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PubMedDate not supplied

"Prespondylosis" and some pain syndromes following denervation supersensitivity.

Pain is determined by the neurologic properties of receptor organs, neurons, and their interconnections. These may become supersensitive or hyperreactive following denervation (Cannon's Law). A common cause of denervation in the peripheral nervous system is neuropathy or radiculopathy as a sequel to spondylosis. Spondylosis in its early stage may be "asymptomatic" or painless and hency unsuspected, because small-diameter pain fibers may not initially be involved despite the attenuation of the other component fibers of the nerve. The term "prespondylosis" is introduced here to describe this presently unrecognized phase of insidious attrition to the other functions of the nerve, especially the trophic aspect. It is postulated that many diverse pain syndromes of apparently unrelated causation may be attributed to abnormal noxious input into the central nervous system from supersensitive receptor organs (nociceptors) and hyperreactive control systems at internuncial pools. Furthermore, trauma to a healthy nerve is usually painless or only briefly painful, unless there is preexisting neuropathy. Some pain syndromes in muscle (eg, trigger points and myofascial pain syndromes) and nerve (eg, causalgia and diabetic neuropathy) that may be related to denervation are discussed.

Causalgia↗
PubMedDate not supplied

Significance of lumbar spondylolysis in college football players.

We reviewed the records of 506 consecutive college football players over an eight-year period. Of these athletes, 135 (27%) had low-back pain. Because of persistent low-back symptoms, 58 players had roentgenograms of the lumbosacral spine; 12 cases of lumbar spondylosis were observed. From the 58 players for whom roentgenograms were available, two groups were compared with respect to time lost from games and practices. One group (N = 8) had low-back pain complaints with lumbar spondylosis. The randomly selected control group (N = 12) had low-back pain with no evidence of spondylolysis on roentgenograms. There was no significant difference in time loss between these two groups (4.8% versus 4.0%). It appears that lumbar spondylolysis is of minimal clinical significance over a short (four-year) period. The long-term implications of lumbar spondylolysis are clearly important but are not addressed in this study.

Athletic Injuries↗
PubMedDate not supplied

Lumbar spinal stenosis in a patient with diffuse idiopathic skeletal hypertrophy syndrome.

Lumbar spinal stenosis is associated with a variety of conditions, including dysplastic narrowing of the spine, lumbar spondylosis, Paget's disease, and achondroplastic dwarfism. No case of lumbar stenosis associated with diffuse idiopathic skeletal hyperostosis (DISH) previously has been described. It would appear that this case could represent either another manifestation of DISH characterized by involvement of the ligamentum flavum or coincidental association with lumbar spondylosis. In either case, physicians treating spinal and skeletal diseases should be aware of potential neurologic complications requiring surgical decompression due to narrowing of the spinal canal in this unusual disorder.

Bone Diseases↗
PubMed1984

A comparative analysis of x-ray findings of the lumbar spine in patients with and without lumbar pain.

Roentgenograms of the lumbar spine from 238 patients with lower back pain (LBP) with sciatica were compared with roentgenograms from 66 patients without LBP. No difference between the two groups could be demonstrated concerning the incidence of spondylosis and disc degeneration. Cases with wedge-shaped vertebral bodies are significantly more frequent in patients younger than 40 years old in the group having pain. The incidence of spondylosis and disc degeneration increase with increasing age.

Adult↗
PubMed1984

Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients.

The results of 146 patients with anterior cervical intervertebral disc removal and fusions are reviewed. The diagnosis was cervical spondylosis in 75%, disc protrusion in 16%, and spondylosis at one level with disc protrusions at another in 9%. There were 81 women and 65 men with an average age of 48 +/- 9 years. The average follow-up was 5 +/- 3.3 years. The rate of fusion was 97%. Complete pain relief occurred in 78%, partial in 18% and little or no pain relief in 4%. There were no serious complications, and none of the patients thought they were made worse by surgery.

Adult↗
PubMed1985

The relation of spinal x-ray to low-back pain and physical activity among 60-year-old men and women.

