Abstract
ABSTRACT Objective: Cervical spondylotic myelopathy (CSM) is the main cause of spinal dysfunction in adults. The type of surgical approach to treatment is not well defined in the literature. The objective is to report the results obtained through isolated posterior decompression in patients with a previous indication of the combined approach for the treatment of cervical spondylotic myelopathy. Methods: This is a therapeutic study with level of evidence II, according to the Oxford classification table. Ten patients who underwent isolated posterior approach surgery for the treatment of cervical spondylotic myelopathy were evaluated through imaging and questionnaires (visual analog scale, mJOA-Br scale – Brazilian Portuguese version of the Modified Japanese Orthopedic Association Scale, and Neck Disability Index (NDI)), comparing pre- and postoperative results. Results: Late evaluation of the 10 patients was performed in the period ranging from 24 to 36 months (mean of 30.3 months ± 7.25) following surgery. The comparison of the clinical and radiological parameters in all patients showed a statistical difference in relation to the preoperative scales applied and to the degree of cervical lordosis (p <0.05), evidencing improvement after decompression and posterior fixation of the cervical spine. Conclusions: The isolated posterior approach (decompression, fixation and arthrodesis) allowed the clinical and radiological improvement of patients with cervical spondylotic myelopathy and who had an indication of the complementary anterior approach. Level of evidence II; Retrospective study.
Highlights
Cervical spondylotic myelopathy (CSM) is the most serious consequence of degenerative cervical spine disease and is the main cause of spinal cord dysfunction in adults.[1]
Ten patients who underwent isolated posterior approach surgery for the treatment of cervical spondylotic myelopathy were evaluated through imaging and questionnaires (visual analog scale, mJOA-Br scale – Brazilian Portuguese version of the Modified Japanese Orthopedic Association Scale, and Neck Disability Index (NDI)), comparing pre- and postoperative results
In the period from February 2014 to December 2017, 10 patients were identified with cervical spondylotic myelopathy involving at least three levels of the cervical spine, who had been indicated for the combined surgical approach, whose surgical treatment was limited to the posterior approach, due to improvement in clinical conditions following the surgical procedure, and who did not require complementary treatment by means of the anterior approach
Summary
Cervical spondylotic myelopathy (CSM) is the most serious consequence of degenerative cervical spine disease and is the main cause of spinal cord dysfunction in adults.[1] The constellation of degenerative changes in the cervical spine, characterized by degeneration of the intervertebral discs and facet joints, alterations in sagittal alignment, ossification of the posterior longitudinal ligament (OPLL) and hypertrophy of the yellow ligament lead to a reduction in the diameter of the vertebral canal and compression of the spinal cord.[2,3] Spinal cord compression can be uni- or multisegmental and, together with the sagittal alignment of the cervical spine, guide the therapeutic decision.[4]. The anterior approach to the cervical spine is indicated in uni- or bisegmental compression and the posterior approach is used in patients with compression in three or more vertebral segments. The presence of cervical kyphosis is considered an indication for the combined approach to cervical lordosis reconstruction.[6]
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