We reviewed 75 patients (57 men and 18 women), who had undergone tension-band laminoplasty for cervical spondylotic myelopathy (42 patients) or compression myelopathy due to ossification of the posterior longitudinal ligament (33 patients) and had been followed for more than ten years. Clinical and functional results were estimated using the Japanese Orthopaedic Association score. The rate of recovery and the level of postoperative axial neck pain were also recorded. The pre- and post-operative alignment of the cervical spine (Ishihara curve index indicating lordosis of the cervical spine) and the range of movement (ROM) of the cervical spine were also measured.

The mean rate of recovery of the Japanese Orthopaedic Association score at final follow-up was 52.1% (sd 24.6) and significant axial pain was reported by 19 patients (25.3%). Axial pain was reported more frequently in patients with ossification of the posterior longitudinal ligament than in those with cervical spondylotic myelopathy (p = 0.027). A kyphotic deformity was not seen post-operatively in any patient. The mean ROM decreased post-operatively from 32.8° (sd 12.3) to 16.2° (sd 12.3) (p < 0.001). The mean ROM ratio was 46.9% (sd 28.1) for all the patients. The mean ROM ratio was lower in patients with ossification of the posterior longitudinal ligament than in those with cervical spondylotic myelopathy (p < 0.001). Compared to those with cervical spondylotic myelopathy, patients with ossification of the posterior longitudinal ligament had less ROM and more post-operative axial neck pain.

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 Orthop1996;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.

Much interest and controversy have arisen regarding treatment and prognosis of unstable pelvic fractures. The choice of treatment should be based to a large extent on the long-term outcome. Residual vertical displacement and sacroiliac joint involvement are often cited as being related to poor outcome. This study attempts to clarify whether residual vertical displacement or location of posterior pelvic ring injury correlate with functional outcomes.

33 patients with unstable pelvic fractures not involving the acetabulum were reviewed with greater than 18 months of follow-up. Iowa pelvic scores and descriptive information about sequelae were administered. Fractures were classified according to Tile as 27 type B, and 6 type C fractures. 9 cases were treated with external fixation and 5 cases were treated open reduction and internal fixation. The amount of residual vertical displacement was measured on plain AP radiographs and graded as 0–4,4–10,10–20, or > 20mm. Location of posterior pelvic ring injury was divided into 3 groups, sacral fractures, sacroiliac fracture dislocations, and transiliac fractures.

Residual vertical displacement correlated with the incidence of LBP to some extent, but the difference was not statistically significant. Location of the posterior pelvic injury correlated with the incidence of neurologic injury and gait disturbance.

There was high incidence of lower extremity fractures associated with the pelvic fractures. The incidence of gait disturbance and Iowa pelvic score were not valid as functional assessment tool.

Residual vertical displacement and location of posterior pelvic injury correlated with the functional outcome to some extent.