Laminoplasty

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Hideki Yoshikawa - One of the best experts on this subject based on the ideXlab platform.

  • preservation of muscles attached to the c2 and c7 spinous processes rather than subaxial deep extensors reduces adverse effects after cervical Laminoplasty
    Spine, 2010
    Co-Authors: Hironobu Sakaura, Noboru Hosono, Yoshihiro Mukai, Motoki Iwasaki, Takahito Fujimori, Hideki Yoshikawa
    Abstract:

    Study design Prospective study. Objective To examine whether preservation of subaxial deep extensor muscles plays any significant role in reducing axial neck pain and unfavorable radiologic changes after cervical Laminoplasty in patients with cervical spondylotic myelopathy and to confirm the benefits of preserving muscles attached to the C2 and C7 spinous processes. Summary of background data Axial neck pain and unfavorable radiologic changes after cervical Laminoplasty have been reported to mostly result from detachment of cervical extensor muscles, particularly muscles attached to the C2 and C7 spinous processes. Other surgeons have reported that preservation of subaxial deep extensor muscles reduces these adverse effects after cervical Laminoplasty. Methods Subjects comprised 36 patients with cervical spondylotic myelopathy who underwent C3-C6 open-door Laminoplasty and were followed up for >24 months. Of these, 18 consecutive patients underwent our modified Laminoplasty (muscles-preserved group) and the remaining 18 consecutive patients underwent the conventional procedure (muscles-disrupted group). Both procedures preserved all muscles attached to the C2 and C7 spinous processes. Subaxial deep extensor muscles on the hinged side were also preserved in the muscles-preserved group. Radiologic and clinical data were prospectively collected. Results Both groups achieved equal neurologic improvement. Frequencies of axial neck pain showed no significant differences between groups. This value did not vary according to the side of preservation of subaxial deep extensor muscles or the side of muscle disruption. Postoperative loss of lordosis and range of motion of the cervical spine also demonstrated no significant difference between groups. Conclusion These results indicate that preservation of subaxial deep extensor muscles plays no significant role in reducing axial neck pain and unfavorable radiologic changes after cervical Laminoplasty, supporting the hypothesis that these adverse effects after Laminoplasty largely result from detachment of muscles attached to the C2 and C7 spinous processes.

  • surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament part 1 clinical results and limitations of Laminoplasty
    Spine, 2007
    Co-Authors: Motoki Iwasaki, Kazuo Yonenobu, Hironobu Sakaura, Yoshihiro Mukai, Shinya Okuda, Akira Miyauchi, Hideki Yoshikawa
    Abstract:

    STUDY DESIGN: Retrospective study of 66 patients who underwent Laminoplasty for treatment of cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL). OBJECTIVES: The present study describes surgical results of Laminoplasty for treatment of cervical myelopathy due to OPLL and aims to clarify 1) factors predicting outcome and 2) limitations of Laminoplasty. SUMMARY OF BACKGROUND DATA: During the period 1986 and 1996, Laminoplasty was the only surgical treatment selected for cervical myelopathy at our institutions. METHODS: We reviewed data obtained in 66 patients who underwent Laminoplasty for treatment of cervical myelopathy due to OPLL. Mean duration of follow-up was 10.2 years (range, 5-20 years). Surgical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. RESULTS: Surgical outcome was significantly poorer in patients with occupying ratio greater than 60%. Multiple regression analysis showed that the most significant predictor of poor outcome after Laminoplasty was hill-shaped ossification, followed by lower preoperative JOA score, postoperative change in cervical alignment, and older age at surgery. CONCLUSIONS: Laminoplasty is effective and safe for most patients with occupying ratio of OPLL less than 60% and plateau-shaped ossification. However, neurologic outcome of Laminoplasty for cervical OPLL was poor or fair in patients with occupying ratio greater than 60% and/or hill-shaped ossification.

  • surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament part 2 advantages of anterior decompression and fusion over Laminoplasty
    Spine, 2007
    Co-Authors: Motoki Iwasaki, Kazuo Yonenobu, Hironobu Sakaura, Yoshihiro Mukai, Shinya Okuda, Akira Miyauchi, Hideki Yoshikawa
    Abstract:

    STUDY DESIGN: Retrospective study of 27 patients who underwent anterior decompression and fusion (ADF) for treatment of cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL). OBJECTIVES: To compare surgical outcome of ADF with that of Laminoplasty. SUMMARY OF BACKGROUND DATA: During the period 1986 and 1996, Laminoplasty was the only surgical treatment selected for cervical myelopathy at our institutions. According to surgical results of Laminoplasty performed during this period, we have performed either Laminoplasty or ADF for patients with OPLL since 1996. METHODS: We reviewed clinical data obtained in 27 patients who underwent ADF between 1996 and 2003. Mean duration of follow-up was 6.0 years (range, 2-10 years). Surgical outcomes were assessed using the Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy. Surgical results of ADF were compared with those of Laminoplasty, which was performed in 66 patients during the period 1986 and 1996. RESULTS: ADF yielded a better neurologic outcome at final follow-up than Laminoplasty in patients with occupying ratio > or =60%, although graft complications occurred in 15% and additional surgical intervention was required in 26%. Neither occupying ratio of OPLL, sagittal shape of ossification, nor cervical alignment was found to be related to surgical outcome of ADF. CONCLUSIONS: Although ADF is technically demanding and has a higher incidence of surgery-related complications, it is preferable to Laminoplasty for patients with occupying ratio of OPLL > or =60%.

