Neurologic Outcome of Laminoplasty for Acute Traumatic Spinal Cord Injury without Instability

Hwa Joong Lee, Hwan Soo Kim, Kyoung Hyup Nam, In Ho Han, Won Ho Cho, Byung Kwan Choi, Hwa Joong Lee, Hwan Soo Kim, Kyoung Hyup Nam, In Ho Han, Won Ho Cho, Byung Kwan Choi

Abstract

Objective: The purpose of this study is to evaluate the efficacy of laminoplasty in the treatment of spinal cord injury (SCI) without instability.

Methods: 79 patients with SCI without instability who underwent surgical treatment in our institute between January 2005 and September 2012 were retrospectively reviewed. Twenty nine patients fulfilled the inclusion criteria as follows: SCI without instability, spinal cord contusion in MRI, cervical stenosis more than 20%, follow up at least 6 months. Preoperative neurological state, clinical outcome and neurological function was measured using the American Spinal Injury Association (ASIA) impairment scale, modified Japanese Orthopedic Association (mJOA) grading scale and Hirabayashi recovering rate.

Results: Seventeen patients showed improvement in ASIA grade and twenty six patients showed improvement in mJOA scale at 6 month follow up. However, all patients with ASIA grade B and C have shown improvement of one or more ASIA grade. Mean Hirabayashi recovery rate was 47.4±23.7%. There was better neurologic recovery in those who had cervical spondylosis without ossification of posterior longitudinal ligament (OPLL) (p<0.05, χ(2) test).

Conclusions: It is different in B, C, D with ASIA A that there are debates going on about the application of surgical treatment in ASIA A, and surgical treatment is helpful in B, C, D since it contributes to neurologic improvement. We concluded that laminoplasty provided good neurologic recovery in SCI without instability that cervical canal stenosis, especially spondylosis without OPLL and neurologic deterioration in ASIA B, C and D.

Keywords: Laminoplasty; Spinal cord injury; Surgical decompression.

Figures

Fig. 1
Fig. 1
Neurologic outcome according to pre-existing lesion There was better neurologic outcome in those who had OPLL than other pre-existing lesion before injury (p

Fig. 2

Neurologic outcome according to cervical…

Fig. 2

Neurologic outcome according to cervical stenosis degree Good neurologic outcome was showed at…

Fig. 2
Neurologic outcome according to cervical stenosis degree Good neurologic outcome was showed at 40-60% cord compression rate but no significant statically difference (p≥0.05).
Fig. 2
Fig. 2
Neurologic outcome according to cervical stenosis degree Good neurologic outcome was showed at 40-60% cord compression rate but no significant statically difference (p≥0.05).

