The ability to calculate quality-adjusted life-years (QALYs) for degenerative cervical myelopathy (DCM) would enhance treatment decision making and facilitate economic analysis. QALYs are calculated using utilities, or health-related quality-of-life (HRQoL) weights. An instrument designed for cervical myelopathy disease would increase the sensitivity and specificity of HRQoL assessments. The objective of this study is to develop a multi-attribute utility function for the modified Japanese Orthopedic Association (mJOA) Score. We recruited a sample of 760 adults from a market research panel. Using an online discrete choice experiment (DCE), participants rated 8 choice sets based on mJOA health states. A multi-attribute utility function was estimated using a mixed multinomial-logit regression model (MIXL). The sample was partitioned into a training set used for model fitting and validation set used for model evaluation. The regression model demonstrated good predictive performance on the validation set with an AUC of 0.81 (95% CI: 0.80-0.82)). The regression model was used to develop a utility scoring rubric for the mJOA. Regression results revealed that participants did not regard all mJOA domains as equally important. The rank order of importance was (in decreasing order): lower extremity motor function, upper extremity motor function, sphincter function, upper extremity sensation. This study provides a simple technique for converting the mJOA score to utilities and quantify the importance of mJOA domains. The ability to evaluate QALYs for DCM will facilitate economic analysis and patient counseling. Clinicians should use these findings in order to offer treatments that maximize function in the attributes viewed most important by patients

Purpose: We report results obtained after surgical treatment of cervical myelopathy in 42 patients. Material and methods: This prospective study included 42 consecutive patients who underwent surgical treatment performed by the same operator between 1999 and 2002. Inclusion criteria were clinical expression of cervical cord suffering and radiological evidence (high-intensity intramedullary signal on the T2-weighted MRI). Anterior (corporectomy associated with autologous graft and plate-screw fixation) or posterior (laminoplasty or laminectomy) decompression was performed. The approach was chosen according to the number of levels requiring decompression and static disorders. The Japanese Orthopaedic Association (JAO) score was determined prepoperatively and at six months. Results: Forty-two patients (25 men and 17 women), mean age 65.7 years (38–80) were included, 18 anterior approaches and 24 posterior approaches. There were no neurological or infectious complications. One suffocating haematoma required early revision after an anterior decompression. Metameric hyperpathy occurred in two patients after segmentary laminectomy. The mean pre-operative JOA score was 8.3/17 (2–15); the postoperative score was 13.4 (5–17). There was no significant difference in the JOA score for anterior and posterior decompression. Discussion: The JOA score is one of the rare scores which has been validated for cervical myelopathy. This easy to use scale does not however estimate the importance of manipulation disorders and heaviness in the hands. Most of the items are based on history taking. Recently described scores with measurable parameters appear to be essential to achieve better assessment of these patients. Severe myelopathy (three patients in our series) is considered a poor indication for surgical management although prognosis does not appear to be so bad for active disease or when the objective is limited decompression. Choice of the anterior or posterior approach is based on the predicted position of the cord after surgery. This position depends on static parameters of the cervical spine measured on the lateral view and has not been studied extensively. Conclusion: Proper study of cervical myelopathy requires the development of objective scores using measurable and reproducible items. Study of the cervical spine statics on the lateral view should provide better criteria for choosing the surgical approach

Objective: To reassess whether the Ranawat IIIB (quadriparetic, non-ambulant) rheumatoid arthritis (RA) with cervical myelopathy patients should be surgically treated. Study Design: Retrospective study. Subjects: Over a 12-year period (1988–1999), 51 patients [15 M: 36F; mean age 64 years] in Ranawat IIIB with RA were diagnosed to have cervical myelopathy. These included 47 patients with atlantoaxial subluxation (AAS) [15 with AAS alone, 10 with basilar invagination (BI), 18 with associated subaxial subluxation (SAS) and four patients with BI and SAS] and four patients with SAS alone. Results: Thirty-two patients considered fit for surgery successfully underwent operative treatment (Group 1). All underwent posterior instrumented fixation with or without transoral odontoid peg excision. Postoperatively 22/27 patients were pain free and 21/32 patients initially non-ambulant were able to walk. 3/26 patients died within six months of surgery. 13/19 patients managed conservatively (Group 2) because of medical complications died within six months of presentation. Conclusions: Even in advanced stages of cervical myelopathy in RA, surgical intervention is beneficial with significantly higher morbidity/mortality in conservatively managed patients