X-ray findings in the thoracic and lumbar spine from 666 60-year-old men and women from a general population were related to anamnestic data and physical measurements. Disc degenerations were significantly more common among those with low-back pain (LBP) compared with those without. The corresponding calculated predictive values stressed the importance of taking precaution in interpreting the radiologic findings in the clinical situation. In several instances, there were significantly more positive (abnormal) radiologic findings among those with the heaviest work. Disc degeneration and scoliosis were particularly frequent in this regard. Absolute weight and body mass index was significantly higher in persons with spondylosis. The fingertip-floor distance was greater with higher frequency of spondylosis and L4 disc degeneration.

Back Pain↗
PubMed1987

Impaired fibrinolytic activity in defined chronic back pain syndromes.

Fibrinolytic activity was studied in 34 patients who had chronic low-back pain of defined types (spondylosis, post-laminectomy and postmyelography-proven arachnoiditis, postlaminectomy and postmyelography-possible arachnoiditis, chronic prolapsed intervertebral disc (PID), spinal stenosis, and nonspecific low-back pain). Fibrinolysis was significantly impaired in the back pain patients as a whole compared with matched controls. Similar changes were observed in all the different back pain syndromes. In the smaller subgroups, these did not reach significance but were significant in spondylosis, proven arachnoiditis, and nonspecific back pain. It is suggested that the abnormal persistence of a defect in fibrinolytic activity, leading to fibrin deposition and chronic inflammation, may be an important factor in the chronicity of many back pain syndromes.

Adult↗
PubMed1992

Modified Smith-Robinson procedure for anterior cervical discectomy and fusion.

Fifty-one consecutive patients with cervical radiculopathy or spondylosis were treated with single or multilevel anterior discectomy and fusion using a modified Smith-Robinson procedure. There were 33 single-level fusions, 16 two-level fusions, and 2 three-level fusions. The three modifications included: 1) the endplates at the fusion level were completely removed with a high-speed bur to exposed bleeding cancellous bone in parallel planes; 2) the Caspar distractor (Aesculap, Burlingame, CA) was used to increase distraction and improve visualization; 3) the tricortical autologous iliac crest bone graft was placed in reverse position, that is, with the cortical cross-section facing posteriorly, creating a stabilizing strut in the middle column. With an average follow-up of 1 year, the fusion rate was 94% (67 of 71 levels). The single-level fusion rate was 97%, the two-level fusion rate was 94%, and the three-level fusion rate was 83%. Of the four nonunions, only two were symptomatic. Results by clinical examination revealed 36 (71%) excellent, 11 (21%) good, 3 (6%) satisfactory, and 1 (2%) poor outcomes. There were no significant disc collapses or extrusions. One patient had an increase in kyphotic deformity of > 5 degrees, none with > 10 degrees kyphosis. There were no wound infections or neurologic complications. The modified Smith-Robinson procedure for anterior cervical discectomy and fusion has led to the successful treatment of cervical radiculopathy and spondylosis with improved results and few complications.

Bone Transplantation↗
PubMed1996

Is pathology examination of disc specimens necessary after routine anterior cervical discectomy and fusion?

