Cervical Vertebrae/surgery* ; Esophagus ; Humans ; Spinal Fusion ; Spinal Osteophytosis ; Spondylosis/surgery*

Cervical Vertebrae ; Exostoses, Multiple Hereditary ; Humans ; Spinal Cord Compression ; Spinal Osteophytosis

OBJECTIVE: The aim of this study was to compare geometrically cross-sectional areas of two different laminoplasty techniques in same opening size. Some investigators have studied the expanded areas of the two different techniques using imaging study. Although it is unclear that postoperative spinal canal is correlated with the surgical outcome we just focused on mathematical and geometrical correlation of the expandable area with surgical opening size in different laminoplasty techniques. METHODS: To predict the expandable area by a midline splitting technique and a unilateral open door technique, we placed an imaginary isosceles triangle in the spinal canal and drew graphs for the equation of the expandable areas in same opening size using the Pythagorean theorem and mathematical program. To substitute the constant figures of mathematical formula we estimated the normal cervical spine CT scans of 50 Korean adults. RESULTS: We subtracted the imaginary triangle from the spinal canal and were left with the remaining area of the spinal canal that was not changed before and after surgery. In same opening size the expandable area by the midline splitting technique was same but slightly wider than the unilateral open door technique, irrespective of the triangular shape. For a normal isosceles triangle the results were the same. CONCLUSION: Using mathematical proof, the expandable area after the midline splitting technique was same but slightly larger than that after the unilateral open door technique, irrespective of the size of the lamina opening.
Adult ; Cervical Vertebrae ; Female ; Humans ; Ossification of Posterior Longitudinal Ligament ; Research Personnel ; Spinal Canal ; Spinal Cord Compression ; Spinal Osteophytosis ; Spine ; Tomography, X-Ray Computed

OBJECTIVETo study the microsurgical decompression combined with cervical artificial disc replacement clinical efficacy for the treatment of cervical spondylosis.

METHODSFrom January 2006 to November 2011, 21 cases of cervical spondylosis, totally 23 intervertebral spaces, were under the microscope disc decompression and cervical artificial disc replacement. There were 11 male and 10 female patients; aged from 28 to 60 years, with an average of 46.3 years. The diagnosis included 5 cases of nerve root type cervical spondylosis and 16 cases of cervical spondylotic myelopathy. Application of Bryan prosthesis treatment of 9 patients, a total of 10 intervertebral spaces; ProDisc-C prosthesis to treat 12 patients, a total of 13 intervertebral space. Following-up Japanese Orthopedic Association (JOA), neck disability index (NDI) and visual analogue scale (VAS) scores were recorded and compared with pre-operative scores by the paired t-test.

RESULTSThe patients were followed up for 6 to 74 months, with an average of 27.7 months. Although a patient with spinal bony stenosis symptom improved, but not satisfied, and after the posterior decompression, who had a better prognosis. The remaining patients during follow-up symptoms were obvious improved, and the replacement segments were stable. There was no prosthesis subsidence and significantly offset. In 1 month post-operation and last follow-up compared with pre-operative scores, JOA (t = 9.195 and 17.070), NDI (t = 7.193 and 14.062) and VAS (t = 14.851 and 16.133) scores were significantly different (P < 0.05); and 1 month post-operation compared with last follow-up, JOA (t = 5.916), NDI (t = 7.722) and VAS (t = 4.564) scores were significantly different (P < 0.05).

CONCLUSIONSCervical artificial disc replacement combined with microscopic decompression surgery can completely remove the oppression of nerve tissue caused by pressure, and the efficacy is more secure.

Adult ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Microsurgery ; Middle Aged ; Spinal Osteophytosis ; surgery ; Spinal Stenosis ; surgery ; Total Disc Replacement ; Treatment Outcome

OBJECTIVETo observe and compare the medium-long-term efficacy of Kurokawa's and modified Kurokawa's double door laminoplasty for the treatment of cervical disorders.

METHODSA retrospective analysis was performed to compare the outcomes and complications between two kinds of operations on 172 cases from January 2002 to December 2010, including 106 cases of cervical spondylotic myelopathy, 52 cases of cervical stenosis, 21 cases of cervical ossification of the posterior longitudinal ligament. Patients were divided into two groups according to two surgical methods: traditional group, including 51 male and 18 female patients, with mean age of (56 ± 18) years (35-76 years); modified group, including 75 male and 28 female patients, with mean age of (58 ± 20)years (35-80 years). The two groups were comparable and compared according to different data using t test, χ(2) test and rank sum test.

RESULTSAll patients were followed up continuously for (52 ± 33)months, 123 patients were followed up ≥ 2 years, 71 patients ≥ 5 years. All patients' Japanese Orthopaedic Association (JOA) score improved significantly at the latest follow-up(t = 3.420, P < 0.01); no significant difference between the patients' JOA score improvement rate of two groups. The postoperative incidence rate of axial symptoms in patients of modified group (3.9%) was significantly lower than the traditional group (14.5%) (χ(2) = 7.548, P < 0.05), and cervical intervertebral activity decreased in the modified group was better than the traditional group in the first 3 months postoperatively (27% ± 6% vs. 19% ± 4%,Z = 6.34, P < 0.05), but during the medium-long-term follow-up, no significant difference in the cervical intervertebral activity decreased between two groups.

