Liang Jiang

Study Design: Retrospective cohort study. Objective: To determine the incidence, grading, management, and clinical impact of postoperative spinal epidural hematoma (SEH) following cervical laminoplasty (LAMP) for degenerative cervical myelopathy (DCM). Methods: This study analyzed 207 DCM patients who underwent LAMP between August 2022 and February 2024. Postoperative magnetic resonance imaging (MRI) within 48 h was used to assess SEH, graded based on radiological compression and clinical symptoms. A 3-month MRI evaluated epidural scar formation. Patient demographics, laboratory and operative variables, and clinical outcomes were compared between the SEH and non-SEH groups, and multivariable logistic regression analysis was performed to identify independent risk factors for SEH. Results: SEH was identified in 72 patients (34.8%), of whom 71 (98.6%) were Grades 1-3 and managed conservatively. One patient (0.48%) developed neurological symptoms (Grade 4) requiring percutaneous drainage and achieved full recovery. No patients developed Grade 5 SEH. At the 3-month follow-up, epidural scar formation was observed in 5 (7.7%) patients in the SEH group and 3 (2.6%) in the non-SEH group ( P = .141). Clinical outcomes, including Japanese Orthopaedic Association (JOA) scores, and neck Numerical Rating Scale (NRS) scores were comparable between groups at the 3-month follow-up. No independent predictors of SEH were identified. Conclusions: MRI-detectable postoperative SEH was observed in more than one-third of patients after LAMP, and most cases were asymptomatic. The proposed grading system may support stratified management. Clinical outcomes were comparable between groups, and epidural scar formation was more frequent in the SEH group, but not statistically significant.

Study Design: Retrospective cohort study. Objectives: To investigate whether shifting the medial location of the gutter on the open side during posterior cervical expansive open-door laminoplasty affects postoperative C5 palsy (C5P) incidence. Methods: Patients were divided into two groups based on the opening-side location: the conventional laminar transitional zone (conventional group, dural sac decompression) and a position 1 mm medial to the laminar transitional zone (modified group, spinal cord decompression). The incidence of C5P, radiological parameters, and neurological outcomes were compared. Results: A total of 258 consecutive patients with degenerative cervical myelopathy (DCM) who underwent laminoplasty in the spine surgery unit of our institution between May 2024 and October 2024 were included. C5P occurred in 5/128 (3.9%) in the conventional group and 0/130 in the modified group ( P = 0.029). At the final follow-up, the mean JOA improvement rates were 55.8% ± 18.9% and 54.6% ± 16.9% in the conventional and modified groups, respectively ( P = 0.599). The modified group showed a significantly smaller width between the bilateral gutters (median, 18.7 vs 20.3 mm; P < 0.001) and less posterior spinal cord shift (median, 2.0 vs 3.0 mm; P < 0.001) than the conventional group, with a significant correlation between the two parameters. Conclusions: Positioning the gutter on the open side 1 mm medial to the junction of the laminae and facet joints during cervical expansive open-door laminoplasty may reduce the incidence of C5P without affecting neurological recovery, potentially by limiting posterior spinal cord shift.

Cervical spondylosis is one of the most common degenerative diseases, seriously affecting life quality. Unlike diseases with explicit lesions like cancer, hydroncus, or fracture, the degeneration of the cervical spine cannot be explicitly detected from the appearance of medical images, requiring extensive experience of doctors to interpret subtle clues. However, the extremely high incidence of cervical spondylosis coincides with a serious shortage of experienced doctors and uneven distribution of medical resources, hindering early diagnosis. We propose a cascade-ensemble deep learning framework for cervical spondylosis diagnosis. The framework integrates vertebral body detection and degenerative diagnosis through a cascading architecture, and jointly trains an ensemble of degenerative indicators in a multi-task learning manner. We demonstrate that deep learning models are more sensitive to distance and position based indicators than angle based ones. In intervertebral stenosis analysis, our method achieves comparable performance to senior radiologists and clinicians, with much faster diagnostic speed.

