OBJECTIVE: To evaluate the application of surgical strategies for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) involving the C ₂ segment. METHODS: The literature about the surgery for cervical OPLL involving C ₂ segment was reviewed, and the indications, advantages, and disadvantages of surgery were summarized. RESULTS: For cervical OPLL involving the C ₂ segments, laminectomy is suitable for patients with OPLL involving multiple segments, often combined with screw fixation, and has the advantages of adequate decompression and restoration of cervical curvature, with the disadvantages of loss of cervical fixed segmental mobility. Canal-expansive laminoplasty is suitable for patients with positive K-line and has the advantages of simple operation and preservation of cervical segmental mobility, and the disadvantages include progression of ossification, axial symptoms, and fracture of the portal axis. Dome-like laminoplasty is suitable for patients without kyphosis/cervical instability and with negative R-line, and can reduce the occurrence of axial symptoms, with the disadvantage of limited decompression. The Shelter technique is suitable for patients with single/double segments and canal encroachment >50% and allows for direct decompression, but is technically demanding and involves risk of dural tear and nerve injury. Double-dome laminoplasty is suitable for patients without kyphosis/cervical instability. Its advantages are the reduction of damage to the cervical semispinal muscles and attachment points and maintenance of cervical curvature, but there is progress in postoperative ossification. CONCLUSION OPLL involving the C ₂ segment is a complex subtype of cervical OPLL, which is mainly treated through posterior surgery. However, the degree of spinal cord floatation is limited, and with the progress of ossification, the long-term effectiveness is poor. More research is needed to address the etiology of OPLL and to establish a systematic treatment strategy for cervical OPLL involving the C ₂ segment.
Humans ; Longitudinal Ligaments/surgery* ; Ossification of Posterior Longitudinal Ligament/surgery* ; Treatment Outcome ; Osteogenesis ; Decompression, Surgical/methods* ; Cervical Vertebrae/surgery* ; Laminoplasty/methods* ; Kyphosis/surgery* ; Retrospective Studies

Objective: To compare the volumetric changes of cervical disc herniation (CDH) after cervical microendoscopic laminoplasty(CMEL),expansive open-door laminoplasty (EOLP) and conservative treatment. Methods: A retrospective study was conducted involving 101 patients with cervical spondylotic myelopathy(CSM),at the Department of Orthopaedic Surgery,the First Affiliated Hospital of Zhengzhou University from April 2012 to April 2021. The patients included 52 males and 49 females with an age of (54.7±11.8) years(range:25 to 86 years). Among them, 35 patients accepted CMEL treatment,33 patients accepted EOLP treatment,while 33 patients accepted conservative treatment. Volume data of CDH were measured by three-dimensional analysis of the initial and follow-up MRI images. The absorption rate and reprotrusion rate of CDH were calculated. The happening of resorption or reprotrusion was defined when the ratio was greater than 5%. The clinical outcomes and quality of life were evaluated by the Japanese Orthopaedic Association (JOA) score and the neck disability index (NDI).Quantitative data was analyzed by one-way ANOVA with post LSD-t test (multiple comparison) or Kruskal-Wallis test. Categorical data was analyzed by χ² test. Results: The follow-up time of the CMEL group,EOLP group and the conservative treatment group were (27.6±18.8)months,(21.6±6.9)months and(24.9±16.3)months respectively with no significant difference(P>0.05). Changes of CDH volume in patients:(1) There were 96 CDH of 35 patients in the CMEL group,among which 78 showed absorption. The absorption frequency was 81.3%(78/96) and the absorption rate was ranged 5.9% to 90.9%;9 CDH showed reprotrusion,the reprotrusion frequency was 9.4% (9/96) and the reprotrusion rate was 5.9% to 13.3%;(2) There were 94 CDH of 33 patients in the EOLP group,of which 45 showed absorption. The absorption prevalence was 47.9% (45/94) and the absorption rate was 5.0% to 26.7%;20 CDH showed reprotruded,with the reprotrusion frequency of 21.3% (20/94) and the reprotrusion rate was 5.8% to 28.3%;(3) There were 102 CDH in 33 patients of the conservative group. Among them, 5 showed absorption. The absorption frequency was 4.9% (5/102),and the absorption rate was 7.2% to 14.3%;58 CDH showed reprotruded with the re-protrusion ratio of 56.9% (58/102) and the re-protrusion rate was 5.4% to 174.1%. The absorption ratio and reprotrusion ratio of the CMEL group were statistically different from EOLP group or the conservative group (P<0.01).The absorption ratio and reprotrusion ratio of the EOLP group was different from conservative group (all P<0.01). In terms of clinical outcomes, the excellent/good rate of the JOA score and NDI scores in the CMEL group were different from that of conservative group (all P<0.01) but not from that of the EOLP group(P>0.05). Conclusions: CMEL is an effective method for the treatment of CSM,making CDH easier to resorption compared to the EOLP or conservative treatment,thus making a better decompression effect on the nerves. This study enlightened on a new strategy for the clinical treatment of CSM.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Retrospective Studies ; Intervertebral Disc Displacement/surgery* ; Conservative Treatment ; Quality of Life ; Treatment Outcome ; Spondylosis/surgery* ; Cervical Vertebrae/surgery* ; Spinal Cord Diseases ; Laminoplasty/methods* ; Decompression

