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      Volumetric analysis of bilateral spinal canal decompression via hemilaminectomy versus laminoplasty in cervical spondylotic myelopathy

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          Abstract

          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.

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          Most cited references17

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          Expansive open-door laminoplasty for cervical spinal stenotic myelopathy.

          Although the operative results have been improving since the air drill was introduced for cervical laminectomy instead of an ordinary rongeur, post-laminectomy complications, such as postoperative fragility of the cervical spine to acute neck trauma, posterior spur formation at the vertebral body, and malalignment of the lateral curvature have still remained as unsolved problems. In order to avoid these disadvantages, a new surgical technique called "expansive open-door laminoplasty" was devised by the author in 1977, which is relatively easier, safer, and better than the ordinary laminectomy from the standpoint of structural mechanics of the cervical spine. The operative procedure is described in detail. Operative results in the patients with cervical OPLL, spondylosis, and canal stenosis were satisfactory, and optimal widening of the AP diameter of the spinal canal is considered to be over 4 mm. From this procedure a bilateral, open-door laminoplasty has been devised for extensive exploration at the intradural space.
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            Technical improvements and results of laminoplasty for compressive myelopathy in the cervical spine.

            The laminoplasty reported in Spine 1982 by the author (H.T.) was modified by a technical improvement to obtain a more reliable enlargement of the cervical spinal canal. The technical improvements and results are described in detail. The osteotomized laminae that floated en bloc like a hinged door must be stabilized by bone blocks with wire ligatures. Thirty patients with severe cervical myelopathy due to multisegmental spondylosis or ossification of posterior longitudinal ligament underwent surgery. The extent of the enlargement of the canal was 4.1 mm on the average in the anteroposterior diameter, and in no case was a significant reduction in the diameter of the canal noted during the follow-up period. A stable and thorough decompression of the spinal canal was noted on the postoperative computed tomograms with satisfactory surgical results.
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              Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord.

              A study to measure the shifts of the spinal cords and the effects of decompression laminoplasty in 65 patients with cervical lesions who underwent computed tomographic myelography before and after laminoplasty. To investigate limitations of the spinal cord posterior shift after laminoplasty and to clarify the optimal decompression areas to obtain effective posterior shifting. Although several types of laminoplasty have been performed, all procedures share the common purpose of posterior decompression. No previous studies have examined the limitations of posterior decompression or the optimal decompression range. The distance from the posterior edge of each vertebral body or disc level to the posterior edge of the spinal cord was measured by computed tomographic myelography. After the posterior shift was determined by calculating the difference between pre- and postsurgical distances, the relations between posterior shift and neck alignment, clinical results, and the areas of decompression were analyzed. The spinal cord shift ranged from a maximum of 6.6 mm to a minimum of 0 mm. Clinically, spinal cord shifts greater than 3 mm were associated with good clinical outcomes. Upward or downward advanced laminoplasty was related to larger spinal cord shifts at the upper or lower cervical spine. A mean spinal cord shift of > 3 mm was associated with good clinical outcomes after laminoplasty. In cases with compressive lesions at the upper or lower cervical spine, extension of decompression one level above or one level below likely results in a greater posterior spinal cord shift at these lesions.
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                Author and article information

                Contributors
                silvia.hernandez@med.uni-goettingen.de
                Journal
                Acta Neurochir (Wien)
                Acta Neurochir (Wien)
                Acta Neurochirurgica
                Springer Vienna (Vienna )
                0001-6268
                0942-0940
                25 June 2020
                25 June 2020
                2020
                : 162
                : 9
                : 2069-2074
                Affiliations
                [1 ]GRID grid.7450.6, ISNI 0000 0001 2364 4210, Department of Neurological Surgery, , Universitaetsmedizin Goettingen, ; Robert-Koch-Str. 40, 37075 Goettingen, Germany
                [2 ]Department of Neurological Surgery, Stadt Krankenhaus Korbach gGmbH, Dr.-Hartwig-Str. 19, 34497 Korbach, Germany
                [3 ]GRID grid.7450.6, ISNI 0000 0001 2364 4210, Department of Neuroradiology, , Universitaetsmedizin Goettingen, ; Robert-Koch-Str. 40, 37075 Goettingen, Germany
                [4 ]GRID grid.465291.d, ISNI 0000 0000 9253 1263, Department of Neurological Surgery, , Klinikum Vest GmbH, ; Dorstener Str. 151, 45657 Recklinghausen, Germany
                Author information
                http://orcid.org/0000-0003-0959-8697
                Article
                4453
                10.1007/s00701-020-04453-z
                7415020
                32583084
                fd463670-3179-45cc-8aa9-00b198206d25
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 28 April 2020
                : 8 June 2020
                Funding
                Funded by: Georg-August-Universität Göttingen (1018)
                Categories
                Original Article - Spine degenerative
                Custom metadata
                © Springer-Verlag GmbH Austria, part of Springer Nature 2020

                Surgery
                cervical spondylotic myelopathy,laminoplasty,laminotomy,volume gain
                Surgery
                cervical spondylotic myelopathy, laminoplasty, laminotomy, volume gain

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