Хирургия позвоночника (Mar 2021)
Bilateral osteoplastic decompression laminoplasty with simultaneous foraminotomy to treat multilevel cervical stenosis
Abstract
Objective. To analyze surgical technique and possibilities of using bilateral laminoplasty technique with simultaneous foraminotomy for extended stenosis of the cervical spine. Material and Methods. The analysis included results of surgical treatment of 26 patients (18 males and 8 females, mean age 60.2 ± 1.3 years) operated on by the method of bilateral laminoplasty with simultaneous foraminotomy from January 2016 to April 2020. Pre- and postoperative clinical condition of patients was assessed, including using VAS, JOA and Nurick scales. An objective assessment of stenosis degree (linear dimensions, areas, volume of the stenotic spinal canal) was performed using standard measuring tools of the RadiAnt DICOM Viewer software. To assess the statistical significance of the obtained results, nonparametric Wilcoxon-T and Mann – Whitney-U tests were used. Differences were considered significant at p < 0.05. Results. Upon admission to the hospital, all patients had specific neurological symptoms with varying degree of pain, myelopathic and radicular symptoms. According to neurovisualisation, the average number of involved in the process levels (stenotic) was 3.2 ± 0.1, (the average length of stenosis was 5.1 ± 0.2 cm). In the postoperative period, all patients showed positive dynamics in the form of a decrease in the severity of neurological disorders and pain (from 7.2 ± 0.1 to 5.07 ± 0.1 according to VAS, p < 0.001). The manifestations of myelopathy decreased according to Nurick scale from 2.08 ± 0.71 to 1.84 ± 0.10 points (p < 0.05). According to MRI data, the average area of the dural sac objectively increased from 1.25 ± 0.30 cm2 to 2.26 ± 0.27 cm2 (p < 0.001), and the volume of spinal canal in the area of stenosis increased from 7.2 ± 0.2 cm3 to 13.4 ± 0.1 cm3 (p < 0.001). Patients were mobilized on the 2nd day after surgery. The duration of inpatient treatment ranged from 4 to 17 days (on average, 7.1 ± 0.4 days). Intraoperative complications were not observed in the presented series. Mild postoperative complications were detected only in two out of 26 operated patients. Conclusion. Bilateral laminoplasty with simultaneous foraminotomy using titanium miniplates and osteoinductive material has a number of advantages and can be the surgery of choice in the treatment of patients with extended cervical stenosis complicated by myelopathy and radicular pain syndrome.
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