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Multilevel posterior foraminotomy with laminoplasty versus laminoplasty alone for cervical spondylotic myelopathy with radiculopathy: a comparative study.
Spine J. 2018 03; 18(3):414-421.SJ

Abstract

BACKGROUND CONTEXT

Conventional laminoplasty is useful for expanding a stenotic spinal canal. However, it has limited use for the decompression of accompanying neural foraminal stenosis. As such, an additional posterior foraminotomy could be simultaneously applied, although this procedure carries a risk of segmental kyphosis and instability.

PURPOSE

The aim of this study was to elucidate the long-term surgical outcomes of additional posterior foraminotomy with laminoplasty (LF) for cervical spondylotic myelopathy (CSM) with radiculopathy.

STUDY DESIGN/SETTING

A retrospective comparative study was carried out.

PATIENT SAMPLE

Ninety-eight consecutive patients who underwent laminoplasty for CSM with radiculopathy between January 2006 and December 2012 were screened for eligibility. This study included 66 patients, who were treated with a laminoplasty of two or more levels and followed up for more than 2 years after surgery.

OUTCOME MEASURES

The Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) scores, JOA recovery rates, and visual analog scale (VAS) were used to evaluate clinical outcomes. The C2-C7 sagittal vertical axis distance, cervical lordosis, range of motion (ROM), and angulation and vertebral slippage at the foraminotomy level were used to measure radiological outcomes using the whole spine anterioposterior or lateral and dynamic lateral radiographs.

METHODS

Sixty-six patients with CSM with radiculopathy involving two or more levels were consecutively treated with laminoplasty and followed up for more than 2 years after surgery. The first 26 patients underwent laminoplasty alone (LA group), whereas the next 40 patients underwent an additional posterior foraminotomy at stenotic neural foramens with radiating symptoms in addition to laminoplasty (LF group). In the LF group, the foraminotomy with less resection than 50% of facet joint to avoid segmental kyphosis and instability was performed at 78 segments (unilateral-to-bilateral ratio=57:21) and 99 sites. Clinical and radiographic data were assessed preoperatively and at 2-year follow-up and compared between the groups.

RESULTS

The NDI, JOA scores, JOA recovery rates, and VAS for neck and arm pain were improved significantly in both groups after surgery. The improvement in the VAS for arm pain was significantly greater in the LF group (from 5.55±2.52 to 1.85±2.39) than the LA group (from 5.48±2.42 to 3.40±2.68) (p<.001). Although cervical lordosis and ROM decreased postoperatively in both groups, there were no significant differences in the degree of reduction between the LF and LA groups. Although the postoperative focal angulation and slippage were slightly increased in the LF group, this was not to a significant degree. Furthermore, segmental kyphosis and instability were not observed in the LF group, regardless of whether the patient underwent a unilateral or bilateral foraminotomy.

CONCLUSIONS

Additional posterior foraminotomy with laminoplasty is likely to improve arm pain more significantly than laminoplasty alone by decompressing nerve roots. Also, performing posterior foraminotomy via multiple levels or bilaterally did not significantly affect segmental malalignment and instability. Therefore, when a laminoplasty is performed for CSM with radiculopathy, an additional posterior foraminotomy could be an efficient and safe treatment that improves both myelopathy symptoms and radicular arm pain.

Authors+Show Affiliations

Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38, Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do 25440, South Korea.Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38, Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do 25440, South Korea. Electronic address: osjungki@gmail.com.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28882525