  • C3-6 Laminoplasty takes over C3-7 Laminoplasty with significantly lower incidence of axial neck pain
    European spine journal : official publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cerv, 2006
    Co-Authors: Noboru Hosono, Hironobu Sakaura, Yoshihiro Mukai, Ryutaro Fujii, Hideki Yoshikawa
    Abstract:

    Five-lamina (C3-7) procedure is the most popular cervical Laminoplasty and there have been no studies on the most appropriate number of laminae to be opened. We prospectively reduced the range of Laminoplasty from C3-7 to C3-6 in 2002 and compared the outcome of C3-6 Laminoplasty (n=37) to that of C3-7 Laminoplasty (n=28). In both groups, neurological gain was satisfactory, radiographic changes were minimal, and postoperative MRI indicated sufficient expansion of the dura and the spinal cord. Average operating period was significantly shorter, and length of the operative wound was significantly less in the C3-6 group than in the C3-7 group. Postoperative axial neck pain was significantly rarer after C3-6 Laminoplasty than after C3-7 Laminoplasty (5.4% vs. 29%, P=0.015). Due to its simplicity and various benefits, C3-6 Laminoplasty is a promising alternative to conventional C3-7 Laminoplasty for treatment of multisegmental compression myelopathy.

  • Long-term outcome of Laminoplasty for cervical myelopathy due to disc herniation: a comparative study of Laminoplasty and anterior spinal fusion.
    Spine, 2005
    Co-Authors: Hironobu Sakaura, Noboru Hosono, Yoshihiro Mukai, Motoki Iwasaki, Takahiro Ishii, Hideki Yoshikawa
    Abstract:

    Study Design. A retrospective study was conducted. Objective. To compare the long-term outcomes after Laminoplasty and anterior spinal fusion (ASF) for cervical myelopathy secondary to disc herniation. Summary of Background Data. There have been no reports of long-term comparative studies of Laminoplasty and ASF for cervical myelopathy due to disc herniation. Methods. Of 21 patients who underwent ASF only between 1984 and 1987, 15 were followed up. Of 22 patients who underwent Laminoplasty only between 1987 and 1994, 18 were followed up. There were no significant differences in preoperative prognostic factors between the 2 groups. Average follow-up was 15 years in the ASF group and 10 years in the Laminoplasty group. Neurologic and radiologic results were examined. Results. Laminoplasty and ASF provided equal neurologic improvement. In the ASF group, additional surgery was required for bone graft complications in 2 patients and for adjacent spondylosis in 1. In the Laminoplasty group, one patient had C5 palsy, and intractable axial pain developed in 5 patients after surgery, but no patients needed additional surgery. Conclusions. Because the 2 procedures provided the same neurologic improvement, the risks of bone graft complication with ASF must be weighed against the risks of chronic neck pain associated with Laminoplasty for determining the best technique. Therefore, because our present surgical strategy for cervical myelopathy due to disc herniation, Laminoplasty is the procedure of choice except for a patient with single level disc herniation without developmental canal stenosis, who is considered to be a good candidate for ASF.

Kazuo Yonenobu - One of the best experts on this subject based on the ideXlab platform.

  • surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament part 1 clinical results and limitations of Laminoplasty
    Spine, 2007
    Co-Authors: Motoki Iwasaki, Kazuo Yonenobu, Hironobu Sakaura, Yoshihiro Mukai, Shinya Okuda, Akira Miyauchi, Hideki Yoshikawa
    Abstract:

    STUDY DESIGN: Retrospective study of 66 patients who underwent Laminoplasty for treatment of cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL). OBJECTIVES: The present study describes surgical results of Laminoplasty for treatment of cervical myelopathy due to OPLL and aims to clarify 1) factors predicting outcome and 2) limitations of Laminoplasty. SUMMARY OF BACKGROUND DATA: During the period 1986 and 1996, Laminoplasty was the only surgical treatment selected for cervical myelopathy at our institutions. METHODS: We reviewed data obtained in 66 patients who underwent Laminoplasty for treatment of cervical myelopathy due to OPLL. Mean duration of follow-up was 10.2 years (range, 5-20 years). Surgical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. RESULTS: Surgical outcome was significantly poorer in patients with occupying ratio greater than 60%. Multiple regression analysis showed that the most significant predictor of poor outcome after Laminoplasty was hill-shaped ossification, followed by lower preoperative JOA score, postoperative change in cervical alignment, and older age at surgery. CONCLUSIONS: Laminoplasty is effective and safe for most patients with occupying ratio of OPLL less than 60% and plateau-shaped ossification. However, neurologic outcome of Laminoplasty for cervical OPLL was poor or fair in patients with occupying ratio greater than 60% and/or hill-shaped ossification.

  • surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament part 2 advantages of anterior decompression and fusion over Laminoplasty
    Spine, 2007
    Co-Authors: Motoki Iwasaki, Kazuo Yonenobu, Hironobu Sakaura, Yoshihiro Mukai, Shinya Okuda, Akira Miyauchi, Hideki Yoshikawa
    Abstract:

    STUDY DESIGN: Retrospective study of 27 patients who underwent anterior decompression and fusion (ADF) for treatment of cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL). OBJECTIVES: To compare surgical outcome of ADF with that of Laminoplasty. SUMMARY OF BACKGROUND DATA: During the period 1986 and 1996, Laminoplasty was the only surgical treatment selected for cervical myelopathy at our institutions. According to surgical results of Laminoplasty performed during this period, we have performed either Laminoplasty or ADF for patients with OPLL since 1996. METHODS: We reviewed clinical data obtained in 27 patients who underwent ADF between 1996 and 2003. Mean duration of follow-up was 6.0 years (range, 2-10 years). Surgical outcomes were assessed using the Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy. Surgical results of ADF were compared with those of Laminoplasty, which was performed in 66 patients during the period 1986 and 1996. RESULTS: ADF yielded a better neurologic outcome at final follow-up than Laminoplasty in patients with occupying ratio > or =60%, although graft complications occurred in 15% and additional surgical intervention was required in 26%. Neither occupying ratio of OPLL, sagittal shape of ossification, nor cervical alignment was found to be related to surgical outcome of ADF. CONCLUSIONS: Although ADF is technically demanding and has a higher incidence of surgery-related complications, it is preferable to Laminoplasty for patients with occupying ratio of OPLL > or =60%.

  • subtotal corpectomy versus Laminoplasty for multilevel cervical spondylotic myelopathy a long term follow up study over 10 years
    Spine, 2001
    Co-Authors: Eiji Wada, Atsunori Kanazawa, Shimpei Miyamoto, S Suzuki, Takashi Matsuoka, Kazuo Yonenobu
    Abstract:

    STUDY DESIGN: A retrospective study was conducted. OBJECTIVE: To compare the long-term outcomes of subtotal corpectomy and Laminoplasty for multilevel cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: No study has compared the long-term outcomes between subtotal corpectomy and Laminoplasty for multilevel cervical spondylotic myelopathy. METHODS: In this study, 23 patients treated with subtotal corpectomy and 24 patients treated with Laminoplasty were followed up for 10 to 14 years after surgery. Neurologic recovery, late deterioration, axial pain, radiographic results (degenerative changes at adjacent levels, alignment, and range of motion of the cervical spine), and surgical complications were compared between the two groups. RESULTS: No significant difference in neurologic recovery was found between the two groups 1 and 5 years after surgery, or at the latest follow-up assessment. Neurologic status deteriorated in one patient of the subtotal corpectomy group because of adjacent degeneration, and in one patient of the Laminoplasty group because of hyperextension injury. Axial pain was observed in 15% of the corpectomy group and in 40% of the Laminoplasty group (P < 0.05). In the corpectomy group, listhesis exceeding 2 mm developed at 38% of the upper adjacent levels, and osteophyte formation at 54% of the lower adjacent levels. In the Laminoplasty group, kyphotic deformity developed in one patient (6%) after surgery. In the corpectomy group, the mean vertebral range of motion had decreased from 39.4 degrees to 19.2 degrees (49%) by the final follow-up assessment. In the Laminoplasty group, the mean vertebral range of motion had decreased from 40.2 degrees to 11.6 degrees (29%) by the final follow-up assessment. Neurologic complications related to the surgery occurred in two patients (one myelopathy from bone graft dislodgement and one C5 root palsy from bone graft fracture) of the corpectomy group and four patients (C5 root palsy) of the Laminoplasty group. All of these patients recovered over time. The corpectomy group needed longer operative time (P < 0.001) and tended to have more blood loss (P = 0.24). Six patients in the corpectomy group needed posterior interspinous wiring because of pseudarthrosis. CONCLUSIONS: Subtotal corpectomy and Laminoplasty showed an identical effect from a surgical treatment for multilevel cervical spondylotic myelopathy. These neurologic recoveries usually last more than 10 years. In the subtotal corpectomy group, the disadvantages were longer surgical time, more blood loss, and pseudarthrosis. In the Laminoplasty group, axial pain occurred frequently, and the range of motion was reduced severely.

