REVISION POSTERIOR CERVICAL LAMINOPLASTY
Spine ConferenceUpper Chesaepeake Medical Center
August 5th, 2016
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
Note:the black line directly posterior to the vertebral bodies and relativeThinning of spinal cord, note normal disc height
C3
C3C4
C4C5
C4C5
C4C5
C5C6
C6C7
C7T1
17?
• 1963 BMJ Lees and Turner Natural Hx of Cervical spondylosis
Inverted supinator reflex
Lhermitte (flexion) and compression test
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
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
typical cervical stenosis
Greenstickfracture of childhood
1) Oyama M, Hattori S, Moriwaki N, Nitta S.: [A new method of cervical laminectomy]. Chuubu Nippon Seikeigeka Gakkai Zasshi 16: 792– 794, 1973
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
Globus stryker
seaspine
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
Muscle reattached avoid postop kyphosis, motion retained, dura coveredTo avoid postlaminectomy membrane and allow earier posterior revision
C3
C3
C3
C3 NOTICE POSTERIOR OPLL
C4NOTE CUT HALFWAY THROUGH THE LAMINA OF C4
C5
C6
C7
POSTOP SAGITTAL
Postop 1/10/14
C4 PREOP
Postop xray 6 weeks out
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
5/11/16: note progression of OPLL at C2C3
May 2016 note OPLL At c3, flexion view
c2c3
c3
May 2016Note increasedOPLL at c2c3
c3
c4
2014
2016
Compare sagittal imagesTo view progression OPLLC2C3
Note inferior laminaOf C2 was removedAnd regrew two yearslater
c6c7
Note foramenal stenosis C6C7
c5c6
Note previous L foramenotomy
c4c5
c3c4
c2c3
• OPLL categories: • Continuous, segmental, mixed, localized• Sessile and pedunculated
TYPES OF CERVICAL STENOSIS MECHANISMS
913 patients, 34 revisions, early v late 24months,
OPLL growth 0.3-1mm/yeargrowth rate can increase postop
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
Increased T1 slope can be associated with postoperative loss of cervical lordosis
111 ANTERIOR OPLLCASES17 CASES DO 15%
ISOLATED 2 DOUBLE LAYER TYPE 7
EN BLOC WITH MENINGEAL TAIL SIGN 1
Double layer sign
anterior floating decompression method: 20mm transverse corpectomy , 5mm thin, 2-3 mm margin to borders
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
Note spinal cord at C2 pre and post operativelyThe shape of C2 round
NOTE SCREW HOLES FROMPLATE REMOVAL AND L C6C7 FORAMENOTOMY
c2
C2 PARS SCREWS, INTRAOPERATIVE THERE WAS SIGNIFICANTMOTION AT C2C3
c3
c5
c6
Note healed green stick fracture of lamina with plate removed
thanks
C4
C5C6
Old images from 2014 postop
Postop 1/10/14
Postop 1/10/14
Postop 1/10/14
c2
c3
Postop 1/10/14
Postop 1/10/14
C2c3 disc space
C3 pedicle
• Questions:• 1. c2
laminoplasty with plate enough?• 2. remove c3?• 3. fusion to stop
progression of disease?• 4. anterior
decompression• C3 corpectomy
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