Several modified muscle-sparing laminoplasty (LP) techniques have been developed to prevent axial symptoms in the treatment of multilevel degenerative cervical myelopathy (MDCM). However, the postoperative changes in posterior muscle volume (PMV) and cervical alignment following these procedures remain controversial. This study aimed to compare the short-term postoperative changes in PMV and cervical alignment between conventional LP and three types of muscle-sparing LPs: unilateral muscle-preservation laminoplasty (UL), double-door laminoplasty (DL), and intermuscular “raising roof” laminoplasty (RL). Consecutive MDCM patients who underwent LP, DL, UL, or RL between February 2022 and May 2022 at a same ward were enrolled. Baseline data and surgical characteristics were collected. Preoperative and postoperative PMV were semiautomatically segmented and evaluated, and cervical alignment was measured. The PMV loss ratio was calculated as the change in PMV divided by the preoperative PMV. A total of 79 MDCM patients were included in this study (LP: 20, DL: 20, UL:23, RL:16). No significant differences were observed in the preoperative demographic data, surgical characteristics and radiological variables. The preoperative C2-7 cobb angles of four groups were 11.59 ± 8.80, 9.54 ± 11.18, 11.08 ± 11.32 and 10.75 ± 10.90, respectively(p = 0.962). The preoperative PMV were 2.726 ± 0.79, 2.607 ± 0.752, 2.808 ± 0.724, 2.686 ± 0.674*105mm3, respectively(p = 0.802). At 1-year follow-up, all four groups showed favorable and comparable JOARR(p = 0.443). The postoperative PMV of four groups were 2.430 ± 0.68, 2.355 ± 0.621, 2.416 ± 0.667, and 2.602 ± 0.666 *105mm3(p = 0.606), and the PMV loss ratio were 10.0%±12.9%, 8.7%±9.6%, 13.6%±10.4%, and 2.8%±11.0%, respectively (p = 0.033). The modified LP groups did not present significant difference in PMV loss or cervical alignment parameters compared with LP. After adjustment, the RL group presented significant lower PMV loss ratio (p = 0.035) compared with LP. Multivariate regression revealed that the loss in cervical alignment was correlated to the PMV loss ratio. The DL group has significant lower postoperative CL-E loss than LP. After adjustment, the RL procedure demonstrated better efficacy in PMV preservation compared to conventional LP. The loss of cervical lordosis at neutral and extension positions was associated with the PMV loss ratio.

Study Design: Retrospective study. Objective: To investigate the impact of preoperative C2 slope (C2S) on change in sagittal vertical axis (SVA) and postoperative cervical sagittal imbalance (CSI) after laminoplasty (LP). Methods: Consecutive patients who underwent LP between January 2015 and January 2022 with a minimum of 12-month follow-up were reviewed. The clinical variables and radiographic measurements were assessed. Patients were divided into improvement (ΔcSVA ≤ −10 mm), stable (−10 mm ≤ ΔcSVA P = 0.026) was risk factor for postoperative CSI, with 8.9 as a potential cut-off value for C2S. Conclusions: Lower preoperative C2S slope was risk factor for post-laminoplasty CSI. The cut-off value of C2S was 8.9. Laminoplasty should be carefully considered for patients with low C2S due to risk of postoperative CSI.

Study Design: Retrospective cohort study. Objective: This study aimed to investigate the long-term outcomes of laminoplasty-alone (LP) and combined procedure (CP), consisting of laminoplasty and single-level anterior cervical discectomy and fusion, in comparable patients who had multilevel degenerative cervical myelopathy (MDCM) with concomitant anterior and posterior compression (CAPC). Methods: Consecutive MDCM patients with CAPC underwent LP or CP between 2012 and 2015 from a same surgical group were enrolled and followed up for a minimum of 8 years. Preoperative demographic, radiological, and clinical variables were collected. Propensity score matching (PSM) analysis was performed to match patients with comparable conditions. The outcomes were evaluated by postoperative Japanese Orthopedic Association (JOA) score improvement, JOA recovery rate (JOARR) and complications. Results: A total of 230 patients were included, of whom 146 underwent LP and 84 underwent CP. After PSM, 84 pairs of comparable patients were matched. The matched groups presented fair comparability in preoperative conditions. The CP group had significantly prolonged surgery time and greater blood loss. At the final follow-up, the postoperative JOA scores of LP and CP groups were 14.51 ± 1.79 and 15.47 ± 1.81 ( P < 0.001) and the JOARR were 42.5% ± 53.3% and 68.5% ± 35.4%, respectively ( P < 0.001). Three (3.6%) patients in the LP group underwent reoperations because of recurrent symptoms ( P = 0.081). Conclusion: Both LP and CP demonstrated considerable long-term neurological recovery in patients with CAPC. The CP showed a significantly higher JOA improvement and JOARR. The combined decompression might be a safe and effective alternative in treating MDCM with CAPC in experienced hands.

