J Korean Soc Spine Surg.  2017 Dec;24(4):231-235. 10.4184/jkss.2017.24.4.231.

Efficacy of Cervical Expansive Laminoplasty for Quadriplegic Patients Without Cervical Bony Injury

• Kim HT
• Kim SK
• Seo HY

• KMID: 2408191
• DOI: http://doi.org/10.4184/jkss.2017.24.4.231

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
To evaluate the efficacy of cervical expansive laminoplasty for patients with quadriplegia due to traumatic cervical spinal cord injury (SCI) without skeletal injury. SUMMARY OF LITERATURE REVIEW: There are a few studies on the surgical results for acute cervical SCI without bony injury.
MATERIALS AND METHODS
From 2003 to 2010, among the patients who visited emergency room with post-traumatic quadriplegia, 12 patients who had underwent cervical expansive laminoplasty for acute cervical SCI without body injury and cord compression on MR images were included in this study. We evaluate the pre-operative swelling on MRI, the change of neurologic symptoms at pre-, post operative state, respiration state, complication and survival period.
RESULTS
The average of motor index scores at the time of admission to the emergency room was 23 (4-30), and the average was changed to 29(4-43) during the follow-up period. No significant neurological improvement was observed in 11 cases except 1 case. The average time for operation after the injury was 26 hours(9-72). 4 patients showed paradoxical respiration when they first visited emergency room and the symptom continued after the operation and during follow-up periods. Another 4 patients showed paradoxical respiration after the operation. In all 8 cases who showed paradoxical respiration, tracheostomy and occasional ventilation were needed. In the follow-up period, 6 patients died due to respiratory failure within 1 year after the surgery. All these patients presented severe spinal cord edema on preoperative MRI with paradoxical respiration.
CONCLUSIONS
Efficacy of expansive laminoplasty for quadriplegic patients due to acute cervical SCI without bony injury may be limited. In many patients, no significant neurological recovery was observed but it was clearly identified that prognosis was related to the grades of spinal cord edema and paradoxical respiration.

Keyword

Cervical spinal cord injury; Quadriplegia; Expansive laminoplasty

MeSH Terms

Cervical Cord
Edema
Emergency Service, Hospital
Follow-Up Studies
Humans
Laminoplasty*
Magnetic Resonance Imaging
Neurologic Manifestations
Prognosis
Quadriplegia
Respiration
Respiratory Insufficiency
Retrospective Studies
Spinal Cord
Tracheostomy
Ventilation

Figure

• 

  Fig. 1. 50/M, in car TA, ASIA impairment scale B, Motor index score 22. Spinal cord injury without bony injury. (A) The cord signal was increased at the C5-6-7 level, which revealed cord injury. (B) T2WI axial MRI at C6-7 showed left paracentral disc herniation but no bony abnormality.

• 

  Fig. 2. 4yrs after C4-5-6-7 Double door laminoplasty. ASIA impairment scale is still B and the Motor index score is improved to 40 points. (A) on plain radiogram, (B) T2WI sagittal MRI at C4-5-6-7 showed a widened spinal canal.

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