STUDY DESIGN: A retrospective chart review was performed from 1990-1994. OBJECTIVES: To evaluate the outcome of pathologic examination of cervical disc specimens submitted after anterior cervical discectomy. SUMMARY OF BACKGROUND DATA: This study is the first to review the outcome of pathologic examination of disc specimens after anterior cervical discectomy and fusion. METHODS: Charts were reviewed based on the procedure code of anterior cervical fusion and the main diagnoses of cervical disc and spondylosis. The following data were recorded for each patient: symptoms, examination, diagnostic studies, operative procedure, operative findings, and pathology report. Statistical analysis was performed. RESULTS: Five hundred six disc levels in 394 patients were reviewed. All patients had symptoms and examination results consistent with cervical radiculopathy. All patients had cervical radiographs and some combination of myelography, computed tomography, or magnetic resonance imaging. Findings at the time of surgery included the presence of either a herniated disc or degenerative spondylitic changes. The pathologic examination results of all specimens reported fibrocartilaginous tissue consistent with disc material with the presence of degenerative changes. No infectious, benign, or malignant process was identified at the time of surgery or on gross and histologic examination of any of the disc specimens. Using confidence intervals (95%) for exact proportions and given 500 negatives, the chance the next occurrence would be positive would be 0.0060 or 0.60% or six of 1000. CONCLUSIONS: This study shows that if the symptoms, physical examination, radiographic diagnostic studies, and surgical findings are consistent with those of cervical disc herniation of spondylosis, the chance of an unexpected, clinically important pathologic finding within the disc specimen is extremely small. The time and expense involved in routine pathologic examination of cervical disc specimens can be avoided.

Cervical Vertebrae↗
PubMed1997

Clinical analysis of two-level compression of the cauda equina and the nerve roots in lumbar spinal canal stenosis.

STUDY DESIGN: This study is a prospective, clinical study assessing the efficacy of selective decompression of the responsible level in two-level stenosis in accordance with neurologic findings defined by the gait load test, and functional diagnosis based on selective nerve root block. OBJECTIVE: To clarify the clinical features of two-level stenosis regarding the neurologic level responsible for the symptoms, neurogenic intermittent claudication, and the outcome of selective decompression. SUMMARY OF BACKGROUND DATA: Experimental studies have indicated that double-level compression of the cauda equina induces a more severe impairment of nerve function than does single-level compression. However, few studies have focused on the clinical importance of two-level stenosis. The clinical effects of two-level stenosis on the cauda equina and nerve roots are unknown. METHODS: A total of 81 patients with lumbar spinal canal stenosis due to spondylosis and degenerative spondylolisthesis were divided into two groups, two-level stenosis at L3-L4 and L4-L5, and one-level stenosis at L4-L5, based on myelography. The types of neurogenic intermittent claudication, the level responsible for neurologic findings, and the postsurgical outcome were compared between both groups. The level responsible for the symptoms in two-level stenosis was determined in accordance with neurologic findings on the gait load test and functional diagnosis based on a selective nerve root block. All patients underwent a prospective, selective decompression at the neurologically responsible level only. The average follow-up period was 4.6 years (range, 1-8 years). RESULTS: The patients with two-level stenosis more frequently had cauda equina symptoms than those with one-level stenosis, except patients with degenerative spondylolisthesis. It was therefore assumed that two-level stenosis was associated with cauda equina impairment, Changes in neurologic condition before and after the gait test were observed in four patients with two-level stenosis. Finally, for 28 patients with two-level stenosis, the levels responsible for the neurologic symptoms were the caudal level (L4-L5) in 22 patients, the cranial level (L3-L4) in 1 patient, and both cranial and caudal levels (L3-L4 and L4-L5) in 5 patients. All stenotic levels on the myelogram were not always symptomatic in two-level stenosis. However, in one-level stenosis, all of the responsible levels completely corresponded to the myelogram. Selective decompression only at the neurologically responsible level improved neurogenic intermittent claudication in all patients. The asymptomatic levels at which the stenotic condition was left unchanged at surgery did not become symptomatic at follow-up; in addition, there was no significant difference in the postoperative outcome between two-level stenosis and one-level stenosis. CONCLUSIONS: Two-level stenosis in patients with lumbar spondylosis is associated with production of cauda equina lesions. The gait load test provides information regarding changes in symptoms and neurologic condition during exercise. The responsible levels should be determined based on neurologic findings after the gait load test and a selective nerve root block. It is uncommon for both stenotic levels to be symptomatic in patients with two-level stenosis. Less invasive surgery such as selective decompression for the responsible level in patients with two-level stenosis is a useful technique with a good potential for long-term success.

Aged↗
PubMed1998

Spinal deformity and instability after multilevel cervical laminectomy for spondylotic myelopathy.

