J Korean Neurosurg Soc.  2015 Jan;57(1):36-41. 10.3340/jkns.2015.57.1.36.

Outcomes of Secondary Laminoplasty for Patients with Unsatisfactory Results after Anterior Multilevel Cervical Surgery

• Liu HW
• Chen L
• Xu NW
• Yang HL
• Gu Y

• KMID: 2067089
• DOI: http://doi.org/10.3340/jkns.2015.57.1.36

Abstract

OBJECTIVE
To investigate the causes for failed anterior cervical surgery and the outcomes of secondary laminoplasty.
METHODS
Seventeen patients failed anterior multilevel cervical surgery and the following conservative treatments between Feb 2003 and May 2011 underwent secondary laminoplasty. Outcomes were evaluated by the Japanese Orthopaedic Association (JOA) Scale and visual analogue scale (VAS) before the secondary surgery, at 1 week, 2 months, 6 months, and the final visit. Cervical alignment, causes for revision and complications were also assessed.
RESULTS
With a mean follow-up of 29.7+/-12.1 months, JOA score, recovery rate and excellent to good rate improved significantly at 2 months (p<0.05) and maintained thereafter (p>0.05). Mean VAS score decreased postoperatively (p<0.05). Lordotic angle maintained during the entire follow up (p>0.05). The causes for secondary surgery were inappropriate approach in 3 patients, insufficient decompression in 4 patients, adjacent degeneration in 2 patients, and disease progression in 8 patients. Complications included one case of C5 palsy, axial pain and cerebrospinal fluid leakage, respectively.
CONCLUSION
Laminoplasty has satisfactory results in failed multilevel anterior surgery, with a low incidence of complications.

Keyword

Cervical spondylosis; Anterior discectomy and fusion; Anterior corpectomy and fusion; Laminoplasty

MeSH Terms

Asian Continental Ancestry Group
Cerebrospinal Fluid
Decompression
Disease Progression
Follow-Up Studies
Humans
Incidence
Paralysis
Spondylosis

Figure

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  Fig. 1 Cervical alignment was created by a line parallel to the inferior aspect of the C2 body and a line parallel to that of the C7 body, according to Cobb's method on lateral view.

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  Fig. 2 A 51-year-old female with OPLL, whose spinal cord was compressed at levels of C5/6 and C6/7 on T2-weight MRI (A), underwent ACCF (B, lateral view) for the first time. However, the patient complained of persisting numbness and weakness of right limbs. After secondary laminoplasty (C, lateral view), the narrowed canal (D) was enlarged (E) on CT and compression of cord was alleviated (F) on MRI. OPLL : ossification of the posterior longitudinal ligament, ACCF : anterior cervical corpectomy and fusion.

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