OBJECTIVE: To compare the clinical effects of total laminectomy with lateral mass screw fixation and single open-door laminoplasty in the treatment of cervical spinal cord injury without fracture and dislocation. METHODS: The clinical data of 75 patients with cervical spinal cord injury without fracture and dislocation treated from December 2014 to April 2020 were retrospectively analyzed, including 65 males and 10 females, aged from 33 to 83 years old with an average of (60.1±11.4) years. According to surgical method, the patients were divided into observation group (36 cases) and control group (39 cases). The observation group was treated with C₃-C₆ single open-door laminoplasty. In the control group, the C₃-C₆ whole lamina was opened by "uncovering", and the lateral mass screw was fixed and fused. The general conditions including operation time, intraoperative blood loss, hospital stay and complications such as axial pain, cerebrospinal fluid leakage, postoperative C₅ nerve palsy were recorded. Visual analogue scale(VAS), Nurick pain scale, Japanese Orthopaedic Association(JOA) scores and American Spinal Injury Association(AISA) injury scale were used to evaluate the improvement of clinical symptoms and related functional recovery 12 months after operation. RESULTS: There were no statistically significant differences in operation time, intraoperative blood loss and hospital stay between two groups(P>0.05). There were statistically significant differences in JOA, VAS, ASIA and Nurick scores of the all patients between 12 months after surgery and before surgery (P<0.05), and there was no significant difference between groups. There was significant difference in the incidence of C5 nerve root palsy and axial pain between two groups(P<0.05), but there was no significant difference in the complications of cerebrospinal fluid leakage between two groups (P>0.05). CONCLUSION Total laminectomy with lateral mass screw fixation and single open-door laminoplasty in treating cervical spinal cord injury without fracture and dislocation can obtain satisfactory results in restoring nerve function, alleviating pain and improving daily behavior, but single open-door laminoplasty has the advantages of less trauma and low incidence of complications.
Adult ; Aged ; Aged, 80 and over ; Bone Screws ; Case-Control Studies ; Cervical Cord/surgery* ; Cervical Vertebrae/surgery* ; Female ; Humans ; Laminectomy/methods* ; Laminoplasty/methods* ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To observe the radiological change and curative effect of cervical spondylosis treated with cervical vertebra pulling therapy in young people. METHODS: A total of 65 patients(shedding in 5 patients and final inclusion in 60 patients) with cervical spondylosis who were treated from January 2018 to September 2019 were randomly divided into treatment group and control group according to the digital table method. There were 30 patients in treatment group, including 14 males and 18 females, aged from 20 to 44 years old with an average of(29.83±6.99) years, who were treated with cervical vertebra pulling therapy(once a week, 4 times in total). The control group consisted of 30 cases, 12 males and 18 females, aged from 18 to 43 years old with an average of (31.77±5.93) years, who received sitting traction therapy(once a week, 4 times in total). The changes of C₂-C₇ Cobb angle, arc-chord distance and T₁ slope (T₁S) in two groups were observed before treatment and 1 month after treatment, for intra-group and inter-group comparison;and the changes of numerical rating scale(NRS) in two groups were observed before treatment and 1, 3 months after treatment, for intra-group and inter-group comparison. RESULTS: Sixty patients were followed up for (3.2±0.3) months. There were no significant differences in NRS, C₂-C₇ Cobb angle, arc-chord distance and T1S between two groups before treatment (P>0.05). One month after treatment, the NRS, C₂-C₇ Cobb angle, arc-chord distance and T1S were(1.67±0.76) scores, (16.55±6.01)°, (10.95±4.04)mm, (18.95±4.19)° in treatment group and(1.40±0.86) scores, (10.23±5.94) °, (6.11±4.17) mm, (13.34±4.25)° in control group respectively. C₂-C₇ Cobb angle, arc-chord distance and T₁S in treatment group were better than those in control group (P<0.05); there was no significant difference in NRS between two groups (P>0.05). Compared with before treatment, there were statistically significant differences in C2-C7 Cobb angle, arc-chord distance and T1S in treatment group(P<0.05), but no statistically significant differences in control group(P>0.05). Three months after operation, NRS of treatment group was (1.60±0.62) scores and that of control group was (4.17±0.70) scores. The treatment group was better than the control group(P<0.05). The scores of treatment group after treatment were lower than those before treatment(P<0.05), and there was no significant difference in control group before and after treatment(P>0.05). CONCLUSION Cervical vertebra pulling method and cervical vertebra sitting traction can relieve the pain symptoms of patients with cervical spondylosis, but the effect of cervical vertebra pulling method is more durable;cervical vertebra pulling method can correct abnormal cervical sagittal parameters.