STUDY DESIGN: A retrospective radiographic and medical record analysis of 58 patients. OBJECTIVES: To describe the incidence and consequences of cervical spinal deformity and instability after multilevel laminectomy in adult patients with myelopathy caused by cervical spondylosis and to determine the usefulness of preoperative dynamic roentgenographic films in the prevention of postoperative destabilization. SUMMARY OF BACKGROUND DATA: Extensive cervical laminectomy has been widely used in the treatment of progressive myelopathy secondary to stenotic conditions. Complications of this procedure, including spinal instability, accelerated spondylotic changes, postoperative spinal deformity, and constriction of the dura mater by formation of extradural scar tissue formation have been recognized. However, the frequency of these complications is probably overestimated, and their effect on clinical outcome remains unknown. METHODS: Fifty-eight patients older than 30 years who underwent a laminectomy at more than three levels without fusion for myelopathy secondary to cervical spondylosis were reviewed retrospectively with an average follow-up of 3.6 years. Functional results were evaluated according to the Japanese Orthopaedic Association's scoring system. Lateral views in neutral position, in flexion, and in extension of the preoperative cervical roentgenograms were analyzed in comparison with the last follow-up films to identify the changes in the curvature of the cervical column, in the range of motion of the neck, and in the intervertebral angular mobility and anteroposterior displacement of the vertebral bodies and finally to quantify the incidence of spinal instability. RESULTS: In 18 patients (31%), postoperative changes in the type of cervical spine curvature developed. Fifteen patients (25%) had destabilization at one or more levels. Deformities of the cervical spine occurring after surgery do not appear to cause symptoms or neurologic abnormalities. Destabilization required repeat surgery in 3 patients. All the levels appearing to be destabilized on the postoperative films were hypermobile on the preoperative dynamic radiographs. Preoperative olisthesis Without hypermobility is not a factor of risk in postoperative destabilization. CONCLUSIONS: The use of preoperative dynamic radiographs should improve the selection of patients undergoing laminectomy for the treatment of multilevel cervical cord compression. Dynamic radiographs may also reinforce the need for such adjunctive procedures as fusion and instrumentation, to prevent postoperative destabilization. Preoperative olisthesis with hypermobility in sagittal or horizontal planes must be fused and instrumented.

Adult↗
PubMed1998

Correlation between bone mineral density and intervertebral disc degeneration.

STUDY DESIGN: Intervertebral disc area, disc bulge ratio, and bone mineral density were measured in 86 postmenopausal women and the data analyzed. OBJECTIVE: To examine quantitatively the correlation between intervertebral disc degeneration and bone mass. SUMMARY OF BACKGROUND DATA: In results of previous studies, an inverse correlation between osteoporosis and spondylosis has been reported. In these studies, only radiographic findings were used to evaluate spondylosis; changes in the intervertebral disc itself were not investigated. METHODS: To determine bone mass, total-body bone mineral density, lumbar bone mineral density, and age-matched control values of bone mineral density were measured by dual-energy X-ray absorptiometry in all cases. To evaluate intervertebral disc degeneration, disc area and disc bulge ratio (calculated by measuring the areas protruding from lines connecting the middle points of the anterior and posterior borders of the vertebral bodies) were obtained from four discs, using magnetic resonance images of the lumbar spine. The correlation between bone mass data and disc area data was analyzed. RESULTS: Bone mineral density showed a significant decrease with increasing age. Disc area and disc bulge ratio had no relation to age. There was a negative correlation between total-body bone mineral density, lumbar bone mineral density, and age-matched control values versus disc area, and a positive correlation between all bone mineral density data and the disc bulge ratio. CONCLUSIONS: According to the results of the analysis by disc morphology and bone mass, especially total body bone mineral density, bone mass has an inverse correlation to intervertebral disc degeneration--i.e., reduction and disc bulge--which is important when considering degenerative spinal diseases and osteoporosis.

Absorptiometry, Photon↗
PubMed2004

Klippel-Feil syndrome associated with persistent trigeminal artery.

