et al. Effect of Cervical Decompression Surgery on Gait in Adult Cervical Spondylotic Myelopathy Patients. The Spine Journal. 2017; 17: S135. doi: 10.1016/j.spinee.2017.07.211 ().
  15. Hirabayashi K., Watanabe K., Wakano K. et al. Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine (Phila Pa 1976). 1983; 8: 693-699. PMID: 6420895
  16. Lesoin F., Bouasakao N., Cama A. et al. [Role of surgical decompression by the anterior approach in myeloradiculopathies caused by cervical arthrosis. Apropos of 850 cases]. Sem Hop. 1983; 59: 2669-2677. PMID: 6316519 (In French)
  17. Oyama M. A new method of cervical laminectomy. Chubu Nippon Seikeisaigaigeka Gakkai Zasshi (Central Jpn J Orthop Traumatol). 1973; 16: 792-794.
  18. Doita M., Sakai H., Harada T. et al. The Influence of Proprioceptive Impairment on Hand Function in Patients With Cervical Myelopathy. Spine (Phila Pa 1976). 2006; 31(14):1580-4. PMID: 16778692 doi: 10.1097/01.brs.0000222034.78210.43
  19. Derenda M., Kowalina I. [Cervical laminoplasty - review of surgical techniques, indications, methods of efficacy evaluation, and complications]. Neurol Neurochir Pol. 2006; 40: 422-432; discussion 433. PMID: 17103356 (In Polish)
  20. Li Q., Kong Q., Zhang L. et al. [Discussion of surgical indications for posterior expansive open-door laminoplasty extended to C1 level]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013; 27: 1214-1220. PMID: 24397134 (In Chin.)
  21. Yoshida M., Tamaki T., Kawakami M. et al. Indication and clinical results of laminoplasty for cervical myelopathy caused by disc herniation with developmental canal stenosis. Spine (Phila Pa 1976). 1998; 23: 2391-2397. PMID: 9836352

Statistics

Views

Abstract: 1122

PDF (Russian): 1273

Article Metrics

Metrics Loading ...

Dimensions

PlumX


Copyright (c) 2017 Dreval' M.D., Arestov S.О., Petrosyan D.V., Kasheev А.А., Vershinin А.V., Poltorako Е.N., Guscha А.О.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies