Abstract
Purpose
Cervical laminectomy is an effective treatment for multilevel cervical compressive myelopathy. Symptomatic spinal cord compression (SSCC) by paraspinal musculature (PSM) following cervical laminectomy is rarely reported. The aim of this study was to evaluate the frequency and pathogenesis of this complication after cervical laminectomy.
Methods
Between 2007 and 2016, the medical records of 1309 cervical laminectomy patients were reviewed. From these 1309 records, seven patients (five men and two women; average age, 64.12 years; range 48–78 years) with SSCC by PSM following cervical laminectomy were identified. The incidence and possible risk factors of this rare condition were evaluated.
Results
The frequency of SSCC by PSM following cervical laminectomy was 0.53%. Presenting symptoms included paralyses and paresthesias, depending on the level and severity of cervical spinal cord compression. The initial onset of neurologic deterioration varied from 12 h to 21 days after operation. Most patients recovered well after surgical management with an average Barthel index of 74.3 at 6 months after surgery. In comparison with 63 controls, this rare complication was associated with preoperative cervical kyphosis, prior antiplatelet therapy, and posterior decompression with prone position.
Conclusions
SSCC by PSM is a rare but devastating complication following cervical laminectomy, especially in those patients with preoperative kyphosis, prior antiplatelet treatment, and decompression with prone position. MRI is an ideal tool to identify this complication. Rapid cervical cord decompression and avoidance of recurrent compressive events can achieve a good clinical outcome.
Graphical abstract
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References
Yoon ST, Hashimoto RE, Raich A, Shaffrey CI, Rhee JM, Riew KD (2013) Outcomes after laminoplasty compared with laminectomy and fusion in patients with cervical myelopathy: a systematic review. Spine 38(22 Suppl 1):S183–S194. https://doi.org/10.1097/BRS.0b013e3182a7eb7c
Xiao SW, Jiang H, Yang LJ, Xiao ZM (2015) Anterior cervical discectomy versus corpectomy for multilevel cervical spondylotic myelopathy: a meta-analysis. Eur Spine J 24(1):31–39. https://doi.org/10.1007/s00586-014-3607-1
Jiang L, Tan M, Dong L, Yang F, Yi P, Tang X, Hao Q (2015) Comparison of anterior decompression and fusion with posterior laminoplasty for multilevel cervical compressive myelopathy: a systematic review and meta-analysis. J Spinal Disord Tech 28(8):282–290. https://doi.org/10.1097/BSD.0000000000000317
Yue WM, Brodner W, Highland TR (2005) Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study. Spine 30(19):2138–2144
Bartolomei JC, Theodore N, Sonntag VK (2005) Adjacent level degeneration after anterior cervical fusion: a clinical review. Neurosurg Clin N Am 16(4):575–587. https://doi.org/10.1016/j.nec.2005.07.004
Imagama S, Matsuyama Y, Yukawa Y, Kawakami N, Kamiya M, Kanemura T, Ishiguro N (2010) C5 palsy after cervical laminoplasty: a multicentre study. J Bone Joint Surg Br 92(3):393–400. https://doi.org/10.1302/0301-620X.92B3.22786
Hosono N, Yonenobu K, Ono K (1996) Neck and shoulder pain after laminoplasty. A noticeable complication. Spine 21(17):1969–1973
Kato Y, Iwasaki M, Fuji T, Yonenobu K, Ochi T (1998) Long-term follow-up results of laminectomy for cervical myelopathy caused by ossification of the posterior longitudinal ligament. J Neurosurg 89(2):217–223. https://doi.org/10.3171/jns.1998.89.2.0217
Kaptain GJ, Simmons NE, Replogle RE, Pobereskin L (2000) Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg 93(2 Suppl):199–204
Albert TJ, Vacarro A (1998) Postlaminectomy kyphosis. Spine 23(24):2738–2745
Yasuoka S, Peterson HA, MacCarty CS (1982) Incidence of spinal column deformity after multilevel laminectomy in children and adults. J Neurosurg 57(4):441–445. https://doi.org/10.3171/jns.1982.57.4.0441
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(1):155–157. https://doi.org/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. https://doi.org/10.1155/2015/275623
Fujiwara Y, Manabe H, Harada T, Izumi B, Adachi N (2017) 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. https://doi.org/10.1007/s00586-017-5001-2
Grob D, Frauenfelder H, Mannion AF (2007) The association between cervical spine curvature and neck pain. Eur Spine J 16(5):669–678. https://doi.org/10.1007/s00586-006-0254-1
