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Microendoscopic laminotomy versus conventional laminoplasty for cervical spondylotic myelopathy: 5-year follow-up study.
J Neurosurg Spine. 2017 Oct; 27(4):403-409.JN

Abstract

OBJECTIVE

The goal of this study was to characterize the long-term clinical and radiological results of articular segmental decompression surgery using endoscopy (cervical microendoscopic laminotomy [CMEL]) for cervical spondylotic myelopathy (CSM) and to compare outcomes to conventional expansive laminoplasty (ELAP).

METHODS

Consecutive patients with CSM who required surgical treatment were enrolled. All enrolled patients (n = 78) underwent CMEL or ELAP. All patients were followed postoperatively for more than 5 years. The preoperative and 5-year follow-up evaluations included neurological assessment (Japanese Orthopaedic Association [JOA] score), JOA recovery rates, axial neck pain (using a visual analog scale), the SF-36, and cervical sagittal alignment (C2-7 subaxial cervical angle).

RESULTS

Sixty-one patients were included for analysis, 31 in the CMEL group and 30 in the ELAP group. The mean preoperative JOA score was 10.1 points in the CMEL group and 10.9 points in the ELAP group (p > 0.05). The JOA recovery rates were similar, 57.6% in the CMEL group and 55.4% in the ELAP group (p > 0.05). The axial neck pain in the CMEL group was significantly lower than that in the ELAP group (p < 0.01). At the 5-year follow-up, cervical alignment was more favorable in the CMEL group, with an average 2.6° gain in lordosis (versus 1.2° loss of lordosis in the ELAP group [p < 0.05]) and lower incidence of postoperative kyphosis.

CONCLUSIONS

CMEL is a novel, less invasive technique that allows for multilevel posterior cervical decompression for the treatment of CSM. This 5-year follow-up data demonstrates that after undergoing CMEL, patients have similar neurological outcomes to conventional laminoplasty, with significantly less postoperative axial pain and improved subaxial cervical lordosis when compared with their traditional ELAP counterparts.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and.Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and.Microendoscopic Spine Institute, Dallas, Texas.Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and.Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and.Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and.Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and.Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and.Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and.Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and.Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28708041

Citation

Minamide, Akihito, et al. "Microendoscopic Laminotomy Versus Conventional Laminoplasty for Cervical Spondylotic Myelopathy: 5-year Follow-up Study." Journal of Neurosurgery. Spine, vol. 27, no. 4, 2017, pp. 403-409.
Minamide A, Yoshida M, Simpson AK, et al. Microendoscopic laminotomy versus conventional laminoplasty for cervical spondylotic myelopathy: 5-year follow-up study. J Neurosurg Spine. 2017;27(4):403-409.
Minamide, A., Yoshida, M., Simpson, A. K., Yamada, H., Hashizume, H., Nakagawa, Y., Iwasaki, H., Tsutsui, S., Okada, M., Takami, M., & Nakao, S. I. (2017). Microendoscopic laminotomy versus conventional laminoplasty for cervical spondylotic myelopathy: 5-year follow-up study. Journal of Neurosurgery. Spine, 27(4), 403-409. https://doi.org/10.3171/2017.2.SPINE16939
Minamide A, et al. Microendoscopic Laminotomy Versus Conventional Laminoplasty for Cervical Spondylotic Myelopathy: 5-year Follow-up Study. J Neurosurg Spine. 2017;27(4):403-409. PubMed PMID: 28708041.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microendoscopic laminotomy versus conventional laminoplasty for cervical spondylotic myelopathy: 5-year follow-up study. AU - Minamide,Akihito, AU - Yoshida,Munehito, AU - Simpson,Andrew K, AU - Yamada,Hiroshi, AU - Hashizume,Hiroshi, AU - Nakagawa,Yukihiro, AU - Iwasaki,Hiroshi, AU - Tsutsui,Shunji, AU - Okada,Motohiro, AU - Takami,Masanari, AU - Nakao,Shin-Ichi, Y1 - 2017/07/14/ PY - 2017/7/15/pubmed PY - 2017/10/7/medline PY - 2017/7/15/entrez KW - CMEL = cervical microendoscopic laminotomy KW - CSM = cervical spondylotic myelopathy KW - ELAP = expansive laminoplasty KW - JOA = Japanese Orthopaedic Association KW - JOACMEQ = JOA Cervical Myelopathy Evaluation Questionnaire KW - OPLL = ossification of the posterior longitudinal ligament KW - VAS = visual analog scale KW - cervical spine KW - cervical spondylotic myelopathy KW - clinical outcome KW - endoscopic surgery KW - laminoplasty KW - minimally invasive surgery KW - pincer mechanism SP - 403 EP - 409 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 27 IS - 4 N2 - OBJECTIVE The goal of this study was to characterize the long-term clinical and radiological results of articular segmental decompression surgery using endoscopy (cervical microendoscopic laminotomy [CMEL]) for cervical spondylotic myelopathy (CSM) and to compare outcomes to conventional expansive laminoplasty (ELAP). METHODS Consecutive patients with CSM who required surgical treatment were enrolled. All enrolled patients (n = 78) underwent CMEL or ELAP. All patients were followed postoperatively for more than 5 years. The preoperative and 5-year follow-up evaluations included neurological assessment (Japanese Orthopaedic Association [JOA] score), JOA recovery rates, axial neck pain (using a visual analog scale), the SF-36, and cervical sagittal alignment (C2-7 subaxial cervical angle). RESULTS Sixty-one patients were included for analysis, 31 in the CMEL group and 30 in the ELAP group. The mean preoperative JOA score was 10.1 points in the CMEL group and 10.9 points in the ELAP group (p > 0.05). The JOA recovery rates were similar, 57.6% in the CMEL group and 55.4% in the ELAP group (p > 0.05). The axial neck pain in the CMEL group was significantly lower than that in the ELAP group (p < 0.01). At the 5-year follow-up, cervical alignment was more favorable in the CMEL group, with an average 2.6° gain in lordosis (versus 1.2° loss of lordosis in the ELAP group [p < 0.05]) and lower incidence of postoperative kyphosis. CONCLUSIONS CMEL is a novel, less invasive technique that allows for multilevel posterior cervical decompression for the treatment of CSM. This 5-year follow-up data demonstrates that after undergoing CMEL, patients have similar neurological outcomes to conventional laminoplasty, with significantly less postoperative axial pain and improved subaxial cervical lordosis when compared with their traditional ELAP counterparts. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/28708041/Microendoscopic_laminotomy_versus_conventional_laminoplasty_for_cervical_spondylotic_myelopathy:_5_year_follow_up_study_ L2 - https://thejns.org/doi/10.3171/2017.2.SPINE16939 DB - PRIME DP - Unbound Medicine ER -