Study Design: Retrospective cohort study. Objective: This study aimed to compare postoperative pain and surgical outcomes of open-door laminoplasty (LP) and three types of muscle-sparing laminoplasties, namely unilateral muscle-preservation laminoplasty (UL), spinous process splitting double-door laminoplasty (DL) and intermuscular “raising roof” laminoplasty (RL) for multilevel degenerative cervical myelopathy (MDCM). Methods: Consecutive MDCM patients underwent LP or modified laminoplasties (UL, DL, RL) in 2022 were enrolled. Patients’ preoperative baseline data and surgical characteristics were collected. Postoperative transient pain (TP), the axial pain and Japanese Orthopedic Association (JOA) score and neck disability index (NDI) at 6-month and 12-month follow-up were documented. Results: A total of 154 MDCM patients were included and a 12-month follow-up was completed for 148 patients (LP: 36, UL:39, DL: 37, RL:36). No significant difference was observed in the baseline data. Four groups presented favorable and comparable surgical outcome. The RL group reported significantly the least severe TP on the first three days following surgery. However, no significant difference was found in the axial pain and axial symptoms at both follow-ups. After regression analysis, RL group exhibited significantly better efficacy in alleviating Day-1 TP ( P = 0.047) and 6-month axial pain ( P = 0.040). However, this superiority was not observed at 12-month follow-up. Conclusion: All the three muscle-sparing laminoplasty procedures showed similar short-term surgical outcomes compared to LP. The RL procedure demonstrated superiority in alleviating TP and 6-month axial pain compared to LP. The RL and DL groups showed less C5 palsy compared to LP.

Background: T2-weighted increased signal intensity (ISI) is commonly recognized as a sign of more severe spinal cord lesions, usually accompanied by worse neurological deficits and possibly worse postoperative neurological recovery. The combined approach could achieve better decompression and better neurological recovery for multilevel degenerative cervical myelopathy (MDCM). The choice of surgical approach for MDCM with intramedullary T2-weighted ISI remains disputed. This study aimed to compare the neurological outcomes of posterior and one-stage combined posteroanterior approaches for MDCM with T2-weighted ISI. Methods: A total of 83 consecutive MDCM patients with confirmed ISI with at least three intervertebral segments operated between 2012 and 2014 were retrospectively enrolled. Preoperative demographic, radiological and clinical condition variables were collected, and neurological conditions were evaluated by the Japanese Orthopedic Assessment score (JOA) and Neck Disability Index (NDI). Propensity score matching analysis was conducted to produce pairs of patients with comparable preoperative conditions from the posterior-alone and combined groups. Both short-term and mid-term surgical outcomes were evaluated, including the JOA recovery rate (JOARR), NDI improvements, complications, and reoperations. Results: A total of 83 patients were enrolled, of which 38 and 45 patients underwent posterior surgery alone and one-stage posteroanterior surgery, respectively. After propensity score matching, 38 pairs of comparable patients from the posterior and combined groups were matched. The matched groups presented similar preoperative clinical and radiological features and the mean follow-up duration were 111.6 ± 8.9 months. The preoperative JOA scores of the posterior and combined groups were 11.5 ± 2.2 and 11.1 ± 2.3, respectively (p = 0.613). The combined group presented with prolonged surgery duration(108.8 ± 28.0 and 186.1 ± 47.3 min, p = 0.028) and greater blood loss(276.3 ± 139.1 and 382.1 ± 283.1 ml, pp = 0.024), while no significant difference in JOARR was observed between the groups at long-term follow-up (posterior group: 49.2%±48.5%, combined group: 59.6%±47.6%, p = 0.136). No significant difference was found in the overall complication and reoperation rates. Conclusions: For MDCM patients with ISI, both posterior and one-stage posteroanterior approaches could achieve considerable neurological alleviations in short-term and long-term follow-up. With greater surgical trauma, the combined group presented better short-term JOARR but did not show higher efficacy in long-term neurological function preservation in patients with comparable preoperative conditions.