CONCLUSIONSMedium-long-term efficacy of Kurokawa's and modified Kurokawa's double door laminoplasty is satisfied and reliable. Avoiding damaging of semispinalis cervicis insertion in spinous process of C2, the modified operation method can protect the extensor group of the neck muscle and reduce the incidence of postoperative axial symptoms better.

Adult ; Aged ; Aged, 80 and over ; Cervical Vertebrae ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures ; methods ; Retrospective Studies ; Spinal Osteophytosis ; surgery ; Treatment Outcome

OBJECTIVETo compare the radiographic outcome of three different fusion methods in maintenance of intervertebral height after cervical anterior corpectomy.

METHODSFrom May 2005 to November 2009, a total of 77 patients with cervical spondylotic myelopathy who underwent anterior cervical corpectomy and fusion were reviewed in the study. Fusion methods included autogenous iliac bone grafting in 22 patients (group 1), titanium mesh cages without end caps in 21 patients (group 2) and titanium mesh cages with modular end caps in 34 patients (group 3). No significant differences were found in age, gender or level of corpectomy among the three groups (P > 0.05). The height of anterior border (HAB) and the height of posterior border (HPB) of the fused segment were measured on lateral radiographs pre-operatively, post-operatively and at final follow-up to evaluate the outcome. The incidence of subsidence of titanium mesh cage and iliac bone was also reviewed retrospectively. The statistical analysis included One-way variation analysis and chi-square test.

RESULTSAll cases obtained the follow-up with an average of (30 ± 5) months (range 24 to 46 months). At final follow-up, the loss of the height of anterior border (HAB) of the fused segment in group 3 ((0.4 ± 0.4) mm) was less than that in the other two groups ((0.9 ± 0.6) mm in group 1 and (1.1 ± 0.8) mm in group 2) (mean difference = -0.45 mm and -0.70 mm, P < 0.05), but the difference was not statistically significant between group 1 and group 2 (P > 0.05); the loss of HPB of the fused segment in group 3((0.6 ± 0.5) mm) was less than that in the other two groups ((1.1 ± 0.7) mm in group 1 and (1.6 ± 0.8) mm in group 2) (mean difference = -0.52 mm and -0.98 mm, P < 0.05), but the difference was not statistically significant between group 1 and group 2 (P > 0.05). Iliac bone subsidence occurred in 10 cases (45.5%) in group 1, including mild subsidence (1 - 3 mm) in 9 cases (40.9%) and severe subsidence (> 3 mm) in 1 case (4.5%), and titanium mesh cage subsidence occurred in 11 cases (52.4%) in group 2, including mild subsidence in 9 cases (42.9%) and severe subsidence in 2 cases (9.5%), and 2 cases (5.9%) in group 3 showed mild subsidence of titanium mesh cages. The incidence of titanium mesh cage subsidence in group 3 was less than that in the other two groups (χ(2) = 12.423 and 15.551, P < 0.05), but the difference was not statistically significant between group 1 and 2 (P > 0.05).

CONCLUSIONSTitanium mesh cage with modular end cap is superior to both titanium mesh cage without end cap and auto iliac bone graft in maintenance of the cervical intervertebral height postoperatively. The usage of modular end cap can efficiently reduce postoperative subsidence rate of titanium mesh cage.

Adult ; Aged ; Cervical Vertebrae ; diagnostic imaging ; surgery ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Spinal Fusion ; methods ; Spinal Osteophytosis ; surgery ; Titanium ; Treatment Outcome

OBJECTIVETo investigate the mid-term radiological outcome of sagittal alignment of overall cervical spine and the functional spinal unit after replacement surgery with Bryan cervical disc prosthesis.

METHODSEighteen patients with cervical disc disorder were performed cervical disc replacement with 20 Bryan discs from November 2005 to May 2010, including single-level 16 cases and bi-level 2 cases. The patient consisted of 13 males and 5 females with age ranging from 38 to 59 years (average, (47 ± 6) years). Fourteen cases with overall cervical lordotic alignment and segmental lordotic alignment per-operatively (group 1) and 4 others with segmental kyphotic alignment and overall cervical kyphotic alignment per-operatively (group 2). The overall sagittal alignment (C(2-7)) and segmental sagittal alignment were measured pre-operatively, post-operatively and at final follow-up to evaluate the outcome.

