A New Posterior Extensor Attachment-Point Reconstruction Technique for Cervical Spondylotic Myelopathy Involving C2 Segment: Clinical Outcome and Safety
Background and Study Aim Cervical spondylotic myelopathy (CSM) is a common degenerative disease that mainly occurs in elder patients, leading to different degrees of neurological dysfunction. Spinal cord involvement is mainly distributed at the C3–C7 segments, but it may also involve up to the C2 level. This study aimed to assess the clinical efficacy and safety of open-door laminoplasty using a new extensor attachment-point reconstruction technique for treating CSM involving the C2 segment.
Patients and Methods Fifty-nine patients with CSM involving the C2 segment and undergoing open-door laminoplasty were included in this retrospective study. Based on the titanium plate used in the operation, patients were divided into two groups, a reconstructed titanium plate fixation (RPF) group (n = 28) and a conventional titanium plate fixation (CPF) group (n = 31). Improvements in neurological function, cervical range of motion (ROM), cervical curvature index (CCI), preservation of posterior cervical muscle mass, and axial symptoms were compared between the two groups.
Results There were no significant differences in operative time and intraoperative blood loss between the groups (p > 0.05). The Japanese Orthopaedic Association (JOA) score significantly increased in both groups postsurgery (p < 0.05); the neurological recovery rate was similar between the two groups (64.1 ± 13.3% vs. 65.9 ± 14.7%, p > 0.05). There was no significant loss of cervical ROM in either group (p > 0.05). The anteroposterior dural sac diameter at the C2 level was significantly enlarged in both groups (p < 0.05). Alternatively, CCI was significantly reduced in the CRP group (p < 0.05) but unchanged in the RPF group (p > 0.05). The cross-sectional area of the posterior cervical muscles was also significantly reduced in the CPF group (p < 0.05) but maintained in the RPF group (p > 0.05). Finally, axial symptoms were more severe in the CPF group than in the RPF group (p < 0.05).
Conclusion Laminoplasty is an effective surgical procedure for CSM involving the C2 segment. The reconstructed titanium plate achieved superior maintenance of cervical curvature and reduced both muscle atrophy and severity of axial symptoms compared with titanium conventional plates.
Received: 02 September 2019
Accepted: 20 December 2019
22 December 2020 (online)
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- 1 Zhang J, Hirabayashi S, Saiki K, Sakai H. Effectiveness of multiple-level decompression in laminoplasty and simultaneous C1 laminectomy for patients with cervical myelopathy. Eur Spine J 2006; 15 (09) 1367-1374
- 2 Takeshita K, Seichi A, Akune T, Kawamura N, Kawaguchi H, Nakamura K. Can laminoplasty maintain the cervical alignment even when the C2 lamina is contained?. Spine 2005; 30 (11) 1294-1298
- 3 Kunakornsawat S, , Letho, Pluemvitayaporn T. et al. Variation of C1 spinolaminar line and prevalence of C1 stenosis in normal population. Eur J Orthop Surg Traumatol 2018; 28 (06) 1029-1032
- 4 Zhao B, Wang YF, Lu XD. et al. Extended to Cl, 2 spinal posterior cervical open-door expansion of the angioplasty treatment combined with cervical spinal stenosis. Zhonghua Guke Zazhi 2016; 36: 598-604
- 5 Nori S, Iwanami A, Yasuda A. et al. Risk factor analysis of kyphotic malalignment after cervical intramedullary tumor resection in adults. J Neurosurg Spine 2017; 27 (05) 518-527
- 6 Cheng Z, Chen W, Yan S, Li W, Qian S. Expansive open-door cervical laminoplasty: in situ reconstruction of extensor muscle insertion on the C2 spinous process combined with titanium miniplates internal fixation. Medicine (Baltimore) 2015; 94 (28) e1171
- 7 Ikuma H, Shinohara K, Maehara T, Yokoyama Y, Tanaka M. C2 lamina reconstruction using locking miniplate for the intradural tumor of the craniocervical junction (two case reports). Eur Spine J 2012; 21 (Suppl. 04) S509-S512
- 8 Hosono N, Sakaura H, Mukai Y, Fujii R, Yoshikawa H. C3-6 laminoplasty takes over C3-7 laminoplasty with significantly lower incidence of axial neck pain. Eur Spine J 2006; 15 (09) 1375-1379
- 9 Nakashima H, Kato F, Yukawa Y. et al. Comparative effectiveness of open-door laminoplasty versus French-door laminoplasty in cervical compressive myelopathy. Spine 2014; 39 (08) 642-647
- 10 Kowatari K, Ueyama K, Sannohe A, Yamasaki Y. Preserving the C7 spinous process with its muscles attached: effect on axial symptoms after cervical laminoplasty. J Orthop Sci 2009; 14 (03) 279-284
- 11 Takeuchi K, Yokoyama T, Aburakawa S. et al. Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3-C7 laminoplasty: a modified laminoplasty preserving the semispinalis cervicis inserted into axis. Spine 2005; 30 (22) 2544-2549
- 12 Qian S, Wang Z, Jiang G, Xu Z, Chen W. Efficacy of laminoplasty in patients with cervical kyphosis. Med Sci Monit 2018; 24: 1188-1195
- 13 Choi I, Roh SW, Rhim SC, Jeon SR. The time course of cervical alignment after cervical expansive laminoplasty: determining optimal cut-off preoperative angle for predicting postoperative kyphosis. Medicine (Baltimore) 2018; 97 (47) e13335
- 14 Lin S, Zhou F, Sun Y, Chen Z, Zhang F, Pan S. The severity of operative invasion to the posterior muscular-ligament complex influences cervical sagittal balance after open-door laminoplasty. Eur Spine J 2015; 24 (01) 127-135
- 15 Jiang JL, Tian W. Axial symptoms after cervical laminoplasty. Zhonghua Guke Zazhi 2017; 37: 569-576
- 16 Matsuzaki H, Hoshino M, Kiuchi T, Toriyama S. Dome-like expansive laminoplasty for the second cervical vertebra. Spine 1989; 14 (11) 1198-1203
- 17 Sciubba DM, Chaichana KL, Woodworth GF, McGirt MJ, Gokaslan ZL, Jallo GI. Factors associated with cervical instability requiring fusion after cervical laminectomy for intradural tumor resection. J Neurosurg Spine 2008; 8 (05) 413-419
- 18 Abdullah KG, Yamashita T, Steinmetz MP. et al. Open-door cervical laminoplasty with preservation of posterior structures. Global Spine J 2012; 2 (01) 15-20
- 19 Zhao YJ, Cheng C, Chen HW, Li M, Wang L, Guo ZY. Limited laminectomy and foraminal decompression combined with internal fixation for treating multi-segment cervical spondylotic myelopathy: does it effectively improve neurological function and prevent C5 palsy?. Medicine (Baltimore) 2018; 97 (47) e13327
- 20 Wang M, Luo XJ, Deng QX, Li JH, Wang N. Prevalence of axial symptoms after posterior cervical decompression: a meta-analysis. Eur Spine J 2016; 25 (07) 2302-2310
- 21 Kotani Y, Abumi K, Ito M. et al. Impact of deep extensor muscle-preserving approach on clinical outcome of laminoplasty for cervical spondylotic myelopathy: comparative cohort study. Eur Spine J 2012; 21 (08) 1536-1544
- 22 Yoon SY, Moon HI, Lee SC, Eun NL, Kim YW. Association between cervical lordotic curvature and cervical muscle cross-sectional area in patients with loss of cervical lordosis. Clin Anat 2018; 31 (05) 710-715