Background: Early cervical spondylotic myelopathy (CSM) is challenging to diagnose and easily missed. Diffusion MRI (dMRI) has the potential to identify early CSM. Methods: Using diffusion tensor imaging (DTI), diffusion kurtosis imaging (DKI), and neurite orientation dispersion and density imaging (NODDI), a 1:1 matched case-control study was conducted to evaluate the potential of dMRI in identifying early CSM and assessing uncompressed segments of CSM patients. CSM patients and volunteers were matched by age and spinal location. The differences in dMRI parameters between groups were assessed by the paired t-test, the multicollinearity of the dMRI parameters was evaluated by the variance inflation factor (VIF), and the value of dMRI parameters in distinguishing controls from CSM patients was determined by logistic regression. The univariate t-test was used to analyse differences between CSM patients and volunteers in adjacent uncompressed areas. Results: In total, 56 CSM patients and 56 control volunteers were included. Paired t-tests revealed significant differences in nine dMRI parameters between groups. Multicollinearity calculated through VIF and combined with logistic regression showed that the orientation division index (ODI) was significantly positively correlated (r = 2.12, p = 0.035), and the anisotropic water fraction (AWF) was significantly negatively correlated (r = −0.98, p = 0.015). The fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), isotropic volume fraction (ISOVF), ODI, and AWF were significantly different in the upper and lower uncompressed areas at all ages. Conclusion: dMRI can noninvasively identify early CSM patients and potentially identify the extent of CSM lesions involving the cervical spinal cord. Critical relevance statement: Diffusion MRI (dMRI) can identify early cervical spondylotic myelopathy (CSM) and has the potential to help determine the extent of CSM involvement. The application of dMRI can help screen for early CSM and develop clinical surgical and rehabilitation treatment plans. Key points: • Diffusion MRI can differentiate between normal and early-stage cervical spondylotic myelopathy patients. • Diffusion MRI has the ability to identify the extent of spinal cord involvement in cervical spondylotic myelopathy. • Diffusion MRI enables the early screening of cervical spondylotic myelopathy and helps guide clinical treatment. Graphical

Background: This study aimed to determine potential risk factors for post-laminoplasty kyphosis and the effect of postoperative kyphosis on neurologic function recovery. Methods: A total of 266 patients with cervical spondylotic myelopathy (CSM) underwent traditional cervical laminoplasty with a minimum of a 12-month follow-up period. The patients were divided into non-kyphosis (NK group) and kyphosis (K group) groups based on the postoperative C2-7 Cobb angle. Clinical and radiological measurements were collected preoperatively and at the final follow-up. Results: Of the 266 patients, 26 (9.77%) developed postoperative kyphosis at the final follow-up. The postoperative Japanese Orthopedic Association score did not differ significantly between the NK and K groups (P > 0.05). The postoperative numeric rating scale (NRS) also showed no significant difference between the NK and K groups; however, postoperative NRS improved better than the preoperative values in the NK group (P < 0.001). Multivariate analysis revealed that the preoperative C2-7 extension Cobb angle and C2-7 Cobb angle were independent predictors of post-laminoplasty kyphosis. Cut-off values for predicting postoperative kyphosis were a C2-7 extension Cobb angle of 18.00° and a C2-7 Cobb angle of 9.30°. Conclusions: Low preoperative C2-7 extension Cobb angle and C2-7 Cobb angle may be associated with post-laminoplasty kyphosis in CSM patients without preoperative kyphosis. The cut-off value of the C2-7 extension Cobb angle and C2-7 Cobb angle were 18.00° and 9.30°, respectively.