高弘　Takahiro 飯塚　Iizuka

Cross Tightening Cervical Muscles for Cervical Laminoplasty in the Structural Option to Reduce Neck Pain after Surgery for Cervical Spondylotic Myelopathy(CSM) - Preliminary Report on Reconstruction of the C2,C6 and C7 Muscle Attachments in the Anatomical Direction with Cross Tightening Cervical Muscles‐ https://journals.sagepub.com/doi/epub/10.1177/21925682221096074 Las Vegas USA Takahiro IIZUKA ,MD. PhD. A.Kashiro MD, T. Iwami MD, H. Debata,MD. T.Takai MD. Title: Cross tightening cervical muscles for cervical laminoplasty in the structural option to reduce neck pain after surgery for cervical spondylotic myelopathy (CSM). Preliminary report on reconstruction of the C2, C6 and C7 muscle attachments in the anatomical direction with cross tightening cervical muscles Takahiro Iizuka1, Tokuji Kashiro1, Hiroshige Debata1, Toyohito Iwami1, and Tetsuro Takai1 1Kouseikai Takai Hospital, Orthopaedic Spine Surgery, NARA, Japan Introduction: Neck Pain following Cervical Laminoplasty is one of the major concerns as well as neurological recovery. In literatures many authors recommend preservation of C7 muscle attachments. To repair the muscular structures of cervical spine may be the key of post-operative neck pain after laminoplasty. Some reports on this postoperative complication were reduced by C7 preservation or skip laminoplasty. However many cases still requires C7 laminoplasty and/or laminectomy to treat CSM in daily practice. We aimed to reduce the postoperative neck pain. We repair the muscular function to restore the cervical muscular function. We focused cervical muscular function on muscular function attached to C2 and C7 which have large spinous process. That means C2 and C7 play a major cervical motor function because morphologically C2 and C7 may have a main muscular function. In order to reduce postoperative neck pain and restore cervical motor function to report muscular restoration of C2 and C7 muscular attachment in the same anatomical direction with non-absorbable suture stitches (Cross Tightening Muscles). Material and Methods: 40 patients enrolled in this study. We divided randomly patients to two groups: Conventional Suture Group: 20 and Cross Tightening. Muscle Group: 20 patients. All of them were performed C3-7 laminoplasty. Preoperative JOA scores for CSM and Cervical Curves were documented. Techniques of Cross Tightening Muscle 1. Skin incision was made in midline over C2-Th1 2. Multifidus Muscles attached C2 were ligated with 1-0 Ethbond before detach. 3. Mulitfidus Muscles attached C7 were also ligated with 1-0 Ethbond before detach. 4. Laminoplasty were performed with left open using spacers (Center piece: Sofamoadanech, Chanber: Nuvasive). 5. Muscles were reconstructed in anatomical direction tightening to the opposite fascia. We evaluated the cervical vertebral alignment (C1-Th1) for each patient and neck pain (VAS) at 2 ,4 and 12 weeks after surgery. Results: Cervical curvature between C1-Th1 was significantly restored in Cross Tightening Group and VAS score regarding Neck Pain was also significantly reduced at 4 and 12 weeks after surgery. VAS was 0 to 2 at 4 weeks after surgery compared with the patients (VAS 4-8), p < 0.05. Conclusion: CSM often requires C3 to C7 laminoplasty, but post-operative neck pain is the major concerns though many reports suggest us the preservation of C7 structures. Actually, conventional laminoplasty didn’t show the significance of muscular function after surgery. Preparing laminoplasty we require the removal of muscle attachment from laminae. We often observe Multifidus Muscles are shortened as if they were gum bands. Besides C2 and C7 have a larger spinous process which seems to have major roles for cervical motion. We focused on the muscle function restoration in order to reduce post-operative neck pain. We report the preliminary restoration methods for cervical motor function with Cross Tightening Multifidus Muscles. This suture method may restore the muscular function in major cervical motion in the normal anatomical direction comparing with the conventional fascia suture, and may be superior to the convention suture methods in terms of post-operative neck pain and cervical anatomical curvature.