Tsung‑Chiao Wua,†, Kuang‑Ting Yeha,b,†, Ru‑Ping Leec, Tzai‑Chiu Yua,b, Ing‑Ho Chena,b, Cheng‑Huan Penga, Kuan‑Lin Liua, Jen‑Hung Wangd, Wen‑Tien Wua,b*
aDepartment of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, bSchool of Medicine, Tzu Chi University, Hualien, Taiwan, cInstitute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, dDepartment of Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
†Both authors contributed equally to this work.
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
Abstract
Objectives: Expansive open‑door laminoplasty (EOLP) is effective for multilevel cervical spondylotic myelopathy (MCSM). When MCSM is combined with one‑ or two‑level segmental kyphosis, instability, or major anterior foci, EOLP with short‑segment anterior
cervical fusion (ACF) results in good short‑term neurological recovery and can preserve postoperative range of motion (ROM). The objective of this study was to evaluate the medium‑term clinical outcomes of this procedure and to analyze the risk factors affecting
the neurological function at the last follow‑up. Materials and Methods: A total of 87 patients were enrolled in this retrospective study conducted from January 2007 to May 2011. These patients exhibited MCSM with combined short segmental kyphosis, instability,
or major anterior pathology, and received EOLP and short‑segment anterior fusion. The follow‑up period lasted at least 60 months. The radiographic outcomes were collected from plain radiographs with dynamic views checked preoperatively and at the last follow‑up.
Neurological status and visual analog scale scores for neck pain were evaluated. Logistic regression analysis was then applied to determine the correlation between radiographic parameters and rates of neurological recovery. Results: The mean Japanese Orthopedics Association recovery rate at the last follow‑up was 77.8%. The improvement in functional scores and reduction in neck pain were statistically significant. The most influential risk factor affecting neurologic recovery was preoperative functional status. Conclusions: EOLP followed by short‑segment ACF is a favorable treatment for patients with MCSM with concomitant short‑segment kyphosis, instability, or major anterior pathology.
Keywords: Anterior major pathology, Expansive open door laminoplasty, Japanese Orthopedic Association recovery rate, Segmental instability or local kyphosis, Short level
anterior cervical fusion
