Evaluation of result of lumbar laminoplasty for multilevel lumbar canal stenosis

<p class="Abstract">The aim of our study is to evaluate the clinical and functional outcome following lumbar laminoplasty with posterior element reconstruction with mini-plate and screws for multilevel lumbar canal stenosis. This study was done on 40 patients (18 males and 22 females) of degenerative multilevel lumber canal stenosis patients underwent open double door lumbar laminoplasty with posterior element reconstruction with mini-plate and screws from January 2015 to June 2018. Thirty four patients underwent surgery for 2 level involvement and 6 underwent for 3 level involvement of lumbar canal stenosis. The mean post-operative hospital stay was 5.2 ± 1.1 days. Per-operative complication was dural tear in 2 cases. Pre-operative mean VAS score of back pain and leg pain were 7.0 ± 0.7 and 7.2 ± 1.1 which were significantly reduced to 1.0 ± 0.2 and 1.0 ± 0.8 respectively at final follow-up. All patients were followed-up for minimum 1 year. Pre-operative mean Japanese Orthopedic Association score was 8.6 ± 2.2 which was significantly increased to 14.8 ± 0.4 after 12 months of surgery. Pre-operative mean Oswestry Disability Index was 34.4 ± 3.0 which was significantly reduced to 8.5 ± 2.2 after 12 months of surgery. The outcome of lumbar laminoplasty with posterior element reconstruction with mini-plate and screws for multilevel lumbar canal stenosis show good result and can be one of the good option for the treatment for multilevel lumbar canal stenosis.</p>

Minimally Invasive Microscopic Posterior Cervical Decompression: Simple, Safe, and Effective

Background and Study Aims Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in the elderly population. Surgery is usually successful in preventing any deterioration, as well as improving functional status and quality of life. This study assesses the safety and efficacy of minimally invasive microscopic posterior cervical decompression for the treatment of CSM. Materials and Methods A retrospective review of patients with myelopathy from cervical stenosis treated with minimally invasive posterior cervical decompression was performed. The operation was performed through a nonexpandable tubular retractor and operating microscope. Results Twelve patients were identified. There were no early or late complications. Average age was 74.5 years. Three patients were > 80 years of age and tolerated the operation extremely well. Three cases were two-level decompressions; nine were single level. Eight patients were operated on as elective cases, with average postoperative length of stay of 0.9 days. Average surgical time was 77.5 minutes per level. Postoperative neck pain was minimal (1.5/10). All patients improved postoperatively, particularly those who started with severe deficits. In fact, five patients were unable to walk preoperatively and were wheelchair- or bed-bound, and they returned to walking within weeks. The modified Japanese Orthopedic Association score improved from 8.4 (range: 4–14) to 13.5 (range: 10–15); the Nurick score changed from 3.8 (range: 2–5) to 2.3 (range: 1–4). Conclusions Minimally invasive microscopic posterior cervical decompression is a safe and effective treatment for CSM in selected cases. Our initial experience highlights the potential benefits of this relatively new technique.

A Prospective, Randomized Trial Comparing Expansile Cervical Laminoplasty and Cervical Laminectomy and Fusion for Multilevel Cervical Myelopathy

BACKGROUND: Controversy exists as to the best posterior operative procedure to treat multilevel compressive cervical spondylotic myelopathy. OBJECTIVE: To determine clinical, radiological, and patient satisfaction outcomes between expansile cervical laminoplasty (ECL) and cervical laminectomy and fusion (CLF). METHODS: We performed a prospective, randomized study of ECL vs CLF in patients suffering from cervical spondylotic myelopathy. End points included the Short Form-36, Neck Disability Index, Visual Analog Scale, modified Japanese Orthopedic Association score, Nurick score, and radiographic measures. RESULTS: A survey of academic North American spine surgeons (n = 30) demonstrated that CLF is the most commonly used (70%) posterior procedure to treat multilevel spondylotic cervical myelopathy. A total of 16 patients were randomized: 7 to CLF and 9 to ECL. Both groups showed improvements in their Nurick grade and Japanese Orthopedic Association score postoperatively, but only the improvement in the Nurick grade for the ECL group was statistically significant (P &lt; .05). The cervical range of motion between C2 and C7 was reduced by 75% in the CLF group and by only 20% in the ECL group in a comparison of preoperative and postoperative range of motion. The overall increase in canal area was significantly (P &lt; .001) greater in the CLF group, but there was a suggestion that the adjacent level was more narrowed in the CLF group in as little as 1 year postoperatively. CONCLUSION: In many respects, ECL compares favorably to CLF. Although the patient numbers were small, there were significant improvements in pain measures in the ECL group while still maintaining range of motion. Restoration of spinal canal area was superior in the CLF group.

Postoperative Magnetic Resonance Imaging Can Predict Neurological Recovery After Surgery for Cervical Spondylotic Myelopathy: A Prospective Study With Blinded Assessments

BACKGROUND: Factors that can predict the recovery of cervical spondylotic myelopathy (CSM) patients postoperatively are of significant interest to physicians and patients and their families. Magnetic resonance imaging (MRI) scans are a common method of examination after surgery, and thus of interest as a predictor of outcome. OBJECTIVE: To investigate whether findings on MRI at 6 months postoperatively could predict recovery at 1 year in CSM patients. METHODS: In 52 consecutive prospective patients, MRI was performed preoperatively and 6 months postoperatively. T1 and T2 signal change (area, height, and segmentation) and spinal cord re-expansion were measured. Outcome measures evaluated at 1 year postoperatively were compared with preoperative values. Univariate and stepwise multiple regressions were undertaken. RESULTS: Using univariate analysis, patients whose cord failed to re-expand had poorer outcome according to the modified Japanese Orthopedic Association score and Nurick score (P = .014) and grip test (P = .006) postoperatively. Stepwise multivariate regression showed lack of cord re-expansion to be predictive of prognosis postoperatively in the modified Japanese Orthopedic Association score (P = .013) and Berg Balance Scale (P = .014), and walking test (P = .011). Postoperative hyperintense T2 signal change was predictive of worse outcome on the Berg Balance Scale (P = .014) and walking test (P = .020), Nurick score (P = .001), and Short Form-36 scores (P = .020). In cases in which the T2 signal intensified, there was a poorer outcome on Nurick scores (P = .013), grip test (P = .017), and Short Form-36 scores (P = .030). CONCLUSION: Findings on postoperative MRI at 6 months is of predictive value in determining outcomes in CSM patients. The persistence and type of T2 signal change and lack of re-expansion of the cord correlate with poorer recovery and likely reflect irreversible structural changes in the spinal cord.