STUDY DESIGN: In the present report, radiologic findings of the patient with the Klippel-Feil syndrome associated with persistent trigeminal artery are reviewed. In same case, there was also spina bifida occulta, cervical spondylosis, atlanto-occipital assimilation, bilateral cervical ribs, and lack of flow signal in the C4 segment of contralateral vertebral artery. The persistent trigeminal artery and Klippel-Feil syndrome can be seen together and with the other anomalies. It should be considered that they might be related with the insufficiency or dysfunction of the embryologic developmental process. OBJECTIVES: To draw attention to this rare presentation of Klippel-Feil syndrome associated with persistent trigeminal artery. SUMMARY OF BACKGROUND DATA: Klippel-Feil syndrome is a congenital spinal malformation characterized by the failure in segmentation of 2 or more cervical vertebrae. Although the anomaly is defined by its skeletal component, Klippel-Feil Syndrome may also be associated with developmental defects in many other organ systems including the inner ear, spinal cord, heart, and genitourinary tract. The primitive trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries are persistent fetal anastomoses between the carotid and vertebrobasilar circulations. The authors report the association of a persistent trigeminal artery with the Klippel-Feil syndrome. METHODS: Radiologic findings of a case of Klippel-Feil syndrome associated with persistent trigeminal artery are described. RESULTS: There was vertebral fusion, spina bifida occulta, bilateral cervical ribs, atlanto-occipital assimilation, and cervical spondylosis. Magnetic resonance angiography showed the persistent trigeminal artery between the left internal carotid and basilar artery, but there was no sign of flow in the C4 segment of right vertebral artery. CONCLUSIONS: It should be kept in mind that a persistent trigeminal artery and Klippel-Feil syndrome can be seen together and with the other anomalies. Because of this reason, this type of case should prompt a search for the other related anomalies, and magnetic resonance angiography can be used as a noninvasive diagnostic technique in the persistent trigeminal artery determination.

Abnormalities, Multiple↗
PubMed2003

Cluster analysis classification of SF-36 profiles for patients with spinal pain.

STUDY DESIGN: A k-means cluster analysis of patients with spinal and radicular pain based on the SF-36 Health Survey scales. OBJECTIVE: The aim was to determine whether spine patients fall into clusters according to self-reported health status as measured by the SF-36 and to determine if clustering is similar across four common diagnostic categories: herniated disc, spinal stenosis, spondylosis, and chronic pain syndrome. SUMMARY OF BACKGROUND DATA: Cognitive-behavioral classifications of chronic pain patients have previously identified three patient groups described as Dysfunctional, Interpersonally Distressed, and Minimizers/Adaptive Copers. The purpose of these classifications is to facilitate and direct treatment based not only on biomedical diagnosis but also on emotional, social, and behavioral diagnoses. This type of analysis has not been done on the quality-of-life scores of patients with specific spinal diagnoses. METHODS: Health status data were reviewed from the initial visits of 15,748 spine patients in the National Spine Network database. Based on the eight scales of the SF-36, k-means cluster analysis divided the National Spine Network population into distinct clusters of similar patients. Clustering was performed separately for each clinical diagnosis group. RESULTS: In all four diagnostic categories, cluster analysis classified patients into three groups. Group 1 had fairly high (relative to the entire sample) scores on all scales and was labeled "Highly Functional." Group 2 had low measures on physical variables but comparatively high scores on the mental scales. These were labeled "Emotional Adapters." Group 3 had low scores on all scales. These patients were labeled "Dysfunctional." Although patients in each diagnostic category fell into one of the three groups, the proportion of patients within each group was quite different among chronic pain patients as compared to the other three diagnostic groups. For example, 29% of herniated disc patients were in the Highly Functional group, whereas only 14% of patients in chronic pain were categorized as Highly Functional. Thirty-three percent of spondylosis patients were classified as Dysfunctional compared with 51% of chronic pain patients. CONCLUSIONS: Patients with spinal pain fall into three groups according to their profile of scores on the SF-36 Health Survey. It is proposed that such empirical groupings can guide decision-making in selecting the most appropriate therapies.

