To determine long-term radiological and clinical outcome of a muscle-sparing surgical technique for posterior decompression of the cervical spinal cord (cervical split laminectomy).
ID
Source
Brief title
Condition
- Spinal cord and nerve root disorders
- Nervous system, skull and spine therapeutic procedures
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Primary study parameters are the occurence of cervical kyphosis and segmental
instability on a cervical radiograph performed at least 2 years after surgery.
Secondary outcome
Secondary study parameters include the Neck Disability Index, the Nurick score
the Japanes Orthopaedic Association score and perceived recovery on a 5-point
Likert scale.
Background summary
Cervical spondylotic myelopathy (CSM) is a frequent cause of gait disturbance
and impairment in the elderly, which often requires surgical treatment. The
common surgical therapy for multisegmental CSM is posterior decompression of
the spinal canal by removing the involved cervical lamina and the ligamentum
flavum. Unfortunately, this procedure is associated with significant
postoperative problems such as axial neck pain, restriction of cervical motion,
cervical instability and kyphotic deformity occurring in up to 20% of cases
after multilevel cervical spine laminectomy. These problems are putatively due
to surgical damage to the posterior extensor mechanism of the cervical spine.
To avoid kyphosis while maintaining cervical mobility, muscle-sparing
techniques aiming to preserve the posterior muscle-ligament complex have been
proposed. We have developed a modified *split-laminectomy* technique that aims
at selective decompression of the spinal canal with only minimal interruption
of the muscular and ligamentous attachments to the lamina and spinous
processes. This surgical technique included preservation of the multifidus and
semispinalis muscle attachments to spinous processes using an interlaminar
approach. Earlier, we have demonstrated that this surgical technique is safe
and produces short-term clinical results that compare well to conventional
laminectomy. Importantly, the duration of surgery appeared to be shorter, the
surgical wounds were smaller and there was little blood loss associated with
the new technique. Whether the long-term results of in terms of neurological
outcome and kyphotic deformities also compare favorably to standard
laminectomy, however, is still unknown.
Study objective
To determine long-term radiological and clinical outcome of a muscle-sparing
surgical technique for posterior decompression of the cervical spinal cord
(cervical split laminectomy).
Study design
Retrospective observational cohort study
Study burden and risks
There are no specific benefits for the study participants. The burdens of
participating in this study include filling out questionnaires, one visit to
the hospital, undergoing a brief neurological examination and a cervical
radiograph. This burden is considered minor and risk is very low. The radiation
dose of a cervical radiograph is approximately 0,2 mSv, which equals one-tenth
of the normal annual background radiation in the Netherlands. We believe that
this risk is acceptable in relation to the possible benefits that may be gained
from this study, i.e. improved outcome of surgery for CSM.
Jan Tooropstraat 164
1006 AE Amsterdam 1006 AE
NL
Jan Tooropstraat 164
1006 AE Amsterdam 1006 AE
NL
Listed location countries
Age
Inclusion criteria
All patients who underwent a cervical split laminectomy because of cervical myelopathy between 1 01-01-2005 and 31-12-2014 in OLVG-west (formerly Sint Lucas Andreas Ziekenhuis) are considered for inclusion in this study. To be eligible to participate, a subject must meet all of the following criteria: 1. Male and female subjects aged 18 - 80 years at the time of surgery 2. Subject was diagnosed with cervical myelopathy from degenerative spinal disease requiring posterior surgical decompression 3. Cervical Split Laminectomy was performed between 2004 and 2013 4. Radiological diagnosis was in accordance with clinical signs and symptoms 5. Medical records and radiological images are available for review. 6. Subject is able and willing to comply with the study protocol 7. Subject is able to provide written informed consent
Exclusion criteria
1. No split but conventional laminectomy was performed 2. Medical records or radiological images are not available 3. Subject underwent previous neck operations 4. Subject underwent surgery for other indications than spondylotic (degenerative) myelopathy, e.g. trauma, tumor, infection 5. Additional posterior fusion and fixation was performed in the same session 6. Subject had a congenital deformity of the cervical spine, e.g. Klippel-Feil or achondroplasia 7. Subject had significant concomitant neurological disease, e.g. severe polyneuropathy or neurodegenerative disease 8. Subject has died 9. Subject cannot be contacted
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 | NL56669.100.16 |