Laminoplasty with adjunct anterior short segment fusion for multilevel cervical myelopathy associated with local kyphosis.
BACKGROUND
When treating patients who have multilevel cervical spondylotic myelopathy (MCSM) with short-segment kyphosis, instability, or major anterior foci, long-level anterior decompression with fusion is often a standard method but can cause obvious loss of range of motion and usually needs further posterior stabilization. For MCSM with correctable kyphosis or simple instability, laminectomy with lateral-mass instrumented fusion is also a treatment of choice, but all the involved segments are immobilized. Combining expansive open-door laminoplasty (EOLP) and anterior short-segment fusion may be an alternative treatment to save more motion segments.


METHODS
This study included 109 patients who exhibited MCSM with combined local kyphosis, instability, and anterior pathology, and received EOLP and concomitant anterior short-segment fusion. The patients were enrolled from August 2005 to July 2012. Nurick scores and Japanese Orthopedics Association cervical myelopathy scores were used to evaluate the functional outcomes. Follow-up plain films were collected and magnetic resonance imaging was conducted to assess the radiographic outcomes.


RESULTS
One year after the operation, the Japanese Orthopedics Association recovery rate was 83.4 ± 16.6%. The improvement in the functional scores and decrease in neck pain were significant. The canal width improved without further collapse at 12 months. The preservation of range of motion was approximately 57% at 1 year.


CONCLUSION
EOLP with adjunct anterior short-segment decompression fusion yields an excellent outcome for MCSM patients who exhibit concomitant short-segment kyphosis, instability or major anterior pathology. Performing laminoplasty first is safer for the spinal cord due to its posterior shifting while anterior procedures are being done.
['Yeh|Kuang-Ting|KT|', 'Lee|Ru-Ping|RP|', 'Chen|Ing-Ho|IH|', 'Yu|Tzai-Chiu|TC|', 'Peng|Cheng-Huan|CH|', 'Liu|Kuan-Lin|KL|', 'Wang|Jen-Hung|JH|', 'Wu|Wen-Tien|WT|']
D000328:Adult D000368:Aged D002574:Cervical Vertebrae D005260:Female D006801:Humans D007738:Kyphosis D065406:Laminoplasty D008297:Male D008875:Middle Aged D012044:Regression Analysis D013123:Spinal Fusion
multilevel cervical spondylotic myelopathy expansive open-door laminoplasty major anterior pathology anterior cervical decompression fusion