Cluster Analysis↗
PubMed2005

The treatment of disabling multilevel lumbar discogenic low back pain with total disc arthroplasty utilizing the ProDisc prosthesis: a prospective study with 2-year minimum follow-up.

STUDY DESIGN: Prospective, longitudinal minimum 2-year follow-up. OBJECTIVE: To assess the efficacy and safety of the Prodisc implant in patients with disabling multilevel discogenic low back pain (LBP). SUMMARY OF BACKGROUND DATA: Few, if any, alternatives have been proposed to treat recalcitrant and debilitating multilevel lumbar discogenic low back pain. To date, a prospective study specifically examining the use of multilevel Prodisc total disc arthroplasty has not been described. METHODS: A prospective analysis was performed on 25 patients (63 prostheses) treated with multilevel lumbar ProDisc total disc arthroplasty. Minimum follow-up was 2 years. Patients 18 to 60 years of age with disabling discogenic low back pain and minimal radicular pain secondary to multiple level lumbar spondylosis from L1 to S1 were included. Preoperative and postoperative disability and pain scores were measured using Oswestry and visual analog scores. Preoperative and postoperative neurologic, radiographic, and pain medication assessments were also performed at similar postoperative intervals. RESULTS: A total of 29 patients (72 prostheses) were enrolled in the prospective analysis. Twenty-five patients (63 prostheses) fulfilled all follow-up criteria and are included for final analysis. Fifteen bisegmental and 10 trisegmental level cases were performed. Visual analog pain, Oswestry, and patient satisfaction scores were significantly reduced at the 3-month as well as at 48-month follow-up. Radiographic analysis revealed an affected disc height increases from 5 mm to 12 mm (P < 0.05) and affected disc motions from 3 degrees to 7 degrees (P < 0.05). No change in adjacent level disc heights was seen. Complications included a single case of subsidence of the inferior endplate of the L4-L5 segment in a bisegmental L4-L5/L5-S1 case. We also report a delayed case of anterior extrusion of a polyethylene component in a patient who had sustained a fall of a bicycle. CONCLUSIONS: Our preliminary data on multisegmental ProDisc lumbar total disc arthroplasty appear to be a safe and efficacious treatment method for debilitating lumbar spondylosis without significant facet arthropathy. In our select (non-Workers Compensation and/or medical legal) cohort of patients, we demonstrate a patient satisfaction rate of 93%. Careful and appropriate patient selection is essential in ensuring optimal surgical outcomes.

Adult↗
PubMed2006

Three-level anterior cervical discectomy and fusion with plate fixation: radiographic and clinical results.

STUDY DESIGN: Retrospective review of patients with cervical spondylosis treated with 3-level anterior cervical discectomy and fusion with plate fixation. OBJECTIVE: To assess the radiographic and clinical outcome of 3-level instrumented anterior cervical discectomy. SUMMARY OF BACKGROUND DATA: Three-level cervical discectomy without plate fixation has shown high rates of pseudarthrosis and poor outcomes. The addition of internal fixation may improve these parameters. METHODS: A total of 46 patients were observed for an average of 17.6 months (range, 6-51 months). All had 3-level anterior cervical discectomy and fusion with tricortical iliac crest autograft (4 cases), fibular ring allograft (38 cases), or titanium cage (4 cases). Allografts and cages were filled with iliac crest autograft. All patients had semirigid plating. Clinical and radiographic follow-up data were obtained. Clinical outcomes were measured as described by Robinson and with the Nurick scale. RESULTS: Forty-four patients achieved solid fusion. Two patients had additional surgery for junctional disease, and in 1 of them pseudarthrosis repair was also performed. One asymptomatic pseudarthrosis was noted. With a successful result defined as an excellent or good outcome accompanied by significant pain relief, 38 patients had a successful result (83%). Radiographic adjacent level disease was diagnosed in 11 patients after surgery and was symptomatic in 5. CONCLUSION: Three-level anterior cervical discectomy with plate fixation has a high rate of fusion, a low complication rate, and acceptable outcome in the treatment of multilevel cervical spondylosis.