Abstract. Introduction. There is paucity of evidence in predicting outcomes following cervical decompression in patients in octogenerians with cervical myelopathy. Our aim is to analyse the predictive value of Charlson comorbidity index (CCI) on clinical outcomes in this group. Methods. All patients age >80 years who underwent cervical decompression+/−stabilisation between January 2006-December 2021 at University Hospitals of Derby & Burton were included. Logistic regression analysis was performed using JASP. Results. Total 72 patients (n=32 male, n=28 female). Mean age 83.44 ± 3.21 years. 67 patients underwent posterior decompression+ stabilisation & 5 patients had posterior decompression alone. Mean CCI was 5; graded moderate in 32 (44%, CCI=<4) and severe in 40 (55.5%, CCI>4). Mean age and preoperative Nurick grade was similar between moderate and severe groups. Postoperative Nurick grade improved equally in both groups by 0.67 and 0.68 respectively (p=0.403). Mean LOS 16±16.12 days. 5 complications in the moderate group (21.8%) and 8 complications in severe group (21.6%); wound infection (n=7), other infection (n=2), electrolyte derangement (n=2), AKI (n=1), blood transfusion (n=1) and early death (n=3) (p=0.752). 1 early postoperative death <30 days occurred in the moderate group (4.3%) whereas 2 occurred in the severe group (5.3%) (p=0.984). No patients with moderate CCI required nursing home discharge whereas 7.9% of severe patients required this. Conclusion. Both groups benefitted from neurological improvement postoperatively, low 1 year mortality. No difference in hospital stay, complication rate and early mortality between both groups. More patients with severe CCI require nursing care after discharge than those with moderate CCI

Purpose of the study: Progressive cervical myelopathy secondary to cervical stenosis is generally treated surgically. Results of surgical decompression are generally good, but the progression and the type of neurological recovery have not been studied. We followed a cohort of patients who underwent cervical decompression in order to study the kinetics and the mode of the neurological recovery after surgery. Material and methods: This was a prospective mono-centric observation study conducted in a routine clinical setting. The cohort included 60 patients (mean age 65.7 years) who underwent surgery around 2006. Inclusion criteria were an association of stenosis documented on the imaging and clinical signs of medullary compression. One surgeon performed all interventions (80% posterior approach, 15% anterior and 5% mixed). Preoperative evaluation used complete cervical imaging and three validated function tests: the global JOA score, the Crockard walking test, and the nine-hold plug test of manual dexterity (9HPT) for both hands. Patients were reviewed postoperatively at 1, 3, 6, 12, 18 and 24 months. Two populations were distinguished: group 1 with mild to moderate compression: mean preoperative JOA > 10; group 2 with severe compression: mean pre-operative JOA ≤10. Results: The mean preoperative JOA was 11.7/17 (5; 15), the mean Crockard 34.5s (24; 140), and the mean time for the 9HPT 23s for both hands. Analysed by group according to the JOA showed that cervical myelopathy is mainly expressed by sensorial disorders. The JOA score, the walking test and the hand dexterity test for the dominant hand described the same pattern of recovery with a clear improvement for the first three postoperative months then a neurological stabilisation of the acquired improvement on a plateau that persisted till the end of follow-up. There was no improvement in the non-dominant hand. The same pattern was observed in both groups: the severe group presented a better improvement, reaching a final JOA score equivalent to that in the “mild-to-moderate” group. Discussion: The pattern of recovery of cervical neurological deficits occurs rapidly during the first three months following surgical decompression, then stabilises on a plateau, irrespective of the severity of the initial condition. The benefit is certain for initially severe compression

