The purpose of this study is to evaluate the long-term results of the split laminectomy and compare these resultsit to the long-term results of the conventional laminectomy. The prevalence of kyphosis and segmental instability is being investigated…
ID
Source
Brief title
Condition
- Head and neck therapeutic procedures
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Baseline and short-term functional status was scored via a questionnaire, the
Nurick outcome scale. Long-term follow-up functional status was scored by means
of a set of questionnaires: The Nurick outcome scale, the adjusted JOA scale
and Neck disability index.
Preoperative fluoroscopy and MRI of the cervical spine were evaluated. The
fluoroscopy was used to determine the presence of kyphosis and segmental
instability using the methods of, Matsumoto and Knopp respectively.
The preoperative MRI was evaluated to confirm the diagnosis of spondylotic
myelopathy, to count the number of stenotic levels and to assess the presence
of any lesions in the spinal cord. Moreover, the compression ratio of all
cervical levels was measured by dividing the sagittal diameter of the medulla
by the transverse diameter
Secondary outcome
At long-term follow-up a lateral and a flexion-extension fluoroscopy was
obtained and evaluated for the presence of kyphosis and segmental instability.
Anteroposition of more than 2 mm of two adjacent corpora occurring upon motion
was considered as segmental instability.
In addition, prospective data of the perceived recovery were retrieved from a
questionnaire at long-term follow-up, at least 3 year postoperatively
Background summary
Degenerative changes in the cervical spinal column leads to compression of the
spinal cord and causes cervical spondylotic myelopathy (CSM). Patients with CSM
often have severed neurological deficits such as sensory complaints,
disturbance of fine motor skills and disability in walking. If these
neurological symptoms become invalidating, surgical decompression of the spinal
cord can be performed by either an anterior or a posterior approach.
Both approaches have been commonly used but have several important drawbacks.
Because of these drawbacks no real consensus has been reached. The
decision-making and applied type of surgery still depends greatly upon the
surgeon*s preference and familiarity with the type of surgery.
Posterior decompression by laminectomy or laminoplasty is often performed for
the treatment of cervical spondylotic myelopathy (CSM). However, the posterior
approach is associated with postoperative neck pain, frequent wound problems,
decreased range of motion and high risk of late kyphosis with schwan-neck
deformity. These problems are putatively due to stripping of muscular and
ligamentous attachments causing denervation and devascularization of the dorsal
cervical musculature.
To avoid such complications, without losing the benefits of decompression,
Shiraishi et al. developed the so-called *skip* laminectomy technique with the
idea to minimize the drawbacks. The short-term postoperative results compared
to the conventional laminectomy techniques were promising. Similar degree of
decompression of the cervical spinal cord was found while minor complications
occurred. We modified Shiraishi*s *skip* laminectomy technique and conducted
this new *split* laminectomy technique in patients with CSM since 2004. In the
period between 2004 and 2013 over 100 patients were treated with this modified
technique.
Study objective
The purpose of this study is to evaluate the long-term results of the split
laminectomy and compare these resultsit to the long-term results of the
conventional laminectomy. The prevalence of kyphosis and segmental instability
is being investigated, as well as the functional outcome and the patient*s
perceived recovery. Furthermore, correlations will be evaluated between
radiological and clinical outcome. In addition, predisposing variable will be
investigated. Hereby we hope to find new insights in the safety and
effectiveness of the split laminectomy.
Study design
Retrospective database research with follow-up
Study burden and risks
Nature and extent of the burden and risks associated with participation are
considered very low.
Jan Tooropstraat 164
Amsterdam 1061 AF
NL
Jan Tooropstraat 164
Amsterdam 1061 AF
NL
Listed location countries
Age
Inclusion criteria
all patients who underwent a cervical split laminectomy because of cervical myelopathy between the first of januari 2004 and 31 december 2013 in the SLAZ (Sint Lucas Andreas Hospital).
Exclusion criteria
No medical data available
pre-operative MRI of fluoroscopie not available
Cervical operation in patients history
Operation because of other reason then cervical spondylotic myelopathy
Applying cevical spondylodesis during operation
Additional neurological impairment
congentical misformed cervical spine
Patient is deceased
patient is not available
patient gave no informed consent
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL54661.100.15 |