Plate fixation of expansive open-door laminoplasty decreases the incidence of postoperative C5 palsy

Yoshiomi Kobayashi, Satoshi Matsumaru, Tetsuya Kuramoto, Narihito Nagoshi, Akio Iwanami, Osahiko Tsuji, Eijiro Okada, Nobuyuki Fujita, Mitsuru Yagi, Takashi Tsuji, Jun Ogawa, Masaya Nakamura, Morio Masumoto, Ken Ishii, Kota Watanabe

Research output: Contribution to journalArticle

Abstract

Study Design:Retrospective study.Objective:To compare outcomes for plate fixation versus suture suspension in expansive open-door laminoplasty (ELAP) for cervical spondylotic myelopathy (CSM).Summary of Background Data:C5 palsy and laminar closure have been reported to occur after ELAP when suture suspension is used to anchor the opened lamina.Materials and Methods:We assessed 174 patients with CSM who were treated by ELAP using either suture suspension (114 patients, mean age 63.3 y, 83 men and 31 women, mean follow-up 12.0 mo) or laminoplasty plate (60 patients, mean age 65.6 y, 45 men and 15 women, mean follow-up 12.6 mo) to maintain the position of the opened laminae. We compared clinical outcomes, radiographic findings, and complications between the 2 groups.Results:Mean Japanese Orthopaedic Association scores had improved significantly for both groups at the final follow-up (P<0.001), with similar recovery rates: Scores improved from 10.8±2.8 to 13.4±2.8 points in the suture-suspension (SS) group and from 11.3±2.7 to 13.6±2.2 points in the laminoplasty plate (LP) group. The incidence of C5 palsy was significantly higher in the SS group (7.9%) than in the LP group (1.7%; P<0.05). Computed tomography (CT) showed larger mean angles of the opened laminae in the SS group compared with the LP group (P<0.01). Magnetic resonance imaging (MRI) showed that the mean anterior spinal-cord space at the C5 level was larger in the SS group than in the LP group (P<0.01).Conclusions:Plate fixation in ELAP produced comparable clinical outcomes and significantly lowered the incidence of C5 palsy compared with suture suspension. CT and MRI findings indicated that laminoplasty plate fixation prevented excessive opening of the lamina and decreased dorsal spinal-cord shift, which might explain the lower incidence of C5 palsy.

Original languageEnglish
Pages (from-to)E177-E182
JournalClinical Spine Surgery
Volume32
Issue number4
DOIs
Publication statusPublished - 01-05-2019

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Paralysis
Sutures
Suspensions
Incidence
Spinal Cord Diseases
Spinal Cord
Tomography
Magnetic Resonance Imaging
Laminoplasty
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Kobayashi, Y., Matsumaru, S., Kuramoto, T., Nagoshi, N., Iwanami, A., Tsuji, O., ... Watanabe, K. (2019). Plate fixation of expansive open-door laminoplasty decreases the incidence of postoperative C5 palsy. Clinical Spine Surgery, 32(4), E177-E182. https://doi.org/10.1097/BSD.0000000000000790
Kobayashi, Yoshiomi ; Matsumaru, Satoshi ; Kuramoto, Tetsuya ; Nagoshi, Narihito ; Iwanami, Akio ; Tsuji, Osahiko ; Okada, Eijiro ; Fujita, Nobuyuki ; Yagi, Mitsuru ; Tsuji, Takashi ; Ogawa, Jun ; Nakamura, Masaya ; Masumoto, Morio ; Ishii, Ken ; Watanabe, Kota. / Plate fixation of expansive open-door laminoplasty decreases the incidence of postoperative C5 palsy. In: Clinical Spine Surgery. 2019 ; Vol. 32, No. 4. pp. E177-E182.
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abstract = "Study Design:Retrospective study.Objective:To compare outcomes for plate fixation versus suture suspension in expansive open-door laminoplasty (ELAP) for cervical spondylotic myelopathy (CSM).Summary of Background Data:C5 palsy and laminar closure have been reported to occur after ELAP when suture suspension is used to anchor the opened lamina.Materials and Methods:We assessed 174 patients with CSM who were treated by ELAP using either suture suspension (114 patients, mean age 63.3 y, 83 men and 31 women, mean follow-up 12.0 mo) or laminoplasty plate (60 patients, mean age 65.6 y, 45 men and 15 women, mean follow-up 12.6 mo) to maintain the position of the opened laminae. We compared clinical outcomes, radiographic findings, and complications between the 2 groups.Results:Mean Japanese Orthopaedic Association scores had improved significantly for both groups at the final follow-up (P<0.001), with similar recovery rates: Scores improved from 10.8±2.8 to 13.4±2.8 points in the suture-suspension (SS) group and from 11.3±2.7 to 13.6±2.2 points in the laminoplasty plate (LP) group. The incidence of C5 palsy was significantly higher in the SS group (7.9{\%}) than in the LP group (1.7{\%}; P<0.05). Computed tomography (CT) showed larger mean angles of the opened laminae in the SS group compared with the LP group (P<0.01). Magnetic resonance imaging (MRI) showed that the mean anterior spinal-cord space at the C5 level was larger in the SS group than in the LP group (P<0.01).Conclusions:Plate fixation in ELAP produced comparable clinical outcomes and significantly lowered the incidence of C5 palsy compared with suture suspension. CT and MRI findings indicated that laminoplasty plate fixation prevented excessive opening of the lamina and decreased dorsal spinal-cord shift, which might explain the lower incidence of C5 palsy.",
author = "Yoshiomi Kobayashi and Satoshi Matsumaru and Tetsuya Kuramoto and Narihito Nagoshi and Akio Iwanami and Osahiko Tsuji and Eijiro Okada and Nobuyuki Fujita and Mitsuru Yagi and Takashi Tsuji and Jun Ogawa and Masaya Nakamura and Morio Masumoto and Ken Ishii and Kota Watanabe",
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Kobayashi, Y, Matsumaru, S, Kuramoto, T, Nagoshi, N, Iwanami, A, Tsuji, O, Okada, E, Fujita, N, Yagi, M, Tsuji, T, Ogawa, J, Nakamura, M, Masumoto, M, Ishii, K & Watanabe, K 2019, 'Plate fixation of expansive open-door laminoplasty decreases the incidence of postoperative C5 palsy', Clinical Spine Surgery, vol. 32, no. 4, pp. E177-E182. https://doi.org/10.1097/BSD.0000000000000790

