revision posterior cervical laminoplasty

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