Decompressive Cervical Laminectomy and Lateral Mass Screw-Rod Fusion for Multisegmental Cervical Spondylotic Myelopathy with Flexible Sagittal Cervical Alignment

Abstract

Background data: Posterior cervical laminectomy and lateral mass screw-rod fusion techniques were classically recommended in flexible sagittal cervical alignment relying on indirect decompression via posterior cord shift. Purpose: This study aims to investigate the efficacy of posterior cervical laminectomy with lateral mass screw-rod fixation for treating multisegmental cervical spondylotic myelopathy with flexible sagittal cervical alignment. Study Design: Prospective clinical cohort study. Patients and Methods: In total, 38 patients with clinically symptomatic M-CSM with instability and/or flexible kyphosis were admitted to our Zagazig university hospitals for posterior cervical laminectomy and lateral mass screw-rod fusion (long-segment instrumented fusion ≥3 segments) and completed the 24-month follow-up period between April 2014 and June 2018 and the last follow-up visit took place in October 2020. Patients were categorized into lordotic, straight, and kyphotic groups according to the shape of the cervical spine curve on a neutral lateral X-ray view. Results: A total of 266 lateral mass screws were inserted in 134 levels in 38 patients (3 levels in 20 patients, 4 levels in 16 patients, and 5 levels in 2 patients), all the patients had a good fusion, and the cervical spine was stable, based on the absence of hardware failure or subsidence. All 38 patients (100%) gained more lordosis with a variable degree according to the preoperative cervical sagittal alignment. The mean percentage of neck pain improvement according to the Visual Analogue Scale (VAS) for the lordotic group was 69.1%, for the straight group was 43.8%, and for the kyphotic group was 15.8%. The mean percentage of neurological function improvement (JOA score) for the lordotic group was 83.17%, for the straight group was 43%, and for the kyphotic group was 17%. The mean percentage of disability improvement (NDI score) for the lordotic group was 47.66%, for the straight group was 24.5%, and for the kyphotic group was 16.66%. Conclusion: Decompressive cervical spine laminectomy with lateral mass screw stabilization is effective in treating multisegmental cervical spondylotic myelopathy with flexible sagittal cervical alignment. (2022ESJ259)