Plate fixation of expansive open-door laminoplasty decreases the incidence of postoperative C5 palsy. / Kobayashi, Yoshiomi; Matsumaru, Satoshi; Kuramoto, Tetsuya; Nagoshi, Narihito; Iwanami, Akio; Tsuji, Osahiko; Okada, Eijiro; Fujita, Nobuyuki; Yagi, Mitsuru; Tsuji, Takashi; Ogawa, Jun; Nakamura, Masaya; Masumoto, Morio; Ishii, Ken; Watanabe, Kota.

In: Clinical Spine Surgery, Vol. 32, No. 4, 01.05.2019, p. E177-E182.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Plate fixation of expansive open-door laminoplasty decreases the incidence of postoperative C5 palsy

AU - Kobayashi, Yoshiomi

AU - Matsumaru, Satoshi

AU - Kuramoto, Tetsuya

AU - Nagoshi, Narihito

AU - Iwanami, Akio

AU - Tsuji, Osahiko

AU - Okada, Eijiro

AU - Fujita, Nobuyuki

AU - Yagi, Mitsuru

AU - Tsuji, Takashi

AU - Ogawa, Jun

AU - Nakamura, Masaya

AU - Masumoto, Morio

AU - Ishii, Ken

AU - Watanabe, Kota

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Study Design:Retrospective study.Objective:To compare outcomes for plate fixation versus suture suspension in expansive open-door laminoplasty (ELAP) for cervical spondylotic myelopathy (CSM).Summary of Background Data:C5 palsy and laminar closure have been reported to occur after ELAP when suture suspension is used to anchor the opened lamina.Materials and Methods:We assessed 174 patients with CSM who were treated by ELAP using either suture suspension (114 patients, mean age 63.3 y, 83 men and 31 women, mean follow-up 12.0 mo) or laminoplasty plate (60 patients, mean age 65.6 y, 45 men and 15 women, mean follow-up 12.6 mo) to maintain the position of the opened laminae. We compared clinical outcomes, radiographic findings, and complications between the 2 groups.Results:Mean Japanese Orthopaedic Association scores had improved significantly for both groups at the final follow-up (P<0.001), with similar recovery rates: Scores improved from 10.8±2.8 to 13.4±2.8 points in the suture-suspension (SS) group and from 11.3±2.7 to 13.6±2.2 points in the laminoplasty plate (LP) group. The incidence of C5 palsy was significantly higher in the SS group (7.9%) than in the LP group (1.7%; P<0.05). Computed tomography (CT) showed larger mean angles of the opened laminae in the SS group compared with the LP group (P<0.01). Magnetic resonance imaging (MRI) showed that the mean anterior spinal-cord space at the C5 level was larger in the SS group than in the LP group (P<0.01).Conclusions:Plate fixation in ELAP produced comparable clinical outcomes and significantly lowered the incidence of C5 palsy compared with suture suspension. CT and MRI findings indicated that laminoplasty plate fixation prevented excessive opening of the lamina and decreased dorsal spinal-cord shift, which might explain the lower incidence of C5 palsy.

AB - Study Design:Retrospective study.Objective:To compare outcomes for plate fixation versus suture suspension in expansive open-door laminoplasty (ELAP) for cervical spondylotic myelopathy (CSM).Summary of Background Data:C5 palsy and laminar closure have been reported to occur after ELAP when suture suspension is used to anchor the opened lamina.Materials and Methods:We assessed 174 patients with CSM who were treated by ELAP using either suture suspension (114 patients, mean age 63.3 y, 83 men and 31 women, mean follow-up 12.0 mo) or laminoplasty plate (60 patients, mean age 65.6 y, 45 men and 15 women, mean follow-up 12.6 mo) to maintain the position of the opened laminae. We compared clinical outcomes, radiographic findings, and complications between the 2 groups.Results:Mean Japanese Orthopaedic Association scores had improved significantly for both groups at the final follow-up (P<0.001), with similar recovery rates: Scores improved from 10.8±2.8 to 13.4±2.8 points in the suture-suspension (SS) group and from 11.3±2.7 to 13.6±2.2 points in the laminoplasty plate (LP) group. The incidence of C5 palsy was significantly higher in the SS group (7.9%) than in the LP group (1.7%; P<0.05). Computed tomography (CT) showed larger mean angles of the opened laminae in the SS group compared with the LP group (P<0.01). Magnetic resonance imaging (MRI) showed that the mean anterior spinal-cord space at the C5 level was larger in the SS group than in the LP group (P<0.01).Conclusions:Plate fixation in ELAP produced comparable clinical outcomes and significantly lowered the incidence of C5 palsy compared with suture suspension. CT and MRI findings indicated that laminoplasty plate fixation prevented excessive opening of the lamina and decreased dorsal spinal-cord shift, which might explain the lower incidence of C5 palsy.

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