Abstract
Introduction
Cervical myelopathy affects primarily elderly people, caused mainly by a degenerative process of spondylosis in which both static (disc, ligament ossification, congenital stenosis, tumors) and dynamic (flexion-extension of cervical spine adaptive changes, nervous fiber elasticity, ischemia, trauma) factors that lead to the compression and diminished blood supply of the spine cord. The symptoms can range from mild paresthesias according to the compromised cervical level, gait disturbances, pain to as severe as paraplegia, with a natural history of chronic progression, Surgical treatment of this entity include anterior or posterior decompression with arthrodesis and laminoplasty. In this study we aim to report the result obtained with Cervical Laminoplasty described by O'brien during de years 2010 to 2015.
Material and Methods
An observational retrospective descriptive study was performed, reviewing the clinical records from preop to postop of patients with cervical myelopathy, Functional information was gathered using the scale of the Japanese Orthopaedic Association and Pain Analog Visual Scale. X-rays were evaluated measuring canal diameter, Chiba's line, Pavlov index and signs of instability. MRI studies were used to measure canal diameter in the axial plane and to identify signs of myelopathy. Inclusion criteria were patients older than 18 years, that had both clinical and image diagnosis for cervical myelopathy in which the O'brien laminoplasty was performed
Results
10 patients with an average age of 74 (64 to 84yrs) completed follow up according to our inclusion criteria. AVS improved from 7 to 3. The JOA Scale showed improvement in all the patients from 10 to 14 in the global score, which corresponds to a progression from a Functional class II to I. Images evaluation showed widening of the cervical canal as seen with a 0.76 Pavlov index preop to 0.96 postop and a 33% widening in the MRI sagittal view.
Conclusion
For the management of cervical myelopathy, proper documentation of the pathology both clinical and images allows to decide the adequate management of the patient. The O'brien technique for cervical laminoplasty proved to be an effective alternative in the treatment of this entity.