Introduction. Degenerative cervical myelopathy (DCM) is associated with progressive neurological deterioration. Surgical decompression can halt but not reverse this progression. The Modified Japanese Orthopaedic Assessment (MJOA) tool is recommended by international guidelines to grade disease severity into mild, moderate and severe, where moderate and severe are both recommended to undergo surgical intervention. During Covid-19 Nottingham University Hospitals (NUH) NHS Trust, identified DCM patients as high risk for sustaining permanent neurological damage due to surgical delay. The Advanced Spinal Practitioner (ASP) team implemented a surveillance project to evaluate those at risk. Methods. A spreadsheet was compiled of all DCM patients known to the service. Patients were telephoned (Oct-Nov 2021) by an ASP. MJOA score was recorded and those describing progressive deterioration were reviewed by the ASP team on a spinal same day emergency assessment unit. Incident forms were completed for clinical deterioration and recorded as severe harm. Acute, progressive neurological deterioration was fast tracked for emergency surgical decompression. Results. 45 patients were telephoned, 18 (40%) had deteriorated. Of the 18, 9 underwent urgent surgical decompression, 6 still await surgery and 3 continue to be monitored. Those who had deteriorated were sent a formal apology and duty of candour letter. Conclusion. It appears that patients with a diagnosis of DCM deteriorate over time. Delays to timely surgical intervention can have a deleterious effect on patient's neurological function. Baseline assessment should be clearly documented and scoring system such as MJOA considered for effective monitoring. Safety netting for deterioration should be standard practice, and a clear pathway for emergency presentation identified. Conflicts of interest: No conflicts of interest. Sources of funding: No funding obtained

We investigated clinical features and surgical outcomes for compressive cervical myelopathy in patients over 75 years of age. Twenty-one patients who underwent surgical decompression for cervical myelopathy were reviewed. The average age at the time of operation was 78.0 years and the mean follow-up period was 5.7 years. Posterior decompression in 19 patients and anterior decompression in 2 patients were performed. Neurologic deficits before and after surgery were assessed using a scoring system by the Japanese Orthopaedic Association (JOA score). Radiological features were examined with radiographs and MRI. The clinical results were compared to those of 24 control patients who were less than 65 years of age at the time of surgery. The average age was 50.2 years and the mean follow-up period was 4.5 years. In the aged patients, the preoperative mean JOA score was 6.2. Radiological examination revealed that the spinal cord was multisegmentally impinged. The postoperative maximum JOA score averaged 11.1, and the recovery rate was 45.4%. All patients became ambulatory and independent in fundamental daily activities following surgery. Maximum recovery was obtained from 1 to 3 years after the operation and function was maintained for at least 3 years. At the final follow up, the mean JOA score had been reduced to 9.5 and the recovery rate to 27.4%. Only the preoperative duration of symptoms correlated with the outcomes. The pre-operative JOA score in the control patients was 6.5. The postoperative maximum JOA score was 13.8 and the recovery rate was 69.4%. This was not significantly changed at the final follow-up. Although postoperative recovery of function was significantly inferior to that of the control patients, surgical treatment appears to be beneficial, even in patients over 75 years of age, in improving neurological function and ability of activities in daily living

