Clinical and Radiological Outcomes of Anterior Approach Microscopic Surgery for the Pincer Mechanism in Cervical Spondylotic Myelopathy.

Deqing Peng,Bin Lei,Yuyuan Ma

doi:10.1155/2019/9175234

Deqing Peng, Bin Lei + Show 1 more

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https://doi.org/10.1155/2019/9175234

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Abstract

Objective We aimed to evaluate the efficacy of anterior approach microscopic surgery for patients with the pincer mechanism in cervical spondylotic myelopathy. Methods The clinical data of pincer cervical spondylotic myelopathy that received anterior cervical decompression and fusion in our hospital from Aug 2014 to Dec 2017 were analyzed retrospectively, including 12 males and 9 females, with an average age of 64.3 years (range 46-81 years). Occupying rate, anterior occupying rate, and posterior occupying rate were measured on pre- and postoperative mid-sagittal MRIs. Pre- and postoperative Japanese Orthopedic Association (JOA) scores, intervertebral space height, and C2 to C7 Cobb's angle were analyzed. Result Duration of follow-up was six months. The pre- and postoperative anterior occupying rate were averagely 38.6±8.5% and 12.9±5.5%, respectively, the posterior occupying rates were averagely 27.4±7.2% and 13.1±6.6%, respectively, and Cobb's angle changed from 15.3±8.0° to 22.7±7.9°. The intervertebral space height increased from 4.6±0.4mm to 6.5±0.4mm. JOA scores improved significantly by 59.4±34.0% at six months after surgery. Conclusion Decompression by anterior microscopic surgery can increase spinal canal volume directly, recover intervertebral space height, and resize Cobb's angle, but decrease the posterior compression by ligament Flava indirectly. Anterior decompression under the microscope may provide an alternative surgical option for partial patients with the pincer mechanism in cervical spondylotic myelopathy.

Highlights

The cervical spinal cord is compressed by the disc protrusions and ossification of the posterior longitudinal ligament (OPLL), and by the incrassated ligament Flava, which is defined as pincer mechanism [1]
An attempt is the first to be made to find out the clinical efficacy of anterior approach microscopic surgery for patients with the pincer mechanism in cervical spondylotic myelopathy
The spinal cord is recognized with anterior compression of a bony spur and a degenerative bulging disc, and posterior compression of the incrassated ligament Flava (Figure 3(a)), which is defined as the pincer mechanism in cervical spondylotic myelopathy

Summary

Objective

We aimed to evaluate the efficacy of anterior approach microscopic surgery for patients with the pincer mechanism in cervical spondylotic myelopathy. Anterior occupying rate, and posterior occupying rate were measured on pre- and postoperative mid-sagittal MRIs. Pre- and postoperative Japanese Orthopedic Association (JOA) scores, intervertebral space height, and C2 to C7 Cobb’s angle were analyzed. The intervertebral space height increased from 4.6±0.4mm to 6.5±0.4mm. JOA scores improved significantly by 59.4±34.0% at six months after surgery. Decompression by anterior microscopic surgery can increase spinal canal volume directly, recover intervertebral space height, and resize Cobb’s angle, but decrease the posterior compression by ligament Flava indirectly. Anterior decompression under the microscope may provide an alternative surgical option for partial patients with the pincer mechanism in cervical spondylotic myelopathy

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