Adolescent ; Adult ; Cervical Vertebrae/surgery* ; Female ; Humans ; Laminoplasty/methods* ; Lordosis/surgery* ; Male ; Neck ; Retrospective Studies ; Spondylosis/surgery* ; Young Adult

BACKGROUND: The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy. METHODS: A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study. Perioperative information, intraoperative blood loss, clinical and radiological outcomes, and complications were recorded. Japanese Orthopedic Association (JOA) score, 36-item short form survey (SF-36) score and cervical alignment were assessed. RESULTS: There were no significant differences in JOA scores between the anterior and posterior group preoperatively (11.6 ± 1.6 vs. 12.1 ± 1.5), immediately postoperatively (14.4 ± 1.1 vs. 13.8 ± 1.3), or at the last follow-up (14.6 ± 1.0 vs. 14.2 ± 1.1) (P > 0.05). The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values. The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up. The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value (69.4 vs. 61.7). Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively (-2.0° ± 7.3° vs. -1.4° ± 7.5°). The Cobb angle significantly improved immediately postoperatively (12.3° ± 4.2° vs. 9.2° ± 3.6°) and at the last follow-up (12.4° ± 3.5° vs. 9.0° ± 2.6°) in both groups compared with their preoperative values (P = 0.00). Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group. CONCLUSIONS Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features. However, the JOA score recovery rate and SF-36 score in the anterior group were significantly higher. Persistent axial pain could be a major concern when undertaking the posterior approach.
Blood Loss, Surgical ; Cervical Vertebrae/surgery* ; Decompression, Surgical ; Humans ; Laminoplasty ; Retrospective Studies ; Spinal Cord Diseases/surgery* ; Spinal Fusion ; Spondylosis/surgery* ; Treatment Outcome

OBJECTIVE: To explore the clinical efficacy of C expanded half lamina excision combined with unilateral open door laminoplasty for multiple segmental cervical spinal cord compression syndrome. METHODS: The clinical data of 58 patients with multiple segmental cervical spinal cord compression syndrome underwent surgical treatment between September 2014 and May 2018 were retrospectively analyzed. There were 34 males and 24 females with a mean age of 64.4 years old (ranged from 46 to 78 years old). Among them, 28 cases received the surgery of C expanded half lamina excision combined with C-C unilateral open-door laminoplasty (improvedgroup), and 30 cases received a single C-C unilateral open-door laminoplasty (traditional group). Operation time, intraoperative blood loss, complications including C nerve root palsy and axial symptoms were compared between two groups. To evaluate the situation of the imaging indicators by measuring the space available for the spinal cord through cross sectional MRI of cervical spine at the narrowest segment of C (including intervertebral disc levels of C). Pre- and post-operative Japanese Orthopedic Association(JOA) score, Neck Disability Index(NDI) score, and improvement rate of neurological function, were recorded and analyzed between the two groups. RESULTS: All the patients were followed up for 12 to 18 months with an average of(14.5±1.8) months for improved group and (14.5±1.9) months for traditional group, and no significant difference was found between the two groups (>0.05). There was no significant difference in intraoperative blood loss and C nerve root palsy between the two groups (>0.05). The operation time (119±10) min vs (126±12) min and axial symptoms 7.1%(2/28) vs 26.6%(8/30) was significant difference between the two groups (<0.05). Preoperative and postoperative space available for the spinal cord of C was (93.61±9.02) mm and (153.50±12.76) mm respectively, which was obtained obvious improvement in all patients(<0.05). At the final follow up, JOA scores of improved group and traditional group were 14.36±1.70 and 14.03±1.82 respectively, and NDI scores were 10.36±2.55 and 12.47±3.46 respectively, there was significant difference between two groups (<0.05). However, there was no significant difference between two groups for the improvement rate (68.36±0.12)%VS (65.01±0.12)%of neurological function(>0.05). CONCLUSION C expanded half lamina excision combined with unilateral open-door laminoplasty is an effective method to treat multiple segmental cervical spinal cord compression syndrome, for it can not only fully relieved spinal cord compression, but also achievedgood effect in preventing complications such as axial symptoms by reducing stripping of muscles from C2 spinous process.