In multilevel posterior cervical instrumented fusions, extending the fusion across the cervico-thoracic junction at T1 or T2 (CTJ) has been associated with decreased rate of re-operation and pseudarthrosis but with longer surgical time and increased blood loss. The impact on patient reported outcomes (PROs) remains unclear. The primary objective was to determine whether extending the fusion through the CTJ influenced PROs at 3 and 12 months after surgery. Secondary objectives were to compare the number of patients reaching the minimally clinically important difference (MCID) for the PROs and mJOA, operative time duration, intra-operative blood loss (IOBL), length of stay (LOS), discharge disposition, adverse events (AEs), re-operation within 12 months of the surgery, and patient satisfaction. This is a retrospective analysis of prospectively collected data from a multicenter observational cohort study of patients with degenerative cervical myelopathy. Patients who underwent a posterior instrumented fusion of 4 levels of greater (between C2-T2) between January 2015 and October 2020 with 12 months follow-up were included. PROS (NDI, EQ5D, SF-12 PCS and MCS, NRS arm and neck pain) and mJOA were compared using ANCOVA, adjusted for baseline differences. Patient demographics, comorbidities and surgical details were abstracted. Percentafe of patient reaching MCID for these outcomes was compared using chi-square test. Operative duration, IOBL, AEs, re-operation, discharge disposittion, LOS and satisfaction were compared using chi-square test for categorical variables and independent samples t-tests for continuous variables. A total of 206 patients were included in this study (105 patients not crossing the CTJ and 101 crossing the CTJ). Patients who underwent a construct extending through the CTJ were more likely to be female and had worse baseline EQ5D and NDI scores (p> 0.05). When adjusted for baseline difference, there was no statistically significant difference between the two groups for the PROs and mJOA at 3 and 12 months. Surgical duration was longer (p 0.05). Satisfaction with the surgery was high in both groups but significantly different at 12 months (80% versus 72%, p= 0.042 for the group not crossing the CTJ and the group crossing the CTJ, respectively). The percentage of patients reaching MCID for the NDI score was 55% in the non-crossing group versus 69% in the group extending through the CTJ (p= 0.06). Up to 12 months after the surgery, there was no statistically significant differences in PROs between posterior construct extended to or not extended to the upper thoracic spine. The adverse event profile did not differ significantly, but longer surgical time and blood loss were associated with construct extending across the CTJ

AIM: To compare the outcomes between two different surgical techniques for cervical myelopathy (skip laminectomy vs laminoplasty). METHODS: Cervical skip laminectomy is a new technique described by Japanese surgeons in 2000. The advantage of this procedure over the other conventional techniques is it addresses multilevel problem in a least traumatic way without need for instrumentation. We are comparing the above two techniques with 25 patients in each group operated by 3 surgeons. The first group had conventional laminoplasty and the second group underwent the skip laminectomy. The groups were comparable in age, sex, pathology and clinical presentation. Both these group had clinical outcome measurements using SF 12 questionnaires, pre and postoperative clinical assessment with standard tools performed by independent surgeon and a specialist spinal physiotherapist. We also routinely performed pre and postoperative MRI scans to assess the adequacy of decompression. RESULTS & CONCLUSION: There was no significant difference in the outcome of these patients in terms of the operative technique, hospital stay, clinical and radiological outcome. However skip laminectomy is relatively a easier procedure to perform, while the laminoplasty does need instrumentation

Aim: To compare the outcomes between two different surgical techniques for cervical myelopathy (skip laminectomy vs laminoplasty). Methods: Cervical skip laminectomy is a new technique described by Japanese surgeons in 2000. The advantage of this procedure over the other conventional techniques is it addresses multilevel problem in a least traumatic way without need for instrumentation. We are comparing the above two techniques with 25 patients in each group operated by 3 surgeons. The first group had conventional laminoplasty and the second group underwent the skip laminectomy. The groups were comparable in age, sex, pathology and clinical presentation. Both these group had clinical outcome measurements using SF 12 questionnaires, pre and postoperative clinical assessment with standard tools performed by independent surgeon and a specialist spinal physiotherapist. We also routinely performed pre and postoperative MRI scans to assess the adequacy of decompression. Results and Conclusion: here was no significant difference in the outcome of these patients in terms of the operative technique, hospital stay, clinical and radiological outcome. However skip laminectomy is relatively a easier procedure to perform, while the laminoplasty does need instrumentation

Introduction:. Cervical spondylotic myelopathy (CSM) is a degenerative condition that results in a non-traumatic, progressive and chronic compression of the cervical spinal cord. Surgery is indicated for patients with moderate to severe myelopathy or progressive myelopathy. Literature shows that decompressive surgery halts progression of the condition. We undertook this study to see if there is a worthwhile improvement in function in patients who had spine decompression for cervical spondylotic myelopathy. Material and Method:. From a retrospective review of our medical records, a total of 61 patients had decompressive surgery for cervical myelopathy during the period between January 2008 and January 2014. 11 Patients were excluded because their cervical myelopathy was due to compression from tuberculosis or a tumour. 33 patients had incomplete records. We are reporting on the 17 patients who had complete records. From the patients' notes we recorded the detailed preoperative neurologic examination usually done for these patients in our clinic. This was compared to the neurological examination done at 6 months, 12 months and at more than 2 years follow-up. Where this examination was not adequate, patients were called in for the neurologic examination. Results:. 13 Patients had a Nurick grading of 3 and above pre-operatively and 16 had a Ranawat classification of IIIA and above preoperatively. Post-operatively 14 patients had a Nurick grading of 1 or 0 and 15 had a Ranawat classification of II or I. There was also improvement of the physical signs that are diagnostic of myelopathy. The results were subjected to statistical analysis, but this was not conclusive because of the small numbers. Conclusion:. Decompressive surgery in this small series does not only stop progression of the myelopathy, but also improves neurologic function