  • Neck and shoulder pain after Laminoplasty. A noticeable complication.
    Spine, 1996
    Co-Authors: Noboru Hosono, Kazuo Yonenobu, Keiro Ono
    Abstract:

    Study Design. The authors retrospectively analyzed the prevalence and features of neck and shoulder pain (axial symptoms) after anterior interbody fusion and Laminoplasty in patients with cervical spondylotic myelopathy. Objectives. To reveal the difference in prevalence of postoperative axial symptoms between anterior interbody fusion and Laminoplasty and to clarify the pathogenesis of axial symptoms after Laminoplasty. Summary of Background Data. Out come of the cervical surgery is evaluated on neurologic status alone; axial symptoms after Laminoplasty rarely have been investigated. Such symptoms, however, are often severe enough to interfere with a person's daily activity. Methods. Ninety-eight patients had surgery for their disability secondary to cervical spondylotic myelopathy. Of those patients, 72 had Laminoplasty, and 26 had anterior interbody fusion. The presence or absence of axial symptoms was investigated before and after surgery. The duration, severity, and laterality of symptoms were also recorded. Results. The prevalence of postoperative axial symptoms was significantly higher after Laminoplasty than after anterior fusion (60% vs. 19%; P

  • neck and shoulder pain after Laminoplasty a noticeable complication
    Spine, 1996
    Co-Authors: Noboru Hosono, Kazuo Yonenobu, Keiro Ono
    Abstract:

    Study Design. The authors retrospectively analyzed the prevalence and features of neck and shoulder pain (axial symptoms) after anterior interbody fusion and Laminoplasty in patients with cervical spondylotic myelopathy. Objectives. To reveal the difference in prevalence of postoperative axial symptoms between anterior interbody fusion and Laminoplasty and to clarify the pathogenesis of axial symptoms after Laminoplasty. Summary of Background Data. Out come of the cervical surgery is evaluated on neurologic status alone; axial symptoms after Laminoplasty rarely have been investigated. Such symptoms, however, are often severe enough to interfere with a person's daily activity. Methods. Ninety-eight patients had surgery for their disability secondary to cervical spondylotic myelopathy. Of those patients, 72 had Laminoplasty, and 26 had anterior interbody fusion. The presence or absence of axial symptoms was investigated before and after surgery. The duration, severity, and laterality of symptoms were also recorded. Results. The prevalence of postoperative axial symptoms was significantly higher after Laminoplasty than after anterior fusion (60% vs. 19%; P<0.05). In 18 patients (25%) form the Laminoplasty group, the chief complaints after surgery were related to axial symptoms for more than 3 months, whereas in the anterior fusion groupo, no patient reported having such severe pain after surgery. Conclusions. The prevalence and severity of axial symptoms after Laminoplasty proved to be higher and more serious than has been believed. Such symptoms should be considered in the evaluation of the outcome of cervical spinal surgery.

Noboru Hosono - One of the best experts on this subject based on the ideXlab platform.

  • preservation of muscles attached to the c2 and c7 spinous processes rather than subaxial deep extensors reduces adverse effects after cervical Laminoplasty
    Spine, 2010
    Co-Authors: Hironobu Sakaura, Noboru Hosono, Yoshihiro Mukai, Motoki Iwasaki, Takahito Fujimori, Hideki Yoshikawa
    Abstract:

    Study design Prospective study. Objective To examine whether preservation of subaxial deep extensor muscles plays any significant role in reducing axial neck pain and unfavorable radiologic changes after cervical Laminoplasty in patients with cervical spondylotic myelopathy and to confirm the benefits of preserving muscles attached to the C2 and C7 spinous processes. Summary of background data Axial neck pain and unfavorable radiologic changes after cervical Laminoplasty have been reported to mostly result from detachment of cervical extensor muscles, particularly muscles attached to the C2 and C7 spinous processes. Other surgeons have reported that preservation of subaxial deep extensor muscles reduces these adverse effects after cervical Laminoplasty. Methods Subjects comprised 36 patients with cervical spondylotic myelopathy who underwent C3-C6 open-door Laminoplasty and were followed up for >24 months. Of these, 18 consecutive patients underwent our modified Laminoplasty (muscles-preserved group) and the remaining 18 consecutive patients underwent the conventional procedure (muscles-disrupted group). Both procedures preserved all muscles attached to the C2 and C7 spinous processes. Subaxial deep extensor muscles on the hinged side were also preserved in the muscles-preserved group. Radiologic and clinical data were prospectively collected. Results Both groups achieved equal neurologic improvement. Frequencies of axial neck pain showed no significant differences between groups. This value did not vary according to the side of preservation of subaxial deep extensor muscles or the side of muscle disruption. Postoperative loss of lordosis and range of motion of the cervical spine also demonstrated no significant difference between groups. Conclusion These results indicate that preservation of subaxial deep extensor muscles plays no significant role in reducing axial neck pain and unfavorable radiologic changes after cervical Laminoplasty, supporting the hypothesis that these adverse effects after Laminoplasty largely result from detachment of muscles attached to the C2 and C7 spinous processes.

