高弘　Takahiro 飯塚　Iizuka

Global Spine Congress 2023 which was held at Prague Congress Center in Czech Republic Introduction: Neck Pain following Cervical Laminoplasty and loss of kinematic ROM are still the major concerns as well as neurological recovery. We reported Cross Tightening for laminoplasty at Global Spine Congress 2022 in Las Vegas. This procedure dramatically reduces postoperative neck pain. Considering the ROM of cervical motion, kinematic ROM is limited by laminoplasty because enlarged laminae may interrupt the cervical extension. From a kinematic point of view, the upper cervical spine C0-1-2 is more flexible in extension and flexion of the cervical spine. We arranged the procedure for the next step to make it a cutting-edge method for cervical laminoplasty. We combined Cross Tightening and C3 laminectomy for postoperative axial neck pain and also postoperative neck motion preservation. We report the preliminary results of cervical laminoplasty with Cross Tightening and C3 laminectomy regarding axial pain and kinematical ROM after surgery. To accomplish laminoplasty cross tightening and C3 laminectomy for laminoplastyTakahiro Iizuka1, Tokuji Kashiro1, Tetsuro Takai1, and Hiroshige Debata1 1Kouseikai Takai Hospital, Orthopaedic Spine Surgery, Nara, Japan Introduction: Neck pain following cervical laminoplasty and loss of kinematic ROM are still the major concerns as well as neurological recovery. We reported Cross Tightening for laminoplasty at Global Spine Congress 2023 in Las Vegas. This procedure dramatically reduces postoperative neck pain. Considering ROM of cervical motion, kinematic ROM is limited by laminoplasty because enlarged lamina may interrupt the cervical extension. From a kinematic point of view, the upper cervical spine C0-1-2 is more flexible in extension and flexion of the cervical spine. We arranged the procedure for the next step to make it a cutting-edge method for cervical laminoplasty. We combined Cross Tightening and C3 laminectomy for postoperative axial neck pain and also postoperative neck motion preservation. We report the preliminary results of cervical laminoplasty with Cross Tightening and C3 laminectomy regarding axial pain and kinematical ROM after surgery. Aim: We aimed to report the results of Cross Tightening and C3 laminectomy (combined laminoplasty) regarding postoperative neck pain (axial pain) and kinematic ROM of the cervical spine. Materials and Methods: We introduce the preliminary results of 5 patients who had Cross Tightening and C3 laminectomy compared with 21 patients who had C3-7 laminoplasty with Cross Tightening. Techniques of Cross Tightening Muscle and C3 laminectomy. 1. Patients positioned in the prone position with Mayfield. 2. Skin incision was made in the midline over C2-Th1. 3. Multifidus Muscles attached to C2 were ligated with 5 Ethbond before detaching. 4. Multifidus Muscles attached to C7 were also ligated with 5 Ethbond before detaching. 5. Laminoplasty C4-7 and C3 laminectomy was performed with the left side open using spacers Camber from NuVasive. 6. 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) and ROM on lateral X-rays at 12 weeks after surgery. Results: Laminoplasty with C3 laminectomy improved ROM of the cervical spine compared with C3-7 laminoplasty. Neck Pain was also significantly reduced at 12 weeks after surgery in all of them. Conclusion: CSM often requires C3 to C7 laminoplasty, but post-operative neck pain is the major concern though many reports suggest us the preservation of C7 muscle structures. In preparing laminoplasty we require the removal of muscle attachment from the laminae. We often observe Multifidus Muscles attached to spinous processes are shortened as if they were gum bands. Besides C2 and C7 have a larger spinous process which seems to have a major role in cervical motion. Enlargement of the laminae would interrupt the extension motion. We focused on muscle function restoration to reduce postoperative neck pain and ROM. We report the preliminary restoration methods for cervical motor function with Cross Tightening Multifidus Muscles. This procedure which is combined with Cross Tightening and C3 laminectomy may restore the muscular function in cervical motion in the normal anatomical direction and may be superior to the conventional procedure in terms of postoperative neck pain and ROM.