Purpose of Study and Background. Degenerative cervical myelopathy resulting in cord compromise is a progressive condition that results in significant quality of life limitations. Surgical treatment options available are anterior and/or posterior decompression of the affected levels. Patients are counselled pre-operatively that the aim of surgical intervention is to help prevent deterioration of neurology. Anecdotal evidence suggested improvements in both EMS and PROMs in this cohort of patients. A 2-year prospective study tested this hypothesis. Methodology and Results. 67 patients undergoing anterior cervical surgery were followed up to two years. Myelopathic features, radiological cord compression, myelomalacia change and levels of surgery were recorded. Pre/post intervention myelopathy scores/grades, and PROM's were recorded. Paired t-test was performed when comparing pre/post intervention scores and Annova test when comparing results across levels. Our prospective study identified statistically significant improvements in European myelopathy scores and grade and patient reported clinical outcomes in the said population. Conclusions. DCSM patients undergoing anterior surgery demonstrated statistically significant improvement in PROMs and EMS scores and grades. This has been demonstrated irrespective of number of surgical levels. Conflicts of Interest: None. Sources of Funding: None. Previously presented as a poster at Cervical Spine Research Society, Paris 2020-Virtual Meeting

The evaluation of results following posterior decompression and fusion for the management of cervical spondylotic myelopathy. Between July 2006 and May 2008, 68 patients with cervical myelopathy underwent posterior decompression with laminectomies and pedicle screw fixation of the cervical spine. All patients were selected based on the presence of multi-level degenerative disease and the correction of cervical lordosis on the pre-operative dynamic radiographs. Patient demographics, co-morbidities and post-operative complications were recorded and analysed. Functional outcome was assessed by using the Japanese Orthopaedic Association (JOA) score. There were 37 male and 31 female patients with an average age 67.4 years. The average follow up period was 18 months. The mean pre-operative JOA score was 8.7, whereas the mean post-operative score was 12.1 on the latest follow-up visit. 9 patients had unsatisfactory clinical results and consequently underwent anterior procedures with significant improvement. Complications included 1 epidural haematoma, 2 superficial infections and 4 cases of myofascial pain. In three cases there was mild dysfunction of the C5 nerve root which resolved spontaneously with conservative measures. In the present series of patients posterior decompression with laminectomies is an effective method for the management of cervical spondylotic myelopathy

Introduction: To examine if an individual’s timed walk in sufficiently reproducible to correlate with the degree of spondylitic myelopathy and if surgical decompression has measurement effect on performance.

Methods: A 30mm timed walk, including a turn. The number of paces counted.

Forty-one non-myelopathic individuals were obtained. There was good inter-and intra-observer reliability.

Results: The mean control walking time and steps was 64.7 ± 8.4 seconds 46.9 ± 1.2 steps. The mean patients preoperative walking time and steps was 85.4 ± 11.2 seconds; 74.8 ± 5.3 steps and postoperative 64.7 ± 8.4 seconds; 63.5 ± 4.2 steps.

Significant improvement following surgery (p = 0.0018 and p = 5.87 x 10⁻⁶ respectively) and improvement maintained for at least two years after surgery.

Discussion and Conclusions:

The test is reproducible and reliable with good sensitivity and specificity.

