Kazunari Takeuchi1, Toru Yokoyama2, Takuya Numasawa3, Taito Itabashi4, Yoshihito Yamasaki5, Hitoshi Kudo6. 1. Department of Orthopedic Surgery, Odate Municipal General Hospital, 3-1 Yutaka-cho, Odate, Akita, 017-0885, Japan. t11161968@yahoo.co.jp. 2. Department of Orthopedic Surgery, Odate Municipal General Hospital, 3-1 Yutaka-cho, Odate, Akita, 017-0885, Japan. 3. Department of Orthopedic Surgery, Hachinohe City Hospital, 1 Tamukai Bisyamonntai, Hachinohe, Aomori, 031-8555, Japan. 4. Department of Orthopedic Surgery, Towada City Hospital, 14-8 Nishi Juniban-cho, Towada, Aomori, 034-0093, Japan. 5. Department of Orthopedic Surgery, Aomori City Hospital, 1-14-20 Katsuta, Aomori, Aomori, 030-0821, Japan. 6. Department of Orthopaedic Surgery, Hirosaki University School of Medicine, 53 Hon-cho, Hirosaki, Aomori, 036-8563, Japan.
Abstract
PURPOSE: To present a novel posterior approach in multilevel cervical posterior decompression and fusion (PDF) using C2 pedicle screws that preserves the rectus capitis posterior major, oblique capitis inferior, and semispinalis cervicis. METHODS: We analyzed 30 consecutive patients who underwent C2-T1 PDF using an approach that preserved these three muscles without resecting. We assessed O-C2 range of motion (ROM), cross-sectional area of the cervical posterior muscles, rotational ROM, visual analog scale (VAS) for axial pain, neck disability index (NDI), and limitations of activities of daily living (ADL) involving neck movements. RESULTS: Mean preoperative O-C2 ROM (23.6°) was significantly increased postoperatively (33.0°). Mean atrophy rate of the cross-sectional area was 3.9%. Postoperatively, 69.8% of the preoperative rotational ROM (113.3°) was retained. The preoperative VAS for axial pain and the NDI did not increase postoperatively. The postoperative O-C2 ROM (33.9°) in 26 patients for whom extension ADL were possible was significantly larger than that in four patients for whom extension ADL were impossible (26.9°). The postoperative retained rate of rotational ROM (75.8%) in 18 patients for whom rotation ADL were possible was significantly larger than that in 12 patients for whom rotation ADL were impossible (62.3%). CONCLUSIONS: This is potentially an effective approach for maintaining O-C2 ROM and rotational ROM, which enabled good levels of ADL after C2-T1 PDF. Axial pain and NDI were not worse after PDF.
PURPOSE: To present a novel posterior approach in multilevel cervical posterior decompression and fusion (PDF) using C2 pedicle screws that preserves the rectus capitis posterior major, oblique capitis inferior, and semispinalis cervicis. METHODS: We analyzed 30 consecutive patients who underwent C2-T1 PDF using an approach that preserved these three muscles without resecting. We assessed O-C2 range of motion (ROM), cross-sectional area of the cervical posterior muscles, rotational ROM, visual analog scale (VAS) for axial pain, neck disability index (NDI), and limitations of activities of daily living (ADL) involving neck movements. RESULTS: Mean preoperative O-C2 ROM (23.6°) was significantly increased postoperatively (33.0°). Mean atrophy rate of the cross-sectional area was 3.9%. Postoperatively, 69.8% of the preoperative rotational ROM (113.3°) was retained. The preoperative VAS for axial pain and the NDI did not increase postoperatively. The postoperative O-C2 ROM (33.9°) in 26 patients for whom extension ADL were possible was significantly larger than that in four patients for whom extension ADL were impossible (26.9°). The postoperative retained rate of rotational ROM (75.8%) in 18 patients for whom rotation ADL were possible was significantly larger than that in 12 patients for whom rotation ADL were impossible (62.3%). CONCLUSIONS: This is potentially an effective approach for maintaining O-C2 ROM and rotational ROM, which enabled good levels of ADL after C2-T1 PDF. Axial pain and NDI were not worse after PDF.
Entities:
Keywords:
Muscle preservation; Ossification of the posterior longitudinal ligament; Posterior approach; Posterior decompression and fusion; Range of motion