Citation

Lee, Dong-Ho, et al. "Multilevel Posterior Foraminotomy With Laminoplasty Versus Laminoplasty Alone for Cervical Spondylotic Myelopathy With Radiculopathy: a Comparative Study." The Spine Journal : Official Journal of the North American Spine Society, vol. 18, no. 3, 2018, pp. 414-421.
Lee DH, Cho JH, Hwang CJ, et al. Multilevel posterior foraminotomy with laminoplasty versus laminoplasty alone for cervical spondylotic myelopathy with radiculopathy: a comparative study. Spine J. 2018;18(3):414-421.
Lee, D. H., Cho, J. H., Hwang, C. J., Lee, C. S., Kim, C., & Ha, J. K. (2018). Multilevel posterior foraminotomy with laminoplasty versus laminoplasty alone for cervical spondylotic myelopathy with radiculopathy: a comparative study. The Spine Journal : Official Journal of the North American Spine Society, 18(3), 414-421. https://doi.org/10.1016/j.spinee.2017.08.222
Lee DH, et al. Multilevel Posterior Foraminotomy With Laminoplasty Versus Laminoplasty Alone for Cervical Spondylotic Myelopathy With Radiculopathy: a Comparative Study. Spine J. 2018;18(3):414-421. PubMed PMID: 28882525.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multilevel posterior foraminotomy with laminoplasty versus laminoplasty alone for cervical spondylotic myelopathy with radiculopathy: a comparative study. AU - Lee,Dong-Ho, AU - Cho,Jae Hwan, AU - Hwang,Chang Ju, AU - Lee,Choon Sung, AU - Kim,Chunghwan, AU - Ha,Jung-Ki, Y1 - 2017/09/04/ PY - 2017/05/25/received PY - 2017/08/04/revised PY - 2017/08/08/accepted PY - 2017/9/9/pubmed PY - 2018/11/9/medline PY - 2017/9/9/entrez KW - Cervical KW - Foraminal stenosis KW - Instability KW - Kyphosis KW - Myelopathy KW - Open door laminoplasty KW - Posterior foraminotomy KW - Radiculopathy SP - 414 EP - 421 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 18 IS - 3 N2 - BACKGROUND CONTEXT: Conventional laminoplasty is useful for expanding a stenotic spinal canal. However, it has limited use for the decompression of accompanying neural foraminal stenosis. As such, an additional posterior foraminotomy could be simultaneously applied, although this procedure carries a risk of segmental kyphosis and instability. PURPOSE: The aim of this study was to elucidate the long-term surgical outcomes of additional posterior foraminotomy with laminoplasty (LF) for cervical spondylotic myelopathy (CSM) with radiculopathy. STUDY DESIGN/SETTING: A retrospective comparative study was carried out. PATIENT SAMPLE: Ninety-eight consecutive patients who underwent laminoplasty for CSM with radiculopathy between January 2006 and December 2012 were screened for eligibility. This study included 66 patients, who were treated with a laminoplasty of two or more levels and followed up for more than 2 years after surgery. OUTCOME MEASURES: The Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) scores, JOA recovery rates, and visual analog scale (VAS) were used to evaluate clinical outcomes. The C2-C7 sagittal vertical axis distance, cervical lordosis, range of motion (ROM), and angulation and vertebral slippage at the foraminotomy level were used to measure radiological outcomes using the whole spine anterioposterior or lateral and dynamic lateral radiographs. METHODS: Sixty-six patients with CSM with radiculopathy involving two or more levels were consecutively treated with laminoplasty and followed up for more than 2 years after surgery. The first 26 patients underwent laminoplasty alone (LA group), whereas the next 40 patients underwent an additional posterior foraminotomy at stenotic neural foramens with radiating symptoms in addition to laminoplasty (LF group). In the LF group, the foraminotomy with less resection than 50% of facet joint to avoid segmental kyphosis and instability was performed at 78 segments (unilateral-to-bilateral ratio=57:21) and 99 sites. Clinical and radiographic data were assessed preoperatively and at 2-year follow-up and compared between the groups. RESULTS: The NDI, JOA scores, JOA recovery rates, and VAS for neck and arm pain were improved significantly in both groups after surgery. The improvement in the VAS for arm pain was significantly greater in the LF group (from 5.55±2.52 to 1.85±2.39) than the LA group (from 5.48±2.42 to 3.40±2.68) (p<.001). Although cervical lordosis and ROM decreased postoperatively in both groups, there were no significant differences in the degree of reduction between the LF and LA groups. Although the postoperative focal angulation and slippage were slightly increased in the LF group, this was not to a significant degree. Furthermore, segmental kyphosis and instability were not observed in the LF group, regardless of whether the patient underwent a unilateral or bilateral foraminotomy. CONCLUSIONS: Additional posterior foraminotomy with laminoplasty is likely to improve arm pain more significantly than laminoplasty alone by decompressing nerve roots. Also, performing posterior foraminotomy via multiple levels or bilaterally did not significantly affect segmental malalignment and instability. Therefore, when a laminoplasty is performed for CSM with radiculopathy, an additional posterior foraminotomy could be an efficient and safe treatment that improves both myelopathy symptoms and radicular arm pain. SN - 1878-1632 UR - https://www.unboundmedicine.com/medline/citation/28882525/Multilevel_posterior_foraminotomy_with_laminoplasty_versus_laminoplasty_alone_for_cervical_spondylotic_myelopathy_with_radiculopathy:_a_comparative_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(17)30896-3 DB - PRIME DP - Unbound Medicine ER -