Hatta Y, Shiraishi T, Hase H, Yato Y, Ueda S, Mikami Y, Harada T, Ikeda T, Kubo T (2005) Is posterior spinal cord shifting by extensive posterior decompression clinically significant for multisegmental cervical spondylotic myelopathy? Spine 30(21):2414–2419
Ebersold MJ, Pare MC, Quast LM (1995) Surgical treatment for cervical spondylitic myelopathy. J Neurosurg 82(5):745–751. https://doi.org/10.3171/jns.1995.82.5.0745
Hansen-Schwartz J, Kruse-Larsen C, Nielsen CJ (2003) Follow-up after cervical laminectomy, with special reference to instability and deformity. Br J Neurosurg 17(4):301–305
Butler JC, Whitecloud TS 3rd (1992) Postlaminectomy kyphosis. Causes and surgical management. Orthop Clin N Am 23(3):505–511
Sciubba DM, Chaichana KL, Woodworth GF, McGirt MJ, Gokaslan ZL, Jallo GI (2008) Factors associated with cervical instability requiring fusion after cervical laminectomy for intradural tumor resection. J Neurosurg Spine 8(5):413–419. https://doi.org/10.3171/SPI/2008/8/5/413
Cao J, Zhang J, Yang D, Yang L, Shen Y (2017) Multivariate analysis of factors associated with kyphotic deformity after laminoplasty in cervical spondylotic myelopathy patients without preoperative kyphotic alignment. Sci Rep 7:43443. https://doi.org/10.1038/srep43443
Miyamoto H, Maeno K, Uno K, Kakutani K, Nishida K, Sumi M (2014) Outcomes of surgical intervention for cervical spondylotic myelopathy accompanying local kyphosis (comparison between laminoplasty alone and posterior reconstruction surgery using the screw-rod system). Eur Spine J 23(2):341–346. https://doi.org/10.1007/s00586-013-2923-1
Abumi K (2015) Cervical spondylotic myelopathy: posterior decompression and pedicle screw fixation. Eur Spine J 24(Suppl 2):186–196. https://doi.org/10.1007/s00586-015-3838-9
Currier BL (2012) Neurological complications of cervical spine surgery: C5 palsy and intraoperative monitoring. Spine 37(5):E328–E334. https://doi.org/10.1097/BRS.0b013e3182417276
Nassr A, Eck JC, Ponnappan RK, Zanoun RR, Donaldson WF 3rd, Kang JD (2012) The incidence of C5 palsy after multilevel cervical decompression procedures: a review of 750 consecutive cases. Spine 37(3):174–178. https://doi.org/10.1097/BRS.0b013e318219cfe9
Goldstein CL, Bains I, Hurlbert RJ (2015) Symptomatic spinal epidural hematoma after posterior cervical surgery: incidence and risk factors. Spine J 15(6):1179–1187. https://doi.org/10.1016/j.spinee.2013.11.043
Schroeder GD, Hilibrand AS, Arnold PM, Fish DE, Wang JC, Gum JL, Smith ZA, Hsu WK, Gokaslan ZL, Isaacs RE, Kanter AS, Mroz TE, Nassr A, Sasso RC, Fehlings MG, Buser Z, Bydon M, Cha PI, Chatterjee D, Gee EL, Lord EL, Mayer EN, McBride OJ, Nguyen EC, Roe AK, Tortolani PJ, Stroh DA, Yanez MY, Riew KD (2017) Epidural hematoma following cervical spine surgery. Glob Spine J 7(1 Suppl):120S–126S. https://doi.org/10.1177/2192568216687754
Aono H, Ohwada T, Hosono N, Tobimatsu H, Ariga K, Fuji T, Iwasaki M (2011) Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery. J Neurosurg Spine 15(2):202–205. https://doi.org/10.3171/2011.3.SPINE10716
Stamm S, McClellan JW, Knierim A, Suiter IP, Riew KD (2013) Dynamic MRI reveals soft-tissue compression causing progressive myelopathy in postlaminectomy patients. JBJS Case Connect 3(1):e17
Klineberg E (2010) Cervical spondylotic myelopathy: a review of the evidence. Orthop Clin N Am 41(2):193–202. https://doi.org/10.1016/j.ocl.2009.12.010
Kawaguchi Y, Yabuki S, Styf J, Olmarker K, Rydevik B, Matsui H, Tsuji H (1996) Back muscle injury after posterior lumbar spine surgery. Topographic evaluation of intramuscular pressure and blood flow in the porcine back muscle during surgery. Spine 21(22):2683–2688
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We acknowledge the generous support of Chang Gung Memorial Hospital, Taiwan (CMRPG3D0751).
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The study was found CMRPG3D0751.
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Tu, PH., Chen, CT., Chen, CC. et al. Symptomatic cord compression by paraspinal musculature following cervical laminectomy: rare complication. Eur Spine J 27, 1815–1823 (2018). https://doi.org/10.1007/s00586-018-5685-y
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DOI: https://doi.org/10.1007/s00586-018-5685-y