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6 Lv et al. | Journal of Clinical and Translational Research 2024; 10(1): 1-8
not dissimilar to the idea of a study investigating the impact of spinal of the cervical spine with a pre-existing anterior longitudinal
fusion on quality of life score improvement during the post-operative ligament and intervertebral disc disruption. Masaki et al. [25]
period [22]. This line of evidence proves that laminoplasty not only reported that hypermobility of vertebrae at the cord compression
can lead to complete decompression but also hinder the development level is a risk factor for poor surgical outcomes after laminoplasty.
of anterior approach-associated complications in this cohort. Extra Therefore, stabilization intervention is needed for this cohort
anterior approach-related complications, such as dysphagia, were with options of extra anterior fusion or posterior instrumentation.
observed in the ASF group, but no analogical complications were Studies have indicated that posterior transpedicular screw fixation
observed in the PSF group [23,24]. is biomechanically stronger than anterior fixation in the cervical
For patients with OPLL, we also compared the post-operative spine [26,27]. The strategy of short-segmental fixation was to better
neurological recovery rates, which were similar in the ASF and preserve the mobility of cervical segments, thereby decreasing
PSF groups, as seen in related studies. In patients with giant OPLL the stiffness of the cervical spine, retarding cervical degeneration,
with posterior convex malalignment, the neurological recovery and maintaining post-operative range of motion. We found that
rate was better after laminoplasty and ASF than after laminoplasty there were no instrument failures in the PSF group, whereas four
and PSF. In addition, post-operative neck pain was less severe in instruments became dislodged in the ASF group. Two post-operative
the ASF group. However, perioperative complications were more fixation displacements occurred due to the excessive intervertebral
common in the ASF group. Although there was no statistically cage height, which resulted in focal hyperlordosis of the involved
significant difference in the post-operative nerve recovery rate segment. Two other instruments became dislodged postoperatively
between the two groups, the recovery rate was higher in the ASF in a patient with hyperextension of the cervical spine.
group in patients with kyphosis alignment (C2-C7 angle <0°). In this study, compared to laminoplasty combined with anterior
Post-operative cervical pain was greater and intraoperative blood fusion procedure, laminoplasty associated with transpedicular screw
loss was much more in the PSF group. The improvement in C2-C7 instrumentation decreased intraoperative blood loss, surgery time, and
alignment was greater and the operative time was longer in the length hospital stay. This was not difficult to understand because there
ASF group. Approach-related complications were more frequently was only one surgery approach conducted in PSF group associated
observed in the ASF group than in the PSF group. Drawing upon with less surgical trauma, and patients in this group benefitted more
the comparison between ASF group and PSF group, we concluded and recovered much faster. Xu and Lun [28] reported that laminoplasty
that the PSF group benefited substantially from the treatment, in combination with posterior fixation contributed to several clinical
the patients in this group were assigned in terms of surgery time, advantages, including less surgical trauma, less intraoperative blood
length of hospital stay, blood loss, and complications compared to loss, and satisfactory stability in treating multilevel CSCS and SCI
the ASF group. In the treatment of spinal cervical spondylosis due in the trauma population. Our results from this comparative study
to OPLL, overall post-operative neurologic function (irrespective supported Xu and Lun’s findings to some extent.
of the canal-occupying ratio) was better with the anterior approach There are some limitations in the study. First, in this retrospective
than with the posterior approach. We believe that the anterior multicenter study, the surgical proficiency for decompression
approach is particularly desirable for patients with a canal- and fixation was not controlled in different institutions. Different
occupancy ratio of >50%, although it leads to higher incidences of expertise in surgery would result in technical bias in the treatment.
surgical trauma and surgery-related complications. The posterior However, the number of surgeries performed in this study was not
approach is relatively safe, with lower rates of surgical trauma small, potentially reducing the risk of bias in the results. Second,
and complications. For patients with a canal-occupancy ratio of although all cases were labeled acute cervical spine injuries within
<50%, a posterior approach was recommended, bringing the post- 24 h, it should be noted that controlling the time from injury to
operative neurologic function recovery to a level similar to patients surgery in different institutions was a challenging endeavor, which
treated with an anterior approach. Therefore, in patients with less might influence the treatment results in some aspects.
severe OPLL, we also recommend the posterior approach for safety
reasons and to minimize the chances of developing post-operative 5. Conclusion
complications and patient discomfort. When it comes to treating
patients with OPLL, there is no fixed set of criteria to determine Cervical laminoplasty combined with short-segment
the type of treatment because the optimal surgical plan should be transpedicular screw instrumentation is a reliable and preferred
decided by the attending surgeon after performing a comprehensive option to treat extensional cervical injuries in patients with
evaluation. Patients in both groups had sufficient decompression pre-existing CSCS. This treatment regimen holds the promise
verified by post-operative MRI. Laminoplasty decompression of achieving sufficient cervical spinal cord decompression,
conducted in all patients may explain why neurological function instant three-column fixation, and immediate cervical spine
recovery was not significantly different between the two groups, as restabilization, as well as preventing extra anterior cervical fusion,
reflected in the post-operative ASIA grades and JOA scores. and reducing post-operative complications.
Performing immediate post-operative cervical stabilization is Acknowledgments
another key factor for forestalling secondary injury in patients with
an extensional cervical spinal injury. Laminoplasty can sufficiently We thank the staff members from all six spine centers who
decompress the stenotic canal, but it could aggravate the stability contributed to this study.
DOI: https://doi.org/10.36922/jctr.00037