Kurokawa’s Double Door Laminoplasty Combined With Dome-like Expansive Laminoplasty Of C2for The Treatment Of Ossification Of The Posterior Longitudinal Ligament Involving High Level Cervical Canal

【Objective】Explore the effect of Kurokawa’s double door laminoplasty combinedwith dome-like expansive laminoplasty of C2for the treatment ofossification of the posterior longitudinal ligament involving high levelcervical canal surgical methods, evaluate its clinical value.[Methods]A retrospective analysis from June2010to June2013, in our hospital20patients; male14cases, female8cases, patients aged42years to72years, mean62years. Duration of six hours-30years, an average of3.1years, neurological symptoms of post-traumatic six cases; no traumapatients in14cases.The main clinical manifestations are: cervical pain, limited mobility; limbsnumbness; double diminished grip strength, fine motor difficulties,inflexible can not even hold chopsticks holding chopsticks; unsteady gait,or with " The feeling of stepping on cotton ", upstairs difficulties; chestand abdomen were belted sense. Signs of motor neuron damage occurson the physical examination, the above lower extremity weakness, increased muscle tone, knee tendon hyperreflexia or active, torso, limbsshallow hypoesthesia, Hoffmann sign positive, patellar clonus and ankleclonus positive. The clinical symptoms vary. All20patients underwentcervical lateral X-rays, CT scan and cervical sagittal reconstruction,cervical MRI, Imaging revealed: cervical lordosis decreased ordisappeared, osteoarthritis, behind cervical vertebral is a white longossification shadow, CT and MRI examination showed: prominentossification different physical size and shape of the spinal canal, iscontinuous or dispersed in a mixed ossification high density on magneticresonance imaging showed low signal intensity on the sagittal dural saccompression obviously, some lesions segment deformation, thinning,CSF signal is interrupted,8patients with cervical disc merger, six ofthose exceptions intramedullary spinal cord injuries have varyingdegrees of intramedullary abnormal signal. For the four cases of patientswith acute spinal cord injury in the early eight-hour was given anmethylprednisolone therapy, a proton pump inhibitor drugsintravenously protect the gastric mucosa. After stable patient vital signs,Improve the preoperative examination, timely surgical treatment.according to the classical method of Kurokawa surgery, separate thevertical cut3to7spinous neck, cervical spine upward direction along anarc with a half-burr grind carefully curved slot, complete the lower edgeof the rear of the neck two spinous less dome-style pressure, the4th catheter tip along the lower fornix deep into the lower edge of the internalcarotid canal2,1,2careful exploration of the neck behind the canalpatency, upon completion of spinal decompression smooth, Ladder typeof bone, respectively bundled fixed.2points behind the neck muscles torebuild only after adequate hemostasis, place the flow tube, suturedincision, drainage tube to maintain patency observed drainage.Appropriate treatment were given postoperatively.【Results】Follow-up of20cases, followed up for0.5years to3years, average1years and7months. The age of the patients ranged from42years to72years old, the average age of62years. Clinical efficacy evaluationstandard of evaluation of JOA applications, excellent in2cases (10%),good in12cases (60%), tolerableness in5cases (25%), poor in1case(5%), the excellent and good rate was70%;Neurological symptoms were improved, most patients numbness,unsteady gait improved significantly, the average score for thepreoperative JOA was7.83±2.42, mean postoperative score was12.70±1.86, Improvement rate was52.01%.【Conclusion】(1)Kurokawa’s double door laminoplasty combined with dome-likeexpansive laminoplasty of C2can expand the cervical spinespace， relieve the spinal cord compression. (2) Preoperative and postoperatie JOA score improved significantly,,with satisfactory curative effect.(3)Operation method is simple, do not use internal fixation materials,reduce the cost of operation;maintain the integrity of the cervical backmuscle tissue and most of spinous process of C2, keeping thestability of the cervical spine, protecting the activity degree of cervicalspine.