Revision Posterior Cervical Laminoplasty
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Transcript of Revision Posterior Cervical Laminoplasty
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REVISION POSTERIOR CERVICAL LAMINOPLASTY
Spine ConferenceUpper Chesaepeake Medical Center
August 5th, 2016
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47 year old woman with 6 month h/o neck stiffness and pain with left UE paresthesias intoThe elbow forearm and hand especially IF/thumb
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Note:the black line directly posterior to the vertebral bodies and relativeThinning of spinal cord, note normal disc height
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C3
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C3C4
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C4C5
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C4C5
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C4C5
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C5C6
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C6C7
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C7T1
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17?
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• 1963 BMJ Lees and Turner Natural Hx of Cervical spondylosis
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Inverted supinator reflex
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Lhermitte (flexion) and compression test
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finger escape sign: involuntary flexion/abduction within 1 minute of extended and adducted fingers held statically
Grip and release test” inability to grip and release fist rapidly
:HOffman
Dysdiadochokinesia, or grip and release sign
Finger escape sign: interossei 5th/4th digit
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Mid-sagittal diameter: width1:5 ratio leads to necrosis of gray matter• Ogino H: Canal diameter, anteroposterior compression ratio
and spondylotic myelopathy of the cervical spine. Spine 1983; 8:1-15• Cord compression causes ischemia and direct mechanical
trauma
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typical cervical stenosis
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Greenstickfracture of childhood
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1) Oyama M, Hattori S, Moriwaki N, Nitta S.: [A new method of cervical laminectomy]. Chuubu Nippon Seikeigeka Gakkai Zasshi 16: 792– 794, 1973
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OPLL
2-4% Japanese, otherwise .01-2%
5th-6th decade
3% cervical, 0.8%thoracic
2:1 male:female
Genetic
100% of patient with occupancy ratio > 60% developed myelopathy
Younger patients progress
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Globus stryker
seaspine
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The K-line is a straight line from the midpoints of the spinal canal at C2 and C7
K-LIne
Occupying ratio=a/b x100
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Muscle reattached avoid postop kyphosis, motion retained, dura coveredTo avoid postlaminectomy membrane and allow earier posterior revision
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C3
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C3
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C3
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C3 NOTICE POSTERIOR OPLL
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C4NOTE CUT HALFWAY THROUGH THE LAMINA OF C4
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C5
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C6
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C7
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POSTOP SAGITTAL
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Postop 1/10/14
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C4 PREOP
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Postop xray 6 weeks out
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2.5 years later…………….
• 49 year old woman cc: L posterior arm pain L trapezial pain, neck pain, L IF pain
• HPI:C2C7 laminoplasty removing half of C2/C7 plates on C3-6, L C5C6 foramenotomy 1/9/14 (2.5 years ago); initial symptoms 2013 were L shoulder pain elbow, forearm, L hand numbness
• MEDS: Benicar, HCTZ, Lexapro, Lipitor• SH: RHD mother 4 children, cashier
married• EXAM: 5’3” 210 lb negative clonus,
hoffmans, 0/4 dtr normal motor, normal shoulder exam
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5/11/16: note progression of OPLL at C2C3
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May 2016 note OPLL At c3, flexion view
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c2c3
c3
May 2016Note increasedOPLL at c2c3
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c3
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c4
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2014
2016
Compare sagittal imagesTo view progression OPLLC2C3
Note inferior laminaOf C2 was removedAnd regrew two yearslater
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c6c7
Note foramenal stenosis C6C7
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c5c6
Note previous L foramenotomy
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c4c5
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c3c4
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c2c3
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• OPLL categories: • Continuous, segmental, mixed, localized• Sessile and pedunculated
TYPES OF CERVICAL STENOSIS MECHANISMS
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913 patients, 34 revisions, early v late 24months,
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OPLL growth 0.3-1mm/yeargrowth rate can increase postop
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2009 Wash U130 laminoplasty cases12 revisions 9%5 kyphosis, 5 spondy, 8 disease progression 6%8 disease progression 6% but only one had Progression of OPLL
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Increased T1 slope can be associated with postoperative loss of cervical lordosis
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111 ANTERIOR OPLLCASES17 CASES DO 15%
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ISOLATED 2 DOUBLE LAYER TYPE 7
EN BLOC WITH MENINGEAL TAIL SIGN 1
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Double layer sign
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anterior floating decompression method: 20mm transverse corpectomy , 5mm thin, 2-3 mm margin to borders
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49 year old woman cc: L posterior arm pain L trapezial pain, neck pain, L IF pain
• Questions:
• 1. c2 laminoplasty with plate enough?
• 2. laminectomy C2C3?
• 3. fusion to stop progression of disease?
• 4. anterior decompression
• C3 corpectomy?
• 5. remove plates
• 6. L C6C7 foramenotomy?
• 7. C2T2 PSF/LAMI?
DISCUSSION
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Note spinal cord at C2 pre and post operativelyThe shape of C2 round
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NOTE SCREW HOLES FROMPLATE REMOVAL AND L C6C7 FORAMENOTOMY
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c2
C2 PARS SCREWS, INTRAOPERATIVE THERE WAS SIGNIFICANTMOTION AT C2C3
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c3
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c5
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c6
Note healed green stick fracture of lamina with plate removed
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thanks
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C4
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C5C6
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Old images from 2014 postop
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Postop 1/10/14
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Postop 1/10/14
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Postop 1/10/14
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c2
c3
Postop 1/10/14
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Postop 1/10/14
C2c3 disc space
C3 pedicle
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• Questions:• 1. c2
laminoplasty with plate enough?• 2. remove c3?• 3. fusion to stop
progression of disease?• 4. anterior
decompression• C3 corpectomy