RESULTSAll cases obtained the follow-up with an average of (24 ± 5) months (range 12 to 53 months). To the mean overall cervical alignment, there were 9.9° ± 1.9° per-operatively, 12.8° ± 2.1° post-operatively and 11.6° ± 1.8° at final follow-up in group 1 and -1.8° ± 0.8° per-operatively, 7.3° ± 1.3° post-operatively and 5.0° ± 2.1° at final follow-up in group 2. There were statistical significance between per-operatively and post-operatively (t = -2.987 and -5.058, P < 0.05) and no statistical significance between post-operatively and final follow-up (P > 0.05) in both groups. To the mean segmental alignment there were 2.6° ± 0.8° per-operatively, 5.4° ± 1.0° post-operatively and 4.3° ± 0.9° at final follow-up in group 1 and -3.0° ± 0.8° per-operatively, 3.8° ± 1.3° post-operatively and 0.3° ± 2.8° at final follow-up in group 2. There were statistical significance between per-operatively and post-operatively in both groups (t = -3.829 and -4.086, P < 0.05) and between post-operatively and final follow-up in group 1 (t = 2.630, P < 0.05)but not in group 2 (P > 0.05).

CONCLUSIONSThe Bryan cervical disc prosthesis has a good mid-term outcome for maintaining sagittal alignment of overall cervical spine and the functional spinal unit. Long-term follow-up should be needed to assess the long-term functionality of the prosthesis.

Adult ; Cervical Vertebrae ; surgery ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc ; surgery ; Joint Prosthesis ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fusion ; Spinal Osteophytosis ; surgery ; Treatment Outcome

OBJECTIVETo evaluate and compare the efficacy and clinical results of cervical expansive open door laminoplasty (EOLP) with different hinge position.

METHODSFrom February 2006 to February 2007, a total of 102 cases with cervical spondylotic myelopathy were assessed in this randomized controlled trial. Fifty-seven patients underwent EOLP with the hinge located at the inner margin of the lateral mass classified as wide-open group. Forty-five cases who underwent EOLP with the hinge positioned at the lamina margin served as narrow-open group. The clinical results and radiological examinations of both groups were evaluated 24 months after surgery.

RESULTSThere were no significant differences in operation time, bleeding quantity and recovery rate of Japanese Orthopaedic Association (JOA) scores. The incidence of C(5) palsy and severity of axial symptoms in the wide-open group were significantly lower than those in the narrow-open group (P < 0.05). There were no significant differences in cervical curvature index and range of motion between the two groups.

CONCLUSIONSWell-suited and appropriated inwardly shift the hinge could promote clinical outcomes after EOLP, especially decrease the incidence of the C(5) palsy and the severity of axial symptom, but it is contraindication for patients with ossification of posterior longitudinal ligament, ossification of ligament flavum and fluorosis cervical stenosis.

Aged ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Spinal Osteophytosis ; complications ; surgery ; Spinal Stenosis ; complications ; surgery ; Treatment Outcome

Adult ; Aged ; Cervical Vertebrae ; diagnostic imaging ; Female ; Humans ; Magnetic Resonance Imaging ; instrumentation ; methods ; Male ; Middle Aged ; Radiography ; Spinal Osteophytosis ; diagnosis ; diagnostic imaging ; Young Adult

OBJECTIVETo explore the efficacy of one stage or staging treatment of cervical spondylotic myelopathy through combined posterior and anterior approaches.

METHODSFrom June 2001 to October 2008, 45 patients with pinching cervical spondylotic myelopathy and developmental stenosis of cervical spinal canal were decompressed through combined posterior and anterior approaches in one stage or staging operation. Among the patients, 35 patients were male and 10 patients were female, ranging in age from 45 to 72 years, with an average of 53 years. Five patients were decompressed through combined posterior and anterior approaches in one-stage operation, and other 40 patients were treated in staging operation. All the patients were treated with open-door posterior cervical expansive laminoplasty and anterior decompression, bone graft and titanium plate internal fixation. JOA scores were used to evaluate the therapeutic effects at the 3rd month and one year after operation.

RESULTSAfter the treatment, 44 patients were followed up from 13 to 62 months, with an average of 30 months. One patient was dead of lung infection at the 21th day after operation. The nerve root palsy of C5 was found in 3 cases. One patient had postoperative hoarseness. Axial symptoms were found in 14 cases. Two patients had donor site complications. There were no screws broken or back out, no screw loosening, no moving or sinking of bone block or Ti-net, no door re-closer and cervical deformity. Forty-four patients got spinal fusion. According to JOA score criteria: the average preoperative JOA score was (9.36 +/- 2.24) points, JOA score was (12.34 +/- 2.64) points in 3 months after operation, (12.77 +/- 2.61) points in one year after operation. Among 44 cases, 16 got an excellent result, 19 good, 6 fair, 3 invalid. There were statistically differences between preoperative score and 3 months or one year after operation.

CONCLUSIONDecompression through combined posterior and anterior approaches for the treatment of pinching cervical spondyoltic myelopathy and developmental stenosis of cervical spinal canal has good efficacy, as well as a safety operation method. The operation method with one or staging decompression through combined anterior and posterior approach should be chosen according to the conditions of the patients and the operations. Anterior decompression, bone graft and titanium plate internal fixation could restore the height of vertebral body effectively and prevent fusion complication.

Aged ; Bone Transplantation ; Cervical Vertebrae ; surgery ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Spinal Cord Compression ; Spinal Fusion ; Spinal Osteophytosis ; surgery