Signal intensity changes of the spinal cord on MRI in chronic cervical myelopathy are thought to be indicative of the prognosis. However, the prognostic significance of signal intensity change remains controversial. The purpose of this study was to investigate the characteristics of MR findings in cervical compression myelopathy that reflect the clinical symptoms and the prognosis and to determine the radiographical and clinical factors that correlate to the prognosis. The subjects were 73 patients who underwent cervical expansive laminoplasty. Their mean age was 64 years, and the mean postoperative follow-up was 3.4 years. The pathological conditions were cervical spondylotic myelopathy in 42 and ossification of the posterior longitudinal ligament in 31.MRI (spin-echo sequence) was performed in all patients. Three patterns of spinal cord signal intensity changes on T1-weighted sequences/T2-weighted sequences were detected as follows: normal/ normal. (N/N); normal/ high signal intensity changes (N/Hi); and low signal intensity changes/high signal intensity changes (Lo/Hi). Surgical outcomes were compared among these three groups. The most useful combination of parameters for predicting prognosis was determined. There were 2 patients with N/N, 67 with N/Hi and 4 with Lo/Hi signal change patterns before surgery. Regarding postoperative recovery, the preoperative Lo/Hi group was significantly inferior to the preoperative N/Hi group. The best combination of predictors for surgical outcomes included age, preoperative signal pattern and duration of symptoms. The low signal intensity changes on T1-weighted sequences indicated a poor prognosis. We speculate that high signal intensity changes on T2-weighted images include a broad spectrum of compressive myelomalacid pathologies and reflect a broad spectrum of recuperative potentials of the spinal cord. Predictors for surgical outcomes are preoperative signal intensity change pattern of the spinal cord on radiological evaluations, age at the time of surgery and chronicity of the disease

To audit the routine measurement of Vitamin B12 levels prior to cervical decompressive surgery

Retrospective analysis of medical records and pathology results of patients who underwent decompressive cervical surgery for myelopathy over a 6 month period

26 patients were identified from theatre records.

21 out of 26 patients did not have vitamin B12 levels checked prior to their decompressive surgery

The reports in the literature of co-existent B12 deficient myelopathy and mechanical compression are a cause for concern. Although the incidence of this is unknown and unlikely to be common, good clinical practice would suggest that we should be routinely monitoring B12 levels in myelopathic patients.

We have introduced new standards for routinely checking B12 levels pre-operatively and intend to re-audit the effectiveness of these in six months time.

Subjects and Methods: Surgical results of 12 patients aged 70 or older were compared with those of 15 younger controls with the same degree of cervical spondylotic myelopathy. All the patients were treated with the open-door laminoplasty in our institution from 1984 to 1999. The Japanese Orthopaedic Association Criteria (JOA score) was used for clinical evaluation. Perioperative complications were recorded. Results: The maximum recovery of the JOA score was obtained approximately 1 year after the operation, and the recovery rate was slightly higher in the younger (53.3%) than the older (39.6%) subjects. Both groups exhibited gradual decrease in their JOA score, and the final score of 9.8 in the elderly had no significant difference with that of 11.2 in the control group. Despite the higher frequency of associated systemic disorders in the elderly, there was no major surgical complication in both groups. Discussions: The lower JOA score in elderly subjects were partly due to their accompanied lumbar or knee symptoms. Major perioperative complications could be avoided even in the patient over 80 years old. The open-door laminoplasty demonstrated promising clinical outcomes and should be performed in the elderly patients with cervical spondylotic myelopathy

