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Skip laminectomy--a new treatment for cervical spondylotic myelopathy, preserving bilateral muscular attachments to the spinous processes: a preliminary report.
Spine J. 2002 Mar-Apr; 2(2):108-15.SJ

Abstract

BACKGROUND CONTEXT

Techniques in current use for expansive laminoplasty operations (ELAP) on the cervical spine damage the extensor mechanisms, resulting in restriction of neck motion, loss of lordosis and persistent axial pains.

PURPOSE

This article introduces a new surgical technique called skip laminectomy, which reduces morbidity after decompression of the cervical spinal canal.

STUDY DESIGN/SETTING

A prospective study is presented of all patients with multilevel cervical spondylotic myelopathy (CSM), treated by this new procedure between December 1998 and March 2000.

PATIENT SAMPLE

Since December 1998, 61 patients with CSM have undergone the procedure, of whom 24 (13 men and 11 women) were selected for this study. Follow-up periods ranged from 12 to 25 months, with an average of 18 months. Average age at operation was 69 years (range, 50 to 82 years). Eighteen patients with CSM on whom C3-C7 open-door laminoplasties had been performed by the author before 1998 were selected as controls for study of postoperative atrophy of the deep extensor cervical muscles. There were 11 men and 7 women, average age 67 years (range, 45 to 81).

OUTCOME MEASURES

Axial symptoms and Japanese Orthopaedic Association (JOA) scores were recorded. Pre- and postoperative ranges of neck motion were measured on lateral flexion and extension radiographs. Pre- and postoperative cervical curvature indexes were calculated according to Ishihara's method. For quantitative analysis of damage to the posterior cervical muscles, atrophy rates were calculated from cross-sectional areas of the deep extensor muscles on the pre- and postoperative axial magnetic resonance imaging.

METHODS

In skip laminectomy, standard laminectomies are performed at selected levels, combined with partial laminectomies of the cephalad halves of laminae at other selected levels, where the muscular attachments to the spinous processes are left undisturbed. Instead of a standard laminectomy, an interlaminar decompression can be performed at levels where the anterior spinal cord compression is insignificant. It is accomplished by simply removing the cephalad half of the inferior lamina and ligamentum flavum without detaching the semispinalis cervicis and multifidus muscles from the adjacent spinous processes.

RESULTS

Using JOA scores, the average recovery rate was 61.0%. None of the patients complained of persistent axial symptoms. The postoperative range of flexion-extension motion averaged 97% of the preoperative measures. The cervical curvature index was reduced in 1 of the 24 patients. The atrophy rate of the deep extensor muscles after skip laminectomy was 20% of that seen after open-door laminoplasty.

CONCLUSIONS

Skip laminectomy for cervical spinal canal decompression is less invasive than conventional laminectomy and ELAP. It is effective in preventing postoperative problems, such as persistent axial symptoms, restriction of neck motion and loss of cervical lordosis.

Authors+Show Affiliations

Department of Orthopaedic Surgery, National Tochigi Hospital, 1-10-37, Nakatomatsuri, Utsunomiya, Tochigi, 320-0057, Japan. tateru_shiraishi@samiya.com

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

14588269

Citation

Shiraishi, Tateru. "Skip Laminectomy--a New Treatment for Cervical Spondylotic Myelopathy, Preserving Bilateral Muscular Attachments to the Spinous Processes: a Preliminary Report." The Spine Journal : Official Journal of the North American Spine Society, vol. 2, no. 2, 2002, pp. 108-15.
Shiraishi T. Skip laminectomy--a new treatment for cervical spondylotic myelopathy, preserving bilateral muscular attachments to the spinous processes: a preliminary report. Spine J. 2002;2(2):108-15.
Shiraishi, T. (2002). Skip laminectomy--a new treatment for cervical spondylotic myelopathy, preserving bilateral muscular attachments to the spinous processes: a preliminary report. The Spine Journal : Official Journal of the North American Spine Society, 2(2), 108-15.
Shiraishi T. Skip Laminectomy--a New Treatment for Cervical Spondylotic Myelopathy, Preserving Bilateral Muscular Attachments to the Spinous Processes: a Preliminary Report. Spine J. 2002 Mar-Apr;2(2):108-15. PubMed PMID: 14588269.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Skip laminectomy--a new treatment for cervical spondylotic myelopathy, preserving bilateral muscular attachments to the spinous processes: a preliminary report. A1 - Shiraishi,Tateru, PY - 2003/11/1/pubmed PY - 2003/12/4/medline PY - 2003/11/1/entrez SP - 108 EP - 15 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 2 IS - 2 N2 - BACKGROUND CONTEXT: Techniques in current use for expansive laminoplasty operations (ELAP) on the cervical spine damage the extensor mechanisms, resulting in restriction of neck motion, loss of lordosis and persistent axial pains. PURPOSE: This article introduces a new surgical technique called skip laminectomy, which reduces morbidity after decompression of the cervical spinal canal. STUDY DESIGN/SETTING: A prospective study is presented of all patients with multilevel cervical spondylotic myelopathy (CSM), treated by this new procedure between December 1998 and March 2000. PATIENT SAMPLE: Since December 1998, 61 patients with CSM have undergone the procedure, of whom 24 (13 men and 11 women) were selected for this study. Follow-up periods ranged from 12 to 25 months, with an average of 18 months. Average age at operation was 69 years (range, 50 to 82 years). Eighteen patients with CSM on whom C3-C7 open-door laminoplasties had been performed by the author before 1998 were selected as controls for study of postoperative atrophy of the deep extensor cervical muscles. There were 11 men and 7 women, average age 67 years (range, 45 to 81). OUTCOME MEASURES: Axial symptoms and Japanese Orthopaedic Association (JOA) scores were recorded. Pre- and postoperative ranges of neck motion were measured on lateral flexion and extension radiographs. Pre- and postoperative cervical curvature indexes were calculated according to Ishihara's method. For quantitative analysis of damage to the posterior cervical muscles, atrophy rates were calculated from cross-sectional areas of the deep extensor muscles on the pre- and postoperative axial magnetic resonance imaging. METHODS: In skip laminectomy, standard laminectomies are performed at selected levels, combined with partial laminectomies of the cephalad halves of laminae at other selected levels, where the muscular attachments to the spinous processes are left undisturbed. Instead of a standard laminectomy, an interlaminar decompression can be performed at levels where the anterior spinal cord compression is insignificant. It is accomplished by simply removing the cephalad half of the inferior lamina and ligamentum flavum without detaching the semispinalis cervicis and multifidus muscles from the adjacent spinous processes. RESULTS: Using JOA scores, the average recovery rate was 61.0%. None of the patients complained of persistent axial symptoms. The postoperative range of flexion-extension motion averaged 97% of the preoperative measures. The cervical curvature index was reduced in 1 of the 24 patients. The atrophy rate of the deep extensor muscles after skip laminectomy was 20% of that seen after open-door laminoplasty. CONCLUSIONS: Skip laminectomy for cervical spinal canal decompression is less invasive than conventional laminectomy and ELAP. It is effective in preventing postoperative problems, such as persistent axial symptoms, restriction of neck motion and loss of cervical lordosis. SN - 1529-9430 UR - https://www.unboundmedicine.com/medline/citation/14588269/Skip_laminectomy__a_new_treatment_for_cervical_spondylotic_myelopathy_preserving_bilateral_muscular_attachments_to_the_spinous_processes:_a_preliminary_report_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529943001001188 DB - PRIME DP - Unbound Medicine ER -