  • C3-6 Laminoplasty takes over C3-7 Laminoplasty with significantly lower incidence of axial neck pain
    European spine journal : official publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cerv, 2006
    Co-Authors: Noboru Hosono, Hironobu Sakaura, Yoshihiro Mukai, Ryutaro Fujii, Hideki Yoshikawa
    Abstract:

    Five-lamina (C3-7) procedure is the most popular cervical Laminoplasty and there have been no studies on the most appropriate number of laminae to be opened. We prospectively reduced the range of Laminoplasty from C3-7 to C3-6 in 2002 and compared the outcome of C3-6 Laminoplasty (n=37) to that of C3-7 Laminoplasty (n=28). In both groups, neurological gain was satisfactory, radiographic changes were minimal, and postoperative MRI indicated sufficient expansion of the dura and the spinal cord. Average operating period was significantly shorter, and length of the operative wound was significantly less in the C3-6 group than in the C3-7 group. Postoperative axial neck pain was significantly rarer after C3-6 Laminoplasty than after C3-7 Laminoplasty (5.4% vs. 29%, P=0.015). Due to its simplicity and various benefits, C3-6 Laminoplasty is a promising alternative to conventional C3-7 Laminoplasty for treatment of multisegmental compression myelopathy.

  • Long-term outcome of Laminoplasty for cervical myelopathy due to disc herniation: a comparative study of Laminoplasty and anterior spinal fusion.
    Spine, 2005
    Co-Authors: Hironobu Sakaura, Noboru Hosono, Yoshihiro Mukai, Motoki Iwasaki, Takahiro Ishii, Hideki Yoshikawa
    Abstract:

    Study Design. A retrospective study was conducted. Objective. To compare the long-term outcomes after Laminoplasty and anterior spinal fusion (ASF) for cervical myelopathy secondary to disc herniation. Summary of Background Data. There have been no reports of long-term comparative studies of Laminoplasty and ASF for cervical myelopathy due to disc herniation. Methods. Of 21 patients who underwent ASF only between 1984 and 1987, 15 were followed up. Of 22 patients who underwent Laminoplasty only between 1987 and 1994, 18 were followed up. There were no significant differences in preoperative prognostic factors between the 2 groups. Average follow-up was 15 years in the ASF group and 10 years in the Laminoplasty group. Neurologic and radiologic results were examined. Results. Laminoplasty and ASF provided equal neurologic improvement. In the ASF group, additional surgery was required for bone graft complications in 2 patients and for adjacent spondylosis in 1. In the Laminoplasty group, one patient had C5 palsy, and intractable axial pain developed in 5 patients after surgery, but no patients needed additional surgery. Conclusions. Because the 2 procedures provided the same neurologic improvement, the risks of bone graft complication with ASF must be weighed against the risks of chronic neck pain associated with Laminoplasty for determining the best technique. Therefore, because our present surgical strategy for cervical myelopathy due to disc herniation, Laminoplasty is the procedure of choice except for a patient with single level disc herniation without developmental canal stenosis, who is considered to be a good candidate for ASF.

  • Laminoplasty for cervical myelopathy caused by subaxial lesions in rheumatoid arthritis
    Journal of Neurosurgery: Spine, 2004
    Co-Authors: Yoshihiro Mukai, Noboru Hosono, Hironobu Sakaura, Takahiro Ishii, Tsuyoshi Fuchiya, Keiju Fijiwara, Takeshi Fuji, Hideki Yoshikawa
    Abstract:

    Object. Although controversy exists regarding surgical treatment for rheumatoid subaxial lesions, no detailed studies have been conducted to examine the efficacy of Laminoplasty in such cases. To discuss indications for Laminoplasty in rheumatoid subaxial lesions, the authors retrospectively investigated clinical and radiological outcomes in patients who underwent Laminoplasty for subaxial lesions. Methods. Thirty patients (11 men and 19 women) underwent Laminoplasty for rheumatoid subaxial lesions. The patients were divided into those with mutilating-type rheumatoid arthritis (RA) and those with nonmutilating-type RA according to the number of eroding joints. As of final follow-up examination Laminoplasty resulted in improvement of myelopathy in 24 patients (seven with mutilating- and 17 with nonmutilating-type RA) and transient or no improvement in six (five with mutilating- and one with nonmutilating-type RA). In the group with mutilating-type RA, significantly poorer results were displayed (p < 0.05)....

  • Laminoplasty for cervical myelopathy caused by subaxial lesions in rheumatoid arthritis.
    Journal of neurosurgery, 2004
    Co-Authors: Yoshihiro Mukai, Noboru Hosono, Hironobu Sakaura, Takahiro Ishii, Tsuyoshi Fuchiya, Keiju Fijiwara, Takeshi Fuji, Hideki Yoshikawa
    Abstract:

    Although controversy exists regarding surgical treatment for rheumatoid subaxial lesions, no detailed studies have been conducted to examine the efficacy of Laminoplasty in such cases. To discuss indications for Laminoplasty in rheumatoid subaxial lesions, the authors retrospectively investigated clinical and radiological outcomes in patients who underwent Laminoplasty for subaxial lesions. Thirty patients (11 men and 19 women) underwent Laminoplasty for rheumatoid subaxial lesions. The patients were divided into those with mutilating-type rheumatoid arthritis (RA) and those with nonmutilating-type RA according to the number of eroding joints. As of final follow-up examination Laminoplasty resulted in improvement of myelopathy in 24 patients (seven with mutilating- and 17 with nonmutilating-type RA) and transient or no improvement in six (five with mutilating- and one with nonmutilating-type RA). In the group with mutilating-type RA, significantly poorer results were displayed (p < 0.05). In most patients preoperative radiographs demonstrated vertebral slippage less than or equal to 5 mm at only one or two levels. PostLaminoplasty deterioration of subaxial subluxation and unfavorable alignment change occurred significantly more often in patients with mutilating-type RA (p < 0.05). Patients with nonmutilating-type RA can benefit from Laminoplasty for myelopathy due to subaxial lesions.

