Zhiming Yu1, Da He2, Jiachao Xiong1, Zhimin Pan1,3, Lingxuan Feng1, Jiang Xu1, Zhimin Han4, Cristian Gragnaniello5, Hisashi Koga6, Kevin Phan7, Parisa Azimi8,9, Jong-Joo Lee10, Yoon Ha3, Kai Cao1. 1. Spine Center, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China. 2. Department of Spine Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing 100035, China. 3. Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea. 4. Department of Orthopaedics, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China. 5. Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA. 6. Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan. 7. NeuroSpine Surgery Research Group (NSURG); Prince of Wales Clinical School, University of New South Wales, Sydney, Australia. 8. Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 9. Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 10. Department of Neurosurgery, Bundang Jesaeng Hospital, Seongnam, Korea.
Abstract
BACKGROUND: Laminectomy and laminoplasty are popularly used in posterior cervical spine surgery but still have involved complications. We aimed to compare the clinical outcomes of microscope-assisted extensor muscle-preserving laminectomy (MA-EMPL) and open-door laminoplasty (ODLP) in treating multilevel cervical spondylotic myelopathy (MCSM). METHODS: A prospective study was designed to enroll twenty patients with MCSM underwent MA-EMPL, and recruit twenty-four patients with MCSM received ODLP (control). Radiographic measurements, outcome indicators including Japanese Orthopedic Association (JOA) score and visual analogue score (VAS) were used to evaluate technical effectiveness. Surgical complications were documented to assess technical safety. RESULTS: Postoperative cervical curvature index and range of neck motion (ROM) were not significantly changed except ROM in ODLP group. Postoperative JOA score and VAS in both groups showed improvements at final follow-up. There was no statistical difference in postoperative neurological recovery rates between two groups (67.6%±17.8% vs. 70.15%±19.6%, P=0.632). However, VAS was significantly lower at postoperative 1 month in MA-EMPL group compared with ODLP group (P<0.001). The incidences of C5 palsy were 0 vs. 16.7% between MA-EMPL group and ODLP group. There was no axial symptom occurred in MA-EMPL group while six patients in ODLP group (0 vs. 25%, P=0.049). In addition, the mean blood loss and hospital stay were lesser in MA-EMPL group compared with ODLP group (P<0.001, P=0.002, respectively). CONCLUSIONS: MA-EMPL is an effective, safe and minimally invasive method in treatment of MCSM. Compared with ODLP, MA-EMPL has advantage to decrease intraoperative blood loss, hospital stay, postoperative VAS and axial symptom, as well as preserve postoperative ROM. 2019 Annals of Translational Medicine. All rights reserved.
BACKGROUND: Laminectomy and laminoplasty are popularly used in posterior cervical spine surgery but still have involved complications. We aimed to compare the clinical outcomes of microscope-assisted extensor muscle-preserving laminectomy (MA-EMPL) and open-door laminoplasty (ODLP) in treating multilevel cervical spondylotic myelopathy (MCSM). METHODS: A prospective study was designed to enroll twenty patients with MCSM underwent MA-EMPL, and recruit twenty-four patients with MCSM received ODLP (control). Radiographic measurements, outcome indicators including Japanese Orthopedic Association (JOA) score and visual analogue score (VAS) were used to evaluate technical effectiveness. Surgical complications were documented to assess technical safety. RESULTS: Postoperative cervical curvature index and range of neck motion (ROM) were not significantly changed except ROM in ODLP group. Postoperative JOA score and VAS in both groups showed improvements at final follow-up. There was no statistical difference in postoperative neurological recovery rates between two groups (67.6%±17.8% vs. 70.15%±19.6%, P=0.632). However, VAS was significantly lower at postoperative 1 month in MA-EMPL group compared with ODLP group (P<0.001). The incidences of C5 palsy were 0 vs. 16.7% between MA-EMPL group and ODLP group. There was no axial symptom occurred in MA-EMPL group while six patients in ODLP group (0 vs. 25%, P=0.049). In addition, the mean blood loss and hospital stay were lesser in MA-EMPL group compared with ODLP group (P<0.001, P=0.002, respectively). CONCLUSIONS: MA-EMPL is an effective, safe and minimally invasive method in treatment of MCSM. Compared with ODLP, MA-EMPL has advantage to decrease intraoperative blood loss, hospital stay, postoperative VAS and axial symptom, as well as preserve postoperative ROM. 2019 Annals of Translational Medicine. All rights reserved.
Authors: Daniel J Blizzard; Adam M Caputo; Charles Z Sheets; Mitchell R Klement; Keith W Michael; Robert E Isaacs; Christopher R Brown Journal: Eur Spine J Date: 2016-08-23 Impact factor: 3.134