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2 Lv et al. | Journal of Clinical and Translational Research 2024; 10(1): 1-8
1. Introduction administered general anesthesia. Using the posterior middle
approach, the extensional muscles were detached from the spinous
Cervical spinal canal stenosis (CSCS) is a disorder in which process and lamina to expose the mass from C3 to C6. If C7 was
the spinal cord or nerve roots are compressed, resulting in involved, the C7 articular mass also needed to be exposed. The
symptoms such as pain, paraesthesia, and dyskinesia. Pre-existing lateral margin of the articular masses of the injured level needs
cervical spondylotic changes, cervical ossification of the posterior to be extra-exposed. The notch-referred technique was used to
longitudinal ligament, or developmental cervical stenosis are the place cervical pedicle screws (CPS) [6]. Being virtually unaffected
most common pathologic mechanisms leading to CSCS [1,2]. by bony encumbrances or erosive articular surface variants, the
A hyperextension injury, which is accompanied by anterior lateral vertebral notch is a reliable and consistent anatomical
longitudinal ligament rupture, intervertebral disc destruction, or landmark for lower-axis CPS placement, providing an accurate
cervical fracture-dislocation, induces cervical instability and raises and safe reference point for subaxial CPS placement. When short-
the risk of cervical spinal cord injury (SCI) due to pre-existing segmental transpedicular screw instrumentation was completed in
CSCS [3]. Anterior longitudinal ligament and intervertebral disc
rupture are common findings on magnetic resonance imaging the involved cervical spine, laminoplasty was conducted from C3
to C6 (C7 may be necessary if involved). By sparing the nerve roots
(MRI) in patients with a hyperextension cervical injury without and spinal cord and enlarging the spinal canal, surgery reduces
fracture or dislocation [1,4,5]. The risk of cervical instability the pressure on the spinal cord and nerve roots. At the end of the
demands surgical stabilization to prevent additional harm.
Cervical laminoplasty is a preferred technique to achieve procedure, the surgeon closed the incision layer by layer to promote
complete decompression in patients with an extensional cervical healing [7]. In the treatment of a cervical SCI without fracture or
spinal injury coupled with multilevel cervical stenosis. Moreover, dislocation, single-opening laminoplasty has satisfactory efficacy
an extra-anterior approach fusion at the disruption level is required in the recovery of post-operative neurological function, reduction
to stabilize the cervical spine after laminoplasty. Despite the of pain, and improvement of daily life behaviors compared to total
ability to achieve both complete decompression and satisfactory laminectomy with lateral mass screw fixation. Moreover, single-
reconstruction, the posterior-anterior combined approach is opening laminoplasty achieves lesser trauma and is associated
criticized for necessitating a longer surgery time and triggering with a lower complication rate. Therefore, given its advantages,
complications. Therefore, we advocate only the posterior approach, posterior single-opening laminoplasty coupled with pedicle screw
including laminoplasty and segment transpedicular screw fixation, fixation was our preferred choice of surgical plan. The facets and
to achieve both decompression and stabilization. In this study, we masses were decorticated and bone grafted for fusion (Figure 1).
compared the clinical outcomes of different surgery regimens, such In the laminoplasty and anterior short segment fusion group,
as laminoplasty combined with anterior fusion and laminoplasty the patient was initially placed in a prone position to receive
associated with transpedicular screw instrumentation, to treat laminoplasty and then placed in a supine position to be treated with
extensional cervical spinal injury in patients with CSCS. anterior discectomy and fusion at the involved intervertebral disc.
2. Materials and Methods 2.3. Clinical assessment

2.1. Study participants Routine post-operative X-ray, computed tomography (CT), and
MRI examinations were performed to confirm the instrument’s
The clinical data of 258 patients with acute extensional position and the adequacy of decompression (Figure 1). In
cervical spinal injuries and pre-existing CSCS who were admitted addition, all patients performed neurofunctional rehabilitation
to six spine centers between April 2010 and January 2022 were exercises in the rehabilitation department soon after surgery. Post-
recruited for this retrospective study. Patients with the following operative and follow-up assessments were performed to assess
characteristics were enrolled: aged 18 – 70 years, sustained an and determine the neurological function (ASIA scale and JOA
extensional cervical spinal injury within 24 h, suffered from pre- score), bone-graft fusion, instrument’s location, surgery time,
existing degenerative cervical stenosis, and developed cervical intraoperative blood loss volume, and length of hospital stay of the
stenosis or stenosis involving ossification of the cervical posterior patients in the two groups. The improvement rate of neurological
longitudinal ligament (OPLL). Patients with cervical dislocation, function was calculated using the following formula:
cervical infection, tumor, tuberculous disease, and brain injury Improvement rate of neurological function (%) =
were excluded from this study. The disrupted anterior longitudinal
ligament or intervertebral disc was confirmed by gradient-echo Postoperative JOA score Preoperative JOA score− 100×
T2 (T2-weighted GRE) and STIR-weighted MRI pulse sequences. 17 preoperative JOA score−
The present study was approved by the institutional review board 2.4. Statistical analyses
of each participating hospital.
Continuous variables between the two groups were compared
2.2. Surgical procedures
using t-test. Chi-squared tests were used to compare categorical
In the laminoplasty and posterior short-segment fusion group, variables between the two groups. The software package IBM
each patient was positioned in a Concorde position after being SPSS Statistics version 22 (IBM, USA) was used to perform
DOI: https://doi.org/10.36922/jctr.00037