Analysis of Dural Configuration for Evaluation of Posterior Decompression in Cervical Myelopathy

Analysis of Dural Configuration for Evaluation of Posterior Decompression in Cervical Myelopathy AbstractOBJECTIVEThe goal of this study was to establish the criteria for sufficient decompression of the cervical spinal cord in laminoplastic surgeryMETHODSRadiological examinations and neurological evaluations were conducted for 63 patients with cervical spondylotic myelopathy (CSM) and 31 patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine who underwent suspension laminotomy.RESULTSThe dural configuration in computed tomographic myelograms was evaluated in comparison with the critical value for the dural configuration established from 36 control subjects. Seventy-six of 94 patients were judged to have achieved full decompression. The neurological improvement of patients with full decompression was significantly better than that of patients with insufficient decompression (P < 0.01). The postoperative sagittal diameter of the spinal canal was more than 14 mm in most of the sufficiently decompressed cases of CSM and more than 17 mm in OPLL cases. The laminotomy width was more than 70% of the transverse diameter of the spinal canal in both CSM and OPLL cases. There were four OPLL cases with insufficiently decompressed dura mater in the well-enlarged spinal canal after surgery. In these cases, the ossified posterior longitudinal ligament continuously occupied more than 25% of the preoperative spinal canal area over three or more segments.CONCLUSIONThe following conditions were considered critical for sufficient decompression of the spinal cord in laminoplastic operations: postoperative sagittal diameter of the spinal canal of more than 14 mm in CSM cases and more than 17 mm in OPLL cases and laminotomy width of more than 70% of the transverse diameter of the spinal canal in both CSM and OPLL cases. However, in cases of extensive OPLL, sufficient decompression could not be obtained through posterior enlargement of the spinal canal. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Analysis of Dural Configuration for Evaluation of Posterior Decompression in Cervical Myelopathy

Analysis of Dural Configuration for Evaluation of Posterior Decompression in Cervical Myelopathy

Analysis of Dural Configuration for Evaluation of Posterior Decompression in Cervical Myelopathy Yoshihiro Ishida, M .D ., Kazuo Ohmori, M .D ., Kazuhiro Suzuki, M .D ., Hidenori Inoue, M .D. Department of O rthopaedic and Spinal Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan OBJECTIVE: The goal of this study was to establish the criteria for sufficient decompression of the cervical spinal cord in laminoplastic surgery. METHODS: Radiological examinations and neurological evaluations were conducted for 63 patients with cervical spondylotic myelopathy (CSM) and 31 patients with ossification of the posterior longitudinal ligament (O PLL) of the cervical spine w ho underwent suspension laminotomy. RESULTS: The dural configuration in computed tomographic myelograms was evaluated in comparison with the critical value for the dural configuration established from 36 control subjects. Seventy-six of 94 patients were judged to have achieved full decom pression. The neurological improvement of patients with full decompression was significantly better than that of patients with insufficient decompression (P < 0.01). The postoperative sagittal diameter of the spinal canal was more than 14 mm in most of the sufficiently decompressed cases of CSM and more than 17 mm in O P L L cases. The laminotomy width was more than 7 0 % of the transverse diameter of the spinal canal in both CSM and O P L L cases. There were four O P L L cases with insufficiently decompressed dura mater in the well-enlarged spinal canal after surgery. In these cases, the ossified posterior longitudinal ligament continuously occupied more than 2 5 % of the preoperative spinal canal area over three or more segments. CO N CLU SIO N : The following conditions were considered critical for sufficient decompression of the spinal cord in laminoplastic operations: postoperative sagittal diameter of the spinal canal of more than 14 mm in CSM cases and more than 17 mm in O P L L cases and laminotomy width...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199901000-00051
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVEThe goal of this study was to establish the criteria for sufficient decompression of the cervical spinal cord in laminoplastic surgeryMETHODSRadiological examinations and neurological evaluations were conducted for 63 patients with cervical spondylotic myelopathy (CSM) and 31 patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine who underwent suspension laminotomy.RESULTSThe dural configuration in computed tomographic myelograms was evaluated in comparison with the critical value for the dural configuration established from 36 control subjects. Seventy-six of 94 patients were judged to have achieved full decompression. The neurological improvement of patients with full decompression was significantly better than that of patients with insufficient decompression (P < 0.01). The postoperative sagittal diameter of the spinal canal was more than 14 mm in most of the sufficiently decompressed cases of CSM and more than 17 mm in OPLL cases. The laminotomy width was more than 70% of the transverse diameter of the spinal canal in both CSM and OPLL cases. There were four OPLL cases with insufficiently decompressed dura mater in the well-enlarged spinal canal after surgery. In these cases, the ossified posterior longitudinal ligament continuously occupied more than 25% of the preoperative spinal canal area over three or more segments.CONCLUSIONThe following conditions were considered critical for sufficient decompression of the spinal cord in laminoplastic operations: postoperative sagittal diameter of the spinal canal of more than 14 mm in CSM cases and more than 17 mm in OPLL cases and laminotomy width of more than 70% of the transverse diameter of the spinal canal in both CSM and OPLL cases. However, in cases of extensive OPLL, sufficient decompression could not be obtained through posterior enlargement of the spinal canal.

Journal

NeurosurgeryOxford University Press

Published: Jan 1, 1999

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