A novel posterior approach preserving three muscles inserted at C2 in multilevel cervical posterior decompression and fusion using C2 pedicle screws
To present a novel posterior approach in multilevel cervical posterior decompression and fusion (PDF) using C2 pedicle screws that preserves the rectus capitis posterior major, oblique capitis inferior, and semispinalis cervicis.
We analyzed 30 consecutive patients who underwent C2–T1 PDF using an approach that preserved these three muscles without resecting. We assessed O-C2 range of motion (ROM), cross-sectional area of the cervical posterior muscles, rotational ROM, visual analog scale (VAS) for axial pain, neck disability index (NDI), and limitations of activities of daily living (ADL) involving neck movements.
Mean preoperative O-C2 ROM (23.6°) was significantly increased postoperatively (33.0°). Mean atrophy rate of the cross-sectional area was 3.9%. Postoperatively, 69.8% of the preoperative rotational ROM (113.3°) was retained. The preoperative VAS for axial pain and the NDI did not increase postoperatively. The postoperative O-C2 ROM (33.9°) in 26 patients for whom extension ADL were possible was significantly larger than that in four patients for whom extension ADL were impossible (26.9°). The postoperative retained rate of rotational ROM (75.8%) in 18 patients for whom rotation ADL were possible was significantly larger than that in 12 patients for whom rotation ADL were impossible (62.3%).
This is potentially an effective approach for maintaining O-C2 ROM and rotational ROM, which enabled good levels of ADL after C2–T1 PDF. Axial pain and NDI were not worse after PDF.
KeywordsPosterior decompression and fusion Posterior approach Muscle preservation Range of motion Ossification of the posterior longitudinal ligament
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
- 1.Takeuchi K, Yokoyama T, Ono A, Numasawa T, Wada K, Kumagai G, Ito J, Ueyama K, Toh S (2007) Cervical range of motion and alignment after laminoplasty preserving or reattaching the semispinalis cervicis inserted into axis. J Spinal Disord Tech 20:571–576. https://doi.org/10.1097/BSD.0b013e318046363a CrossRefPubMedGoogle Scholar
- 4.Suda K, Abumi K, Ito M, Shono Y, Kaneda K, Fujiya M (2003) Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy. Spine 28:1258–1262. https://doi.org/10.1097/01.BRS.0000065487.82469.D9 PubMedGoogle Scholar
- 5.Sakai K, Yoshii T, Hirai T, Arai Y, Torigoe I, Tomori M, Sato H, Okawa A (2016) Cervical sagittal imbalance is a predictor of kyphotic deformity after laminoplasty in cervical spondylotic myelopathy patients without preoperative kyphotic alignment. Spine 41:200–205. https://doi.org/10.1097/BRS.0000000000001206 Google Scholar
- 6.Kim B, Yoon do H, Ha Y, Yi S, Shin DA, Lee CK, Lee N, Kim KN (2016) Relationship between T1 slope and loss of lordosis after laminoplasty in patients with cervical ossification of the posterior longitudinal ligament. Spine J 16:219–225. https://doi.org/10.1016/j.spinee.2015.10.042 CrossRefPubMedGoogle Scholar
- 8.Takeuchi K, Yokoyama T, Ono A, Numasawa T, Wada K, Itabashi T, Toh S (2008) Limitations of activities of daily living accompanying reduced neck mobility after laminoplasty preserving or reattaching the semispinalis cervicis into axis. Eur Spine J 17:415–420. https://doi.org/10.1007/s00586-007-0553-1 CrossRefPubMedGoogle Scholar
- 9.Takeuchi K, Yokoyama T, Aburakawa S, Saito A, Numasawa T, Iwasaki T, Okada A, Ito J, Ueyama K, Toh S (2005) Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3–C7 laminoplasty. A modified laminoplasty preserving the semispinalis cervicis inserted into axis. Spine 30:2544–2549CrossRefPubMedGoogle Scholar
- 11.Ono A, Tonosaki Y, Numasawa T, Wada K, Yamasaki Y, Tanaka T, Kumagai G, Aburakawa S, Takeuchi K, Yokoyama T, Ueyama K, Ishibashi Y, Toh S (2012) The relationship between the anatomy of the nuchal ligament and postoperative axial pain after cervical laminoplasty: cadaver and clinical study. Spine 37:E1607–E1613. https://doi.org/10.1097/BRS.0b013e318274101b CrossRefPubMedGoogle Scholar
- 15.Heller JG, Pedlow FX Jr, Gill SS (2005) Anatomy of the cervical spine. In: Clark CR (ed) The cervical spine, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 3–36Google Scholar
- 16.Jr Nolan Jp, Sherk HH (1998) Biomechanical evaluation of the extensor musculature of the cervical spine. Spine 13:9–11Google Scholar
- 19.Takeuchi K, Yokoyama T, Numasawa T, Yamasaki Y, Kudo H, Itabashi T, Chin S, Wada K (2016) K-line (–) in the neck-flexed position in patients with ossification of the posterior longitudinal ligament is a risk factor for poor clinical outcome after cervical laminoplasty. Spine 41:1891–1895. https://doi.org/10.1097/BRS.0000000000001660 CrossRefPubMedGoogle Scholar
- 21.Uehara K, Takahashi J, Ikegami S, Mukaiyama K, Kuraishi S, Shimizu M, Futatsugi T, Ogihara N, Hashidate H, Hirabayashi H, Kato H (2014) Screw perforation features in 129 consecutive patients performed computer-guided cervical pedicle insertion. Eur Spine J 23:2189–2195. https://doi.org/10.1007/s00586-014-3502-9 CrossRefPubMedGoogle Scholar
- 23.Lau D, Winkler EA, Than KD, Chou D, Mummaneni PV (2016) 169 laminoplasty vs laminectomy with posterior spinal fusion for multilevel cervical spondylotic myelopathy: matched cohorts of regional sagittal balance. Neurosurgery 63(Suppl 1):167–168. https://doi.org/10.1227/01.neu.0000489738.69716.77 CrossRefGoogle Scholar
- 24.Liu X, Chen Y, Yang H, Li T, Xu B, Chen D (2017) Expansive open-door laminoplasty versus laminectomy and instrumented fusion for cases with cervical ossification of the posterior longitudinal ligament and straight lordosis. Eur Spine J 26:1173–1180. https://doi.org/10.1007/s00586-016-4912-7 CrossRefPubMedGoogle Scholar
- 25.Boehm H, Greiner-Perth R, El-Saghir H, Allam Y (2003) A new minimally invasive posterior approach for the treatment of cervical radiculopathy and myelopathy: surgical technique and preliminary results. Eur Spine J 12:268–273. https://doi.org/10.1007/s00586-002-0522-7 PubMedPubMedCentralGoogle Scholar