A retrospective review, comparing outcome following circumferential versus anterior decompression and fusion for patients with cervical spondylotic myelopathy (CSM). To assess the safety and efficacy of the circumferential operation for CSM. Cervical spondylotic myelopathy has traditionally been managed by anterior or posterior decompression with/ without fusion. However, there is a considerable variation in neurological recovery and clinical outcome following these procedures. While circumferential decompression and fusion has been shown to provide superior neurological outcome in selected patients with cervical trauma and tumours, its role in the management of CSM has yet to be clearly defined. Fifteen patients who underwent a 360° operation (Groupl) for CSM were matched (age, number of levels operated and follow-up duration) with patients (Group 2, n=15), that underwent anterior decompression and fusion for the same problem. All patients were operated by a single surgeon and reviewed independently. Charts, radiographs, patient interviews and MODEMS Cervical Spine Outcome questionnaires were the basis for assessment. The operative time, blood loss, in-hospital stay and post-operative complications were higher in group l. The pseudoarthrosis rate was comparable though a trend towards increased graft and hardware problems was noted in group 2. Neurological improvement as measured by the mJOA Myelopathy Scale was significantly better (p = 0. 039) in group 1. 87% of those in group1 and 67% in group 2 showed improved function. Patients in group1 also performed better (p=0. 056) in the neurological domain and treatment expectation scales of the cervical spine questionnaire, though the incidence of post-op, neck pain was higher. Single stage circumferential spinal decompression and fusion permits consistent neurological recovery in selected patients with cervical spondylotic myelopathy and it can be performed with limited morbidity

In 141 patients with ossification of posterior longitudinal ligament, open-door expansive laminoplasty was done from 1980 to 1998. A follow-up study was made. 10 patients with cervical cord injury and cerebral diseases before or after operation were excluded. 121 of 131 patients were followd directly one to fifteen years(mean: 5 years and 3 months). Subjects included 93 male and 28 female. At the time of operation, their ages ranged from 40 to 80 years(mean:59.5). Operative results were evaluated using the Japanese Orthopaedic Association’s Score(JOA Score) and Hirabayashi’s improvement rate. X-ray was taken to measure the range of cervical spine motion, curvature of the cervical spine and progression of ossified masses.

Preoperative JOA scores ranged from 2 to 14 points(mean:9.1), postoperative JOA scores ranged 7 to 17 points(mean:14.1). The mean improvement rate was 62%. The range of cervical spine motion decreased from 26.6 degrees prior to operation to 10.8 degrees after operation. Lordotic curvature also fell from 11.8 degrees before operation to 6.6 degrees after operation. In 20 patients, the postoperative kyphotic curvature increased to 5 degrees of more, although no difference was seen in their improvement rates compared with patients whose lordosis remained unchanged. 80 of 121 patients experienced progression of ossified masses. Three patients underwent additional laminectomy due to progression of ossification or insufficient expansion.

Operation took an average 80 minutes and mean amount of blood loss was 215 ml. No patients had postoperative motor paralysis caused by C5 or C6 nerve damage and no serious complications were seen.

All types of cervical laminoplasties for cervical spondylotic myelopathy (CSM) gave the same degree of postoperative neurological recoveries. However, postoperative neck functions differed according to degrees of intervention with posterior supporting elements of the neck (spinoligamentous complex, SLC). To obtain optimal postoperative neck function, SLC should be preserved. Laminar enlargement destroying SLC resulted in anterior tilt of neck, loss of cervical lordosis and loss of cervical range of motion (ROM) by 40–60% of preoperative ROM, whereas, tension-band laminoplasty (. N.Tsuzuki et al. . Int Orthop. 1996. ;. 20. :. 275. –84. ), which preserved SLC, maintained cervical alignment with loss of ROM by 20–40% of preoperative ROM, showing a better postoperative neck-function than that of other laminoplasties. However, about 70% of patients complained of some discomforts of the posterior neck even with good neck movements. To obtain optimal postoperative neurological recovery, the timing of decompression was a key issue. Japanese Orthopaedic Association (JOA) score for cervical myelopathy (normal = 17 points) was used for neurological evaluation. One hundred and nine patients who underwent tension-band laminoplasty, were grouped into 3 groups according to preoperative JOA scores: group A with JOA score above 14 (10 patients), group B with JOA score between 11 and 13 (48 patients), and group C with JOA score below 10 (51 patients). Mean pre-/post- JOA scores and ratios of patients with postoperative JOA score above 16 for each group were as follows: 1. 0.4/14.1, 34% for total patients, 14.6/16.5, 80% for group A, 11.9/14.8, 40% for group B, and 8.2/12.9, 20% for group C. There was a statistical difference among three groups. It was concluded that decompression at the early stage with JOA score above 14 using tension-band laminoplasty might provide the best outcome to CSM-patients regarding neurological improvement and postoperative neck function