Aged ; Cervical Vertebrae ; surgery ; Cross-Sectional Studies ; Female ; Humans ; Laminectomy ; Laminoplasty ; Male ; Middle Aged ; Retrospective Studies ; Spinal Cord Compression ; Treatment Outcome

OBJECTIVE: To systematically assess the efficacy of anterior cervical corpectomy and fusion (ACCF) versus posterior laminoplasty (LAMP) for cervical ossification of posterior longitudinal ligament (OPLL). METHODS: PubMed and EMBASE, Cochrane Library, CBM, CNKI, Wanfang and VIP were collected from 7 databases of ACCF, LAMP from 1970 to May 2018. According to the criteria, the articles were included and independently screened by two authors. The quality of the articles was assessed by using the MINORS scale (methodological index for non randomized studies). After extracting the data from the article, the JOA score, cervical curvature, operation time, bleeding volume, excellent and good rate, recovery rate, adverse events and secondary surgery were analyzed by using Review Manager 5.3 software. RESULTS: Finally, a total of 22 articles with 1 678 patients were included in this Meta-analysis, with 810 patients in ACCF group and 868 patients in LAMP group. Meta analysis results showed that the ACCF group had higher postoperative JOA scores[MD=0.63, 95%CI(0.05, 1.20), = 0.03], higher excellent rate [=1.85, 95%CI (1.14, 3.02), =0.01] and higher recovery rate [=11.90, 95%CI (5.75, 18.05), =0.000 1]. But the LAMP group has a shorter operative time [MD=52.19, 95%CI (29.36, 75.03), <0.000 01], less complications [=1.56, 95%CI (1.03, 2.35), =0.04] and less reoperations [=3.73, 95%CI (1.62, 8.57), =0.002]. There was no significant different in postoperative lordosis [MD=3.15, 95%CI(-0.14, 6.43), =0.06] and blood loss[SMD= 0.26, 95%CI(-0.05, 0.57), =0.10] between two groups. CONCLUSION The recovery of functionof ACCF group was better, but operation time, complications and reoperations of LAMP group were all better than ACCF group. There was no difference in postoperative lordosis and intraoperative blood loss between two groups. However, there are some limitations in this study. Therefore, higher quality and larger sample size clinical studies are needed to further verify.