Praveen V Mummaneni - One of the best experts on this subject based on the ideXlab platform.

  • Laminoplasty versus laminectomy with posterior spinal fusion for multilevel cervical spondylotic myelopathy influence of cervical alignment on outcomes
    Journal of Neurosurgery, 2017
    Co-Authors: Darryl Lau, Ethan A Winkler, Khoi D Than, Dean Chou, Praveen V Mummaneni
    Abstract:

    OBJECTIVE Cervical curvature is an important factor when deciding between Laminoplasty and laminectomy with posterior spinal fusion (LPSF) for cervical spondylotic myelopathy (CSM). This study compares outcomes following Laminoplasty and LPSF in patients with matched postoperative cervical lordosis. METHODS Adults undergoing Laminoplasty or LPSF for cervical CSM from 2011 to 2014 were identified. Matched cohorts were obtained by excluding LPSF patients with postoperative cervical Cobb angles outside the range of Laminoplasty patients. Clinical outcomes and radiographic results were compared. A subgroup analysis of patients with and without preoperative pain was performed, and the effects of cervical curvature on pain outcomes were examined. RESULTS A total of 145 patients were included: 101 who underwent Laminoplasty and 44 who underwent LPSF. Preoperative Nurick scale score, pain incidence, and visual analog scale (VAS) neck pain scores were similar between the two groups. Patients who underwent LPSF had significantly less preoperative cervical lordosis (5.8° vs 10.9°, p = 0.018). Preoperative and postoperative C2-7 sagittal vertical axis (SVA) and T-1 slope were similar between the two groups. Laminoplasty cases were associated with less blood loss (196.6 vs 325.0 ml, p < 0.001) and trended toward shorter hospital stays (3.5 vs 4.3 days, p = 0.054). The perioperative complication rate was 8.3%; there was no significant difference between the groups. LPSF was associated with a higher long-term complication rate (11.6% vs 2.2%, p = 0.036), with pseudarthrosis accounting for 3 of 5 complications in the LPSF group. Follow-up cervical Cobb angle was similar between the groups (8.8° vs 7.1°, p = 0.454). At final follow-up, LPSF had a significantly lower mean Nurick score (0.9 vs 1.4, p = 0.014). Among patients with preoperative neck pain, pain incidence (36.4% vs 31.3%, p = 0.629) and VAS neck pain (2.1 vs 1.8, p = 0.731) were similar between the groups. Similarly, in patients without preoperative pain, there was no significant difference in pain incidence (19.4% vs 18.2%, p = 0.926) and VAS neck pain (1.0 vs 1.1, p = 0.908). For Laminoplasty, there was a significant trend for lower pain incidence (p = 0.010) and VAS neck pain (p = 0.004) with greater cervical lordosis, especially when greater than 20° (p = 0.011 and p = 0.018). Mean follow-up was 17.3 months. CONCLUSIONS For patients with CSM, LPSF was associated with slightly greater blood loss and a higher long-term complication rate, but offered greater neurological improvement than Laminoplasty. In cohorts of matched follow-up cervical sagittal alignment, pain outcomes were similar between Laminoplasty and LPSF patients. However, among Laminoplasty patients, greater cervical lordosis was associated with better pain outcomes, especially for lordosis greater than 20°. Cervical curvature (lordosis) should be considered as an important factor in pain outcomes following posterior decompression for multilevel CSM.

  • anterior corpectomy versus posterior Laminoplasty is the risk of postoperative c 5 palsy different
    Neurosurgical Focus, 2011
    Co-Authors: Gurpreet S Gandhoke, Jauching Wu, Nathan C Rowland, Scott A Meyer, Camilla Gupta, Praveen V Mummaneni
    Abstract:

    Object Both anterior cervical corpectomy and fusion (ACCF) and Laminoplasty are effective treatments for selected cases of cervical stenosis. Postoperative C-5 palsies may occur with either anterior or posterior decompressive procedures; however, a direct comparison of C-5 palsy rates between the 2 approaches is not present in the literature. The authors sought to compare the C-5 palsy rate of ACCF versus Laminoplasty. Methods The authors conducted a retrospective review of 31 ACCF (at C-4 or C-5) and 31 instrumented Laminoplasty cases performed to treat cervical stenosis. The demographics of the groups were similar except for age (ACCF group mean age 53 years vs Laminoplasty group mean age 62 years, p = 0.002). The mean number of levels treated was greater in the Laminoplasty cohort (3.87 levels) than in the ACCF cohort (2.74 levels, p < 0.001). The mean preoperative Nurick grade of the Laminoplasty cohort (2.61) was higher than the mean preoperative Nurick grade of the ACCF cohort (1.10, p < 0.001). Res...

