The authors retrospectively investigated the surgical outcomes and radiographically documented changes after microsurgical posterior foraminotomy with en bloc laminoplasty in patients with cervical spondylotic radiculo-myelopathy (CSRM), including cervical spondylotic amyotrophy (CSA), during a period greater than 2 years.
Thirty-four consecutive patients (24 men and 10 women) were included in this study. Twenty patients had preoperative radicular pain, and CSA was diagnosed in 14 patients. The mean age at the time of surgery was 61 years (range 43–77 years). The follow-up period ranged from 2 to 6.5 years (mean 3.4 years). Foraminotomy was performed at 49 sites. Neurological improvement was evaluated using the Japanese Orthopaedic Association (JOA) scoring system; radicular pain and deltoid muscle strength were also evaluated clinically. Cervical lordosis, flexion–extension angles, range of motion (ROM), and the angulation and the extent of vertebral slippage at the affected nerve root levels were measured preoperatively and at last follow-up examination.
The mean rate of JOA score improvement was 67.2% (range 22.2–100%). In all 20 patients, preoperative radicular pain completely resolved after surgery. In all 14 patients with CSA, deltoid muscle strength improved; in approximately 80% of these patients, there was either no muscle weakness or only slight weakness. The flexion angles and ROM significantly decreased at the time of the last follow-up examination (p = 0.0402 and 0.0196, respectively). No other items changed significantly.
The aforementioned surgical procedure was safely completed and the surgical outcomes were satisfactory for CSRM including CSA. The instability (the angulation and the vertebral slippage) did not significantly change after surgery. This procedure yielded outstanding results and should be considered an option for cervical laminoplasty in the future.
Abbreviations used in this paper:CSA = cervical spondylotic amyotrophy; CSRM = cervical spondylotic radiculomyelopathy; CT = computed tomography; JOA = Japanese Orthopaedic Association; MMT = manual muscle test; MR = magnetic resonance; ROM = range of motion; RSD = reflex sympathetic dystrophy; VB = vertebral body.
Address reprint requests to: Kunihiko Sasai, M.D., Ph.D., Department of Orthopedic Surgery, Kansai Medical University, 2-3-1 Shinmachi, Hirakata City, Osaka 573-1191, Japan. email:
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