| Part I The technique note of modified laminplasty which preserving the cervical extensors and its initial applications[Abstract] Objective To introduce a new modified laminplasty which preserving the cervical extensors and evaluate the clinical efficacy. Methods 21 patients with multilevel cervical myelopathy at our hospital between November 2010 and November 2011 were treated by the modified laminplasty which preserving the cervical extensors. There were 14 male patients and 7 female patients. The age of patients was from 40 to 72(average age 54.9). There were 21 patients of multilevel cervical spondylotic myelopathy,6 patients of ossification of the posterior longitudinal ligament and 3 patients of developmental cervical stenosis. The operation time, blood loss, postoperative complications, visual analogue scale (VAS), neck disability index(NDI), short form 36 questionnaire (SF-36) and Japanese Orthopedic Association Scores (JOA) were recorded. The cervical coronal alignment, sagittal alignment and range of motion for C2-C7 were measured by cervical X-ray radiographs. The decompression status of cervical spinal cord were evaluated by cervical MRI. Results All patients were fulfilled the operation successfully. The operation time was 196 minutes in average(range:170-240min), and the blood loss was 336 mL in average(range:150-700mL), the drainage volume was 160 mL in average(range:50?330mL), and the days in hospital was 13.2 in average(range:8-19days). There were no severe complications during and after operation except for a case of C5 nerve root palsy and a case of incision fat liquefaction. Three patients suffered from axis symptom in neck and shoulder region, but there were no severe pain and no further therpy were needed. There were significant difference of VAS score, NDI score, SF-36 score and JOA score at last follow-up(P<0.05). The excellent and good rate of JOA improvement was 85.7%. There were no significant difference statistically in coronal and sagittal C2-7 Cobb angle. But the cervical range of motion decreased at the last follow-up. Conclusions The modified laminplasty which preserving the cervical extensors was safe and effective in the treatment of multilevel cervical myelopathy. The rate of axis symptom was lower, and it could decrease the damage for cervical extensors and preserve the spinous process-ligament-muscle complex, which can maintain the cervical lordosis. It is a new and effective surgery for multilevel cervical myelopathy which worthy further popularizing.Part II The outcomes of modified laminplasty which preserving the cervical extensors compared with traditional laminplasty using posterior midline approach.[Abstract] Objective To compare the clinical outcomes of modified laminplasty which preserving the cervical extensors and traditional laminplasty using posterior midline approach in the treatment of patients with multilevel cervical myelopathy. Methods 45 patients with multilevel cervical myelopathy at our hospital between November 2010 and November 2011 were treated by posterior laminplasty,21 patients of the modified laminplasty group were matched to 24 patients of traditional laminplasty group. The operation time, blood loss, postoperative complications, visual analogue scale (VAS), neck disability index(NDI), short form 36 questionnaire (SF-36) and Japanese Orthopedic Association Scores (JOA) were recorded. The cervical coronal alignment, sagittal alignment, cervical curvature index(CCI) and range of motion for C2-C7 were measured by cervical X-ray radiographs. The expanded canal area and lamina open angles in expansion were measured by CT scans. And the atrophy rate of cervical extensors were measured by MRI.Results All patients had an improvement of neurological function without serious complications in both groups, but the modified laminplasty group had a higher operation time and blood loss compared to the traditional lamniplasty group(P<0.05). There were no difference in VAS score and JOA score at last follow-up between the two group(P>0.05). On the contrary, NDI score and SF-36 score had a significant difference statistically between the two group(P<0.05). And there were significant difference in cervical curvature index, CO-7 ROM and C2-7 ROM between the two group(P<0.05). Conclusions The modified laminplasty which preserving the cervical extensors and traditional laminplasty using posterior midline approach in the treatment of patients with multilevel cervical myelopathy had a similar outcome in improvement of neurological function. But there were lesser axis symptom rate, higher life quality, better cervical alignment, lesser decrease in cervical range of motion in modified laminplasty compared to traditional laminplasty... |
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