Abstract
Purpose
Posterior cervical laminectomies and laminoplasties are common treatments for cervical spondylotic myelopathy. However, recent studies demonstrated that positional spinal cord compression occurred after cervical laminectomies and caused postoperative progressive myelopathy. Although there were no such reports after laminoplasties, we report two cases in which symptomatic extraordinary positional spinal cord compression occurred after laminoplasties in this paper.
Methods
This study included two patients who showed progressive myelopathy: one case after a laminectomy following failure of a single-door laminoplasty and one case after a double-door laminoplasty without interlaminar spacers.
Results
The MRIs showed mild cord compression in the neutral position in both cases. However, the patients could not extend their necks, because it triggered severe neck pain and numbness. Therefore, the positional CT myelography (CTM) was taken in the flexion and extension positions, and it showed severe spinal cord compression only in the extension position. Posterior instrumented fusions were performed for both patients, which improved their symptoms.
Conclusions
This paper demonstrates that postoperative positional spinal cord compression during neck extension caused a progressive myelopathy even after laminoplasty. When myelopathy symptoms worsen after laminoplasties, we recommend positional CTM/MRI evaluation, even though there is no apparent cord compression in the neutral MRI.
References
Breig A, Turnbull I, Hassler O (1966) Effects of mechanical stresses on the spinal cord in cervical spondylosis. A study on fresh cadaver material. J Neurosurg 25:45–56. doi:10.3171/jns.1966.25.1.0045
Panjabi M, White A (1988) Biomechanics of nonacute cervical spinal cord trauma. Spine (Phila Pa 1976) 13:838–842
Penning L, van der Zwaag P (1966) Biomechanical aspects of spondylotic myelopathy. Acta Radiol Diagn (Stockh) 5:1090–1103
Hirayama K, Tsubaki T, Toyokura Y, Okinaka S (1963) Juvenile muscular atrophy of unilateral upper extremity. Neurology 13:373–380
Fujimoto Y, Oka S, Tanaka N et al (2002) Pathophysiology and treatment for cervical flexion myelopathy. Eur Spine J 11:276–285. doi:10.1007/s005860100344
Morimoto T, Ohtsuka H, Sakaki T, Kawaguchi M (1998) Postlaminectomy cervical spinal cord compression demonstrated by dynamic magnetic resonance imaging. Case report. J Neurosurg 88:155–157. doi:10.3171/jns.1998.88.1.0155
Evans LT, Lollis SS (2015) Dynamic compression of the spinal cord by paraspinal muscles following cervical laminectomy: diagnosis using flexion-extension MRI. Case Rep Radiol 2015:275623. doi:10.1155/2015/275623
Stamm S, McClellan JW, Knierim A et al (2014) Dynamic MRI reveals soft-tissue compression causing progressive myelopathy in postlaminectomy patients: a report of three cases. JBJS Case Connect 3:e17. doi:10.2106/JBJS.CC.L.00174
Suzuki F, Nakajima M, Matsuda M (1999) Cervical cord compression caused by a pillow in a postlaminectomy patient undergoing magnetic resonance imaging. Case report. J Neurosurg 90:145–147
Itoh T, Tsuji H (1985) Technical improvements and results of laminoplasty for compressive myelopathy in the cervical spine. Spine (Phila Pa 1976) 10:729–736
Suda K, Abumi K, Ito M et al (2003) Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy. Spine (Phila Pa 1976) 28:1258–1262. doi:10.1097/01.BRS.0000065487.82469.D9
Kurokawa T, Tsuyama N, Tanaka H et al (1982) Double-door laminoplasty. Bessatsu Seikeigeka 2:234–240
Hirabayashi K, Watanabe K, Wakano K et al (1983) Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine (Phila Pa 1976) 8:693–699
Iwasaki H (1987) Expansive laminoplasty. Bessatsu Seikeigeka Seikeigeka 2:228–233
Shigematsu H, Ueda Y, Takeshima T et al (2010) Degenerative spondylolisthesis does not influence surgical results of laminoplasty in elderly cervical spondylotic myelopathy patients. Eur Spine J 19:720–725. doi:10.1007/s00586-010-1338-5
Matsumoto M, Watanabe K, Hosogane N et al (2012) Impact of lamina closure on long-term outcomes of open-door laminoplasty in patients with cervical myelopathy: minimum 5-year follow-up study. Spine (Phila Pa 1976) 37:1288–1291. doi:10.1097/BRS.0b013e3182498434
Fujibayashi S, Neo M, Nakamura T (2007) Flexion myelopathy of the thoracic spine. Case report. J Neurosurg Spine 6:68–72. doi:10.3171/spi.2007.6.1.13
Ito K, Yukawa Y, Machino M, Kato F (2013) Spinal cord cross-sectional area during flexion and extension in the patients with cervical ossification of posterior longitudinal ligament. Eur Spine J 22:2564–2568. doi:10.1007/s00586-013-2982-3
Yoshii T, Yamada T, Hirai T et al (2014) Dynamic changes in spinal cord compression by cervical ossification of the posterior longitudinal ligament evaluated by kinematic computed tomography myelography. Spine (Phila Pa 1976) 39:113–119. doi:10.1097/BRS.0000000000000086
Kobayashi S, Matsuyama Y, Shinomiya K et al (2014) A new alarm point of transcranial electrical stimulation motor evoked potentials for intraoperative spinal cord monitoring: a prospective multicenter study from the Spinal Cord Monitoring Working Group of the Japanese Society for Spine Surgery and Related. J Neurosurg Spine 20:102–107. doi:10.3171/2013.10.SPINE12944
Fujiwara Y, Izumi B, Fujiwara M et al (2016) C2 spondylotic radiculopathy: the nerve root impingement mechanism investigated by para-sagittal CT/MRI, dynamic rotational CT, intraoperative microscopic findings, and treated by microscopic posterior foraminotomy. Eur Spine J. doi:10.1007/s00586-016-4710-2
Acknowledgements
We appreciate Mr. Vincent John Hykel for his devoted support, and Dr. Benny Lay for his good advices.
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Fujiwara, Y., Manabe, H., Harada, T. et al. Extraordinary positional cervical spinal cord compression in extension position as a rare cause of postoperative progressive myelopathy after cervical posterior laminoplasty detected using the extension/flexion positional CT myelography: one case after laminectomy following failure of a single-door laminoplasty/one case after double-door laminoplasty without interlaminar spacers. Eur Spine J 26 (Suppl 1), 170–177 (2017). https://doi.org/10.1007/s00586-017-5001-2
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DOI: https://doi.org/10.1007/s00586-017-5001-2