Adult↗
PubMed2006

Cervical intervertebral disc degeneration induced by unbalanced dynamic and static forces: a novel in vivo rat model.

STUDY DESIGN: Establishment of a novel in vivo animal model of cervical spondylosis. OBJECTIVE: To investigate apoptotic, degenerative, and inflammatory changes occurring in the cervical intervertebral discs of rats. SUMMARY OF BACKGROUND DATA: Cervical degeneration occurs as the result of imbalance of both static and dynamic spinal stabilizers. The disc degeneration that occurs is characterized by increased local inflammation and increased apoptosis of intervertebral disc cells. METHODS: By excising the paraspinal musculature and posterior cervical spinal ligaments of rats, both static and dynamic cervical stabilizers were disrupted. The resultant biomechanical imbalance resulted in biochemical and histologic changes, which were characterized by light microscopy, electron microscopy, immunostaining, enzyme-linked immunosorbent assay, polymerase chain reaction, and in situ hybridization. RESULTS: Histologic analysis showed characteristic degenerative changes of the intervertebral discs and vertebral endplates following surgery. Ultrastructural examination revealed apoptotic changes, which were verified by immunostaining. Instability also resulted in significant up-regulation of inflammatory factors, as shown by enzyme-linked immunosorbent assay, polymerase chain reaction, and in situ hybridization. CONCLUSIONS: By creating static and dynamic posterior instability of the cervical spine, this novel model of cervical spondylosis results in rapid intervertebral disc degeneration characterized by increased apoptosis and local inflammation, such as that seen clinically.

Animals↗
PubMed2006

Long-term results of expansive open-door laminoplasty for cervical myelopathy--average 14-year follow-up study.

STUDY DESIGN: Retrospective case series on long-term follow-up results of original expansive open-door laminoplasty for cervical myelopathy due to cervical spondylosis (CSM) and ossification of posterior longitudinal ligament (OPLL). OBJECTIVES: To elucidate efficacy and problems of original open-door laminoplasty to improve future surgical outcomes. SUMMARY OF BACKGROUND DATA: Little information is available on long-term outcomes of original open-door laminoplasty without grafts, implants, or instruments. METHOD: The study group included 80 patients who underwent original open-door laminoplasty and were followed for minimum 10 years. Clinical results, including Japanese Orthopedic Association scores, recovery rates, occurrences of complications, and long-term deterioration were investigated. Cervical alignments, type of OPLL, cervical range of motion, anteroposterior diameter of spinal canal, and progression of OPLL were assessed on plain radiographs. Spinal cord decompression was verified on magnetic resonance imaging. RESULTS: Average Japanese Orthopedic Association score and recovery rate improved significantly until 3 years after surgery and remained at an acceptable level in both cervical spondylosis and OPLL patients with slight deterioration after 5 years. Segmental motor palsy developed in 8 patients. Late deterioration, mainly lower extremity motor score decline, developed in 8 CSM and 16 OPLL patients. Overall cervical range of motion decreased by 36%. Patients with cervical lordosis decreased gradually in both patient groups. Such changes in alignments did not affect surgical results in CSM patients, while OPLL patients with preoperative kyphosis had lower recovery rates than those with straight and lordotic alignments. OPLL progression that was detected in 66% of patients did not affect clinical results. Although infrequent, magnetic resonance imaging revealed atrophy of spinal cord, spinal cord compression at adjacent segments due to degenerative changes and OPLL progression. CONCLUSIONS: Long-term results of open-door laminoplasty without bone graft, graft substitutes, or instruments were satisfactory. However, segmental motor paralysis, kyphosis, established before and after surgery, OPLL progression, and late deterioration due to age-related degeneration remain challenging problems.

Adult↗