Calcium ; Cervical Vertebrae ; Decompression, Surgical ; Humans ; Laminoplasty ; Ossification of Posterior Longitudinal Ligament ; Spinal Fusion ; Treatment Outcome ; Vertebroplasty

OBJECTIVE: To evaluate the short-term curative effects of ARCH titanium plate fixation combined with expansive single open-door laminoplasty (EOLP) in treating cervical spondylotic myelopathy (CSM). METHODS: EOLP with ARCH titanium plate as internal fixation material was applied in 32 patients with CSM from January to December 2016. There were 23 males and 9 females with an average age of 64.5 years ranging from 39 to 82 years. The course of disease ranged from 6 to 24 months with an average of 13.1 months. The clinical efficacy was evaluated by Japanese Orthopaedic Association (JOA) scoring method, which included upper and lower limb motor function, limb sensory function and bladder function. The sagittal diameter of the narrowest segment of vertebral canal was measured by imaging data before operation and 6 months after operation, and the improvement rate was calculated to determine the decompression effect. RESULTS: All the patients were followed up from 6 to 20 months with an average of 12.2 months. Preoperative symptoms of 32 patients were improved to varying degrees, the JOA score increased from 9.78±1.34 before operation to 12.94±1.16 at 6 months after operation, the improvement rate of JOA was(44.09±11.06)% (<0.01). The spinal canal was significantly enlarged, the sagittal diameter of the narrowest vertebral canal was increased from (8.47±0.60) mm preoperatively to (12.51±0.78) mm 6 months postoperatively, the improvement rate was (48.27±11.81)% (<0.01). No loosening, displacement, rupture or "re-closure" of the internal fixator was found during the follow-up. CONCLUSIONS ARCH titanium plate fixation combined with EOLP in the treatment of CSM can significantly reduce the possibility of "re-closure" and other related postoperative complications and the short-term clinical efficacy is satisfactory.
Adult ; Aged ; Aged, 80 and over ; Bone Plates ; Cervical Vertebrae ; Female ; Humans ; Laminoplasty ; Male ; Middle Aged ; Retrospective Studies ; Spinal Cord Diseases ; Titanium ; Treatment Outcome

An iatrogenic internal carotid artery (ICA) pseudoaneurysm is an extremely rare complication of cervical spine surgery. Here we report an extraordinary case of massive hematemesis due to a ruptured ICA pseudoaneurysm caused by the laminoplasty plate 10 years after cervical spine surgery. Computed tomography angiography revealed a ruptured 4×10-mm left extracranial ICA pseudoaneurysm probably connected to the pharynx. Emergent surgery was performed because of the uncontrolled massive bleeding. After complete resection of the injured segment, an interposition graft with a 6-mm polytetrafluoroethylene graft was placed and the fistula tract to the pharynx was repaired.
Aneurysm, False ; Angiography ; Carotid Artery, Internal ; Fistula ; Hematemesis ; Hemorrhage ; Laminoplasty ; Pharynx ; Polytetrafluoroethylene ; Spine ; Transplants

STUDY DESIGN: A retrospective review of patients who underwent 2-level anterior cervical discectomy and fusion (ACDF) with standalone polyetheretherketone (PEEK) cages for cervical spondylotic myelopathy (CSM). PURPOSE: To evaluate the efficacy of stand-alone PEEK cage in 2-level cervical interbody fusion for CSM. OVERVIEW OF LITERATURE: ACDF is a standard surgical procedure to treat degenerative disc disease. However, the use of additional anterior plating for 2-level ACDF remains controversial. METHODS: We reviewed outcomes of patients who underwent 2-level ACDF with stand-alone PEEK cages for CSM over a 7-year period (2007–2015) in a regional hospital. Japanese Orthopaedic Association (JOA) score, fusion rate, subsidence rate, cage migration, and cervical alignment by the C2–7 angle as well as the local segmental angle (LSA) of the cervical spine were assessed. RESULTS: In total, 31 patients (mean age, 59 years; range, 36–87 years) underwent 2-level ACDF with a cage-only construct procedure between 2007 and 2015. The minimum follow-up was 24 months; mean follow-up was 51 months. C3–5 fusion was performed in 45%, C4–6 fusion in 32%, and C5–7 fusion in 23%. Mean JOA score improved from 10.1±2.2 to 13.9±2.1 (p<0.01) at the 24-month follow-up. Fusion was achieved in all patients. Subsidence occurred in 22.5% of the cages but was not associated with differences in JOA scores, age, sex, or levels fused. Lordosis of the C2–7 angle and LSA increased after surgery, which were maintained for up to 1 year but subsequently disappeared after 2 years, yet the difference was not statistically significant. No cage migration was noted; two patients developed adjacent segment disease requiring posterior laminoplasty 3 years after ACDF. CONCLUSIONS: The use of a stand-alone PEEK cage in a 2-level cervical interbody fusion achieves satisfactory improvements in both clinical outcomes and fusion.
Animals ; Asian Continental Ancestry Group ; Diskectomy ; Follow-Up Studies ; Humans ; Laminoplasty ; Lordosis ; Retrospective Studies ; Spinal Cord Diseases ; Spine