  • treatment of cervical stenotic myelopathy a cost and outcome comparison of Laminoplasty versus laminectomy and lateral mass fusion
    Journal of Neurosurgery, 2011
    Co-Authors: Jason M Highsmith, Gerald E Rodts, Sanjay S Dhall, Regis W Haid, Praveen V Mummaneni
    Abstract:

    Object Cervical stenotic myelopathy due to spondylosis or ossification of the posterior longitudinal ligament is often treated with Laminoplasty or cervical laminectomy (with fusion). The goal of this study was to compare outcomes, radiographic results, complications, and implant costs associated with these 2 treatments. Methods The authors analyzed the records of 56 patients (age range 42–81 years) who were surgically treated for cervical stenosis. Of this group, 30 underwent Laminoplasty and 26 underwent laminectomy with fusion. Patients who had cervical kyphosis or spondylolisthesis were excluded. An average of 4 levels were instrumented in the Laminoplasty group and 5 levels in the fusion group (p < 0.01). Forty-two percent of the fusions crossed the cervicothoracic junction, but no Laminoplasty instrumentation crossed the cervicothoracic junction, and it only reached C-7 in one-third of the cases. Preoperative and postoperative Nurick grades and modified Japanese Orthopaedic Association (mJOA) scores...

Hironobu Sakaura - One of the best experts on this subject based on the ideXlab platform.

  • preservation of muscles attached to the c2 and c7 spinous processes rather than subaxial deep extensors reduces adverse effects after cervical Laminoplasty
    Spine, 2010
    Co-Authors: Hironobu Sakaura, Noboru Hosono, Yoshihiro Mukai, Motoki Iwasaki, Takahito Fujimori, Hideki Yoshikawa
    Abstract:

    Study design Prospective study. Objective To examine whether preservation of subaxial deep extensor muscles plays any significant role in reducing axial neck pain and unfavorable radiologic changes after cervical Laminoplasty in patients with cervical spondylotic myelopathy and to confirm the benefits of preserving muscles attached to the C2 and C7 spinous processes. Summary of background data Axial neck pain and unfavorable radiologic changes after cervical Laminoplasty have been reported to mostly result from detachment of cervical extensor muscles, particularly muscles attached to the C2 and C7 spinous processes. Other surgeons have reported that preservation of subaxial deep extensor muscles reduces these adverse effects after cervical Laminoplasty. Methods Subjects comprised 36 patients with cervical spondylotic myelopathy who underwent C3-C6 open-door Laminoplasty and were followed up for >24 months. Of these, 18 consecutive patients underwent our modified Laminoplasty (muscles-preserved group) and the remaining 18 consecutive patients underwent the conventional procedure (muscles-disrupted group). Both procedures preserved all muscles attached to the C2 and C7 spinous processes. Subaxial deep extensor muscles on the hinged side were also preserved in the muscles-preserved group. Radiologic and clinical data were prospectively collected. Results Both groups achieved equal neurologic improvement. Frequencies of axial neck pain showed no significant differences between groups. This value did not vary according to the side of preservation of subaxial deep extensor muscles or the side of muscle disruption. Postoperative loss of lordosis and range of motion of the cervical spine also demonstrated no significant difference between groups. Conclusion These results indicate that preservation of subaxial deep extensor muscles plays no significant role in reducing axial neck pain and unfavorable radiologic changes after cervical Laminoplasty, supporting the hypothesis that these adverse effects after Laminoplasty largely result from detachment of muscles attached to the C2 and C7 spinous processes.

  • surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament part 1 clinical results and limitations of Laminoplasty
    Spine, 2007
    Co-Authors: Motoki Iwasaki, Kazuo Yonenobu, Hironobu Sakaura, Yoshihiro Mukai, Shinya Okuda, Akira Miyauchi, Hideki Yoshikawa
    Abstract:

    STUDY DESIGN: Retrospective study of 66 patients who underwent Laminoplasty for treatment of cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL). OBJECTIVES: The present study describes surgical results of Laminoplasty for treatment of cervical myelopathy due to OPLL and aims to clarify 1) factors predicting outcome and 2) limitations of Laminoplasty. SUMMARY OF BACKGROUND DATA: During the period 1986 and 1996, Laminoplasty was the only surgical treatment selected for cervical myelopathy at our institutions. METHODS: We reviewed data obtained in 66 patients who underwent Laminoplasty for treatment of cervical myelopathy due to OPLL. Mean duration of follow-up was 10.2 years (range, 5-20 years). Surgical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. RESULTS: Surgical outcome was significantly poorer in patients with occupying ratio greater than 60%. Multiple regression analysis showed that the most significant predictor of poor outcome after Laminoplasty was hill-shaped ossification, followed by lower preoperative JOA score, postoperative change in cervical alignment, and older age at surgery. CONCLUSIONS: Laminoplasty is effective and safe for most patients with occupying ratio of OPLL less than 60% and plateau-shaped ossification. However, neurologic outcome of Laminoplasty for cervical OPLL was poor or fair in patients with occupying ratio greater than 60% and/or hill-shaped ossification.

  • surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament part 2 advantages of anterior decompression and fusion over Laminoplasty
    Spine, 2007
    Co-Authors: Motoki Iwasaki, Kazuo Yonenobu, Hironobu Sakaura, Yoshihiro Mukai, Shinya Okuda, Akira Miyauchi, Hideki Yoshikawa
    Abstract:

    STUDY DESIGN: Retrospective study of 27 patients who underwent anterior decompression and fusion (ADF) for treatment of cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL). OBJECTIVES: To compare surgical outcome of ADF with that of Laminoplasty. SUMMARY OF BACKGROUND DATA: During the period 1986 and 1996, Laminoplasty was the only surgical treatment selected for cervical myelopathy at our institutions. According to surgical results of Laminoplasty performed during this period, we have performed either Laminoplasty or ADF for patients with OPLL since 1996. METHODS: We reviewed clinical data obtained in 27 patients who underwent ADF between 1996 and 2003. Mean duration of follow-up was 6.0 years (range, 2-10 years). Surgical outcomes were assessed using the Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy. Surgical results of ADF were compared with those of Laminoplasty, which was performed in 66 patients during the period 1986 and 1996. RESULTS: ADF yielded a better neurologic outcome at final follow-up than Laminoplasty in patients with occupying ratio > or =60%, although graft complications occurred in 15% and additional surgical intervention was required in 26%. Neither occupying ratio of OPLL, sagittal shape of ossification, nor cervical alignment was found to be related to surgical outcome of ADF. CONCLUSIONS: Although ADF is technically demanding and has a higher incidence of surgery-related complications, it is preferable to Laminoplasty for patients with occupying ratio of OPLL > or =60%.

  • C3-6 Laminoplasty takes over C3-7 Laminoplasty with significantly lower incidence of axial neck pain
    European spine journal : official publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cerv, 2006
    Co-Authors: Noboru Hosono, Hironobu Sakaura, Yoshihiro Mukai, Ryutaro Fujii, Hideki Yoshikawa
    Abstract:

    Five-lamina (C3-7) procedure is the most popular cervical Laminoplasty and there have been no studies on the most appropriate number of laminae to be opened. We prospectively reduced the range of Laminoplasty from C3-7 to C3-6 in 2002 and compared the outcome of C3-6 Laminoplasty (n=37) to that of C3-7 Laminoplasty (n=28). In both groups, neurological gain was satisfactory, radiographic changes were minimal, and postoperative MRI indicated sufficient expansion of the dura and the spinal cord. Average operating period was significantly shorter, and length of the operative wound was significantly less in the C3-6 group than in the C3-7 group. Postoperative axial neck pain was significantly rarer after C3-6 Laminoplasty than after C3-7 Laminoplasty (5.4% vs. 29%, P=0.015). Due to its simplicity and various benefits, C3-6 Laminoplasty is a promising alternative to conventional C3-7 Laminoplasty for treatment of multisegmental compression myelopathy.

  • Long-term outcome of Laminoplasty for cervical myelopathy due to disc herniation: a comparative study of Laminoplasty and anterior spinal fusion.
    Spine, 2005
    Co-Authors: Hironobu Sakaura, Noboru Hosono, Yoshihiro Mukai, Motoki Iwasaki, Takahiro Ishii, Hideki Yoshikawa
    Abstract:

    Study Design. A retrospective study was conducted. Objective. To compare the long-term outcomes after Laminoplasty and anterior spinal fusion (ASF) for cervical myelopathy secondary to disc herniation. Summary of Background Data. There have been no reports of long-term comparative studies of Laminoplasty and ASF for cervical myelopathy due to disc herniation. Methods. Of 21 patients who underwent ASF only between 1984 and 1987, 15 were followed up. Of 22 patients who underwent Laminoplasty only between 1987 and 1994, 18 were followed up. There were no significant differences in preoperative prognostic factors between the 2 groups. Average follow-up was 15 years in the ASF group and 10 years in the Laminoplasty group. Neurologic and radiologic results were examined. Results. Laminoplasty and ASF provided equal neurologic improvement. In the ASF group, additional surgery was required for bone graft complications in 2 patients and for adjacent spondylosis in 1. In the Laminoplasty group, one patient had C5 palsy, and intractable axial pain developed in 5 patients after surgery, but no patients needed additional surgery. Conclusions. Because the 2 procedures provided the same neurologic improvement, the risks of bone graft complication with ASF must be weighed against the risks of chronic neck pain associated with Laminoplasty for determining the best technique. Therefore, because our present surgical strategy for cervical myelopathy due to disc herniation, Laminoplasty is the procedure of choice except for a patient with single level disc herniation without developmental canal stenosis, who is considered to be a good candidate for ASF.

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