Expansive laminoplasty in cervical canal stenosis
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Transcript of Expansive laminoplasty in cervical canal stenosis
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EXPANSIVE LAMINOPLASTY IN CERVICAL CANAL STENOSIS
Deepak Agrawal, B S Sharma, V S Mehta
Deptt of Neurosurgery,CN Centre, AIIMS,
New Delhi
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SURGICAL OPTIONS
ANTERIOR CERVICAL DECOMPRESSION AND SPINAL FUSION (ACDF)
LAMINECTOMY/LAMINOPLASTY
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ACDF LENGTHY AND COMPLICATED IMMOBILIZES SEGMENTS HIGH MECHANICAL DEMANDS ON
ADJACENT SEGMENTS RADIOLOGICAL & CLINICAL EVIDENCE OF
DETERIORATION ON FOLLOW UP
Expansive laminoplasty in cervical canal stenosis
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LAMINECTOMY
KYPHOSIS SPINAL INSTABILTY LAMINECTOMY MEMBRANE
Expansive laminoplasty in cervical canal stenosis
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Expansive laminoplasty in cervical canal stenosis
BEAUTY LIES IN SIMPLICITY
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Expansive laminoplasty in cervical canal stenosis
EXPANSIVE LAMINOPLASTY QUICK, EFFICACIOUS & DURABLE MANTAINS CERVIVAL MOBILITY PREVENTS KYPHOSIS LONG TERM RESULTS SURPASS
THAT OF ANTERIOR PROCEDURES
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INDICATIONSCERVICAL CANAL STENOSIS
OPLL-continuous/ mixed Multisegmental cervical
spondylotic myelopathy (MSCS) Ligamentum flavum hypertrophy
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CONTRAINDICATIONS Focal anterior compression Established, absolute kyphosis Isolated radiculopathy Spinal instability (Trauma, tumour
or infection)
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RETROSPECTIVE STUDY
PERIOD: Jan 1999- Nov 2002
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DEMOGAPHIC PROFILE
24 patients M:F 21:3 (7:1) Mean age: 57 yrs (36-76 yrs)
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MRI FINDINGS OPLL (Continuous/ Mixed) 12 MSCS (Multisegmental cervical spondylosis) 18 Lig flavum hypertrophy 05 Cord changes 20
(11 pts had more than one pathology)
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Expansive laminoplasty in cervical canal stenosis
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Expansive laminoplasty in cervical canal stenosis
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SURGICAL PROCEDUREMODIFIED OPEN-DOOR LAMINOPLASTY
Number of pts Titanium miniplates and screws 22 Hydroxyapatite spacer 01 Autologous bone spacer 01
AVERAGE NUMBER OF LEVELS OPERATED- 5 (4-6)
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NEUROLOGICAL ASSESMENT
NURICKS SCALE WAS USED PREOPERATIVELY AND AT LAST
FOLLOW UP
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NURICKS GRADE 0- Radiculopathy 1- Myelopathy+, No gait disturbance 2- Mild gait dist/ carry on with daily activity 3- Mod gait dist- works without assistance 4- Severe gait dist-works with assistance 5- Bedridden
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Expansive laminoplasty in cervical canal stenosis
NURICKSGRADE
PREOPERATIVE(No. of pts)
POSTOPERATIVE(No. of pts)
GRADE 1 0 2
GRADE 2 1 1
GRADE 3 2 14
GRADE 4 9 4
GRADE 5 12 3
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Expansive laminoplasty in cervical canal stenosis
2
9
12
14
43
0
2
4
6
8
10
12
14
Preop Postop
Grade 3 Grade 4 Grade 5
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Expansive laminoplasty in cervical canal stenosis
NURICKSGRADE
CORD CHANGES(No. of pts)
GRADE 1 0
GRADE 2 0
GRADE 3 1
GRADE 4 7
GRADE 5 12
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RESULTS 21 PTS (87%) had improvement
3 pts remained unchanged in their Nuricks grade (All had severe cord changes)
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COMPLICATIONS CSF leak 1
(resolved on conservative Mx)
Deterioration in power1
(compression by spacer- Reoperated-improved
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CONCLUSIONS Laminoplasty is a valuable
procedure in multisegmental anterior compression (results =/> anterior procedures)
For best results- should be performed before cord changes develop
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