References

    1. Amar AP, Levy ML. Pathogenesis and pharmacological strategies for mitigating secondary damage in acute spinal cord injury. Neurosurgery. 1999;44:1027–1039. discussion 1039-1040.
    1. Anderson DK, Hall ED. Pathophysiology of spinal cord trauma. Ann Emerg Med. 1993;22:987–992.
    1. Bedbrook GM. Spinal injuries with tetraplegia and paraplegia. J Bone Joint Surg Br. 1979;61-B:267–284.
    1. Bedbrook GM, Sakae T. A review of cervical spine injuries with neurological dysfunction. Paraplegia. 1982;20:321–333.
    1. Bose B, Northrup BE, Osterholm JL, Cotler JM, DiTunno JF. Reanalysis of central cervical cord injury management. Neurosurgery. 1984;15:367–372.
    1. Carlson GD, Gorden CD, Oliff HS, Pillai JJ, LaManna JC. Sustained spinal cord compression: part I: time-dependent effect on long-term pathophysiology. J Bone Joint Surg Am. 2003;85-A:86–94.
    1. Chen TY, Dickman CA, Eleraky M, Sonntag VK. The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis. Spine (Phila Pa 1976) 1998;23:2398–2403.
    1. Cheung WY, Arvinte D, Wong YW, Luk KD, Cheung KM. Neurological recovery after surgical decompression in patients with cervical spondylotic myelopathy - a prospective study. Int Orthop. 2008;32:273–278.
    1. Chikuda H, Seichi A, Takeshita K, Matsunaga S, Watanabe M, Nakagawa Y, et al. Acute cervical spinal cord injury complicated by preexisting ossification of the posterior longitudinal ligament: a multicenter study. Spine (Phila Pa 1976) 2011;36:1453–1458.
    1. Dimar JR, 2nd, Glassman SD, Raque GH, Zhang YP, Shields CB, et al. The influence of spinal canal narrowing and timing of decompression on neurologic recovery after spinal cord contusion in a rat model. Spine (Phila Pa 1976) 1999;24:1623–1633.
    1. Edwards CC, 2nd, Heller JG, Silcox DH, 3rd, et al. T-Saw laminoplasty for the management of cervical spondylotic myelopathy: clinical and radiographic outcome. Spine (Phila Pa 1976) 2000;25:1788–1794.
    1. Faden AI. Experimental neurobiology of central nervous system trauma. Crit Rev Neurobiol. 1993;7:175–186.
    1. Fehlings MG, Rabin D, Sears W, Cadotte DW, Aarabi B. Current practice in the timing of surgical intervention in spinal cord injury. Spine (Phila Pa 1976) 2010;35:S166–S173.
    1. Fehlings MG, Vaccaro A, Wilson JR, Singh A, W Cadotte D, Harrop JS, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) PLoS One. 2012;7:e32037.
    1. Fessler RG, Steck JC, Giovanini MA. Anterior cervical corpectomy for cervical spondylotic myelopathy. Neurosurgery. 1998;43:257–265. discussion 265-257.
    1. Hirabayashi K, Satomi K. Operative procedure and results of expansive open-door laminoplasty. Spine (Phila Pa 1976) 1988;13:870–876.
    1. Hovda DA, Becker DP, Katayama Y. Secondary injury and acidosis. J Neurotrauma. 1992;9(Suppl 1):S47–S60.
    1. Katoh S, el Masry WS, Jaffray D, McCall IW, Eisenstein SM, Pringle RG, et al. Neurologic outcome in conservatively treated patients with incomplete closed traumatic cervical spinal cord injuries. Spine (Phila Pa 1976) 1996;21:2345–2351.
    1. Kawano O, Ueta T, Shiba K, Iwamoto Y. Outcome of decompression surgery for cervical spinal cord injury without bone and disc injury in patients with spinal cord compression: a multicenter prospective study. Spinal Cord. 2010;48:548–553.
    1. Lee TT, Green BA, Gromelski EB. Safety and stability of open-door cervical expansive laminoplasty. J Spinal Disord. 1998;11:12–15.
    1. Lee TT, Manzano GR, Green BA. Modified open-door cervical expansive laminoplasty for spondylotic myelopathy: operative technique, outcome, and predictors for gait improvement. J Neurosurg. 1997;86:64–68.
    1. McKinley W, Meade MA, Kirshblum S, Barnard B. Outcomes of early surgical management versus late or no surgical intervention after acute spinal cord injury. Arch Phys Med Rehabil. 2004;85:1818–1825.
    1. Mirza SK, Krengel WF, 3rd, Chapman JR, Anderson PA, Bailey JC, Grady MS, et al. Early versus delayed surgery for acute cervical spinal cord injury. Clin Orthop Relat Res. 1999:104–114.
    1. Papadopoulos SM, Selden NR, Quint DJ, Patel N, Gillespie B, Grube S. Immediate spinal cord decompression for cervical spinal cord injury: feasibility and outcome. J Trauma. 2002;52:323–332.
    1. Tator CH, Duncan EG, Edmonds VE, Lapczak LI, Andrews DF. Neurological recovery, mortality and length of stay after acute spinal cord injury associated with changes in management. Paraplegia. 1995;33:254–262.
    1. Tator CH. Update on the pathophysiology and pathology of acute spinal cord injury. Brain Pathol. 1995;5:407–413.
    1. Vale FL, Burns J, Jackson AB, Hadley MN. Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. J Neurosurg. 1997;87:239–246.
    1. Wilmot CB, Hall KM. Evaluation of the acute management of tetraplegia: conservative versus surgical treatment. Paraplegia. 1986;24:148–153.
    1. Yoo DS, Lee SB, Huh PW, Kang SG, Cho KS. Spinal cord injury in cervical spinal stenosis by minor trauma. World Neurosurg. 2010;73:50–52. discussion e54.
    1. Young W. The post-injury responses in trauma and ischemia: secondary injury or protective mechanisms? Cent Nerv Syst Trauma. 1987;4:27–51.

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