Long-term impacts of different posterior operations on curvature, neurological recovery and axial symptoms for multilevel cervical degenerative myelopathy

Wei Du,Longxi Ren,Linfeng Wang,Yong Shen,Wenyuan Ding,Yingze Zhang

doi:10.1007/s00586-013-2741-5

Abstract

PurposeTo investigate the long-term impacts of different posterior operations on curvature, neurological improvement and axial symptoms for multilevel cervical degenerative myelopathy (CDM), and to study the relationship among loss of cervical lordosis, recovery rate and axial symptom severity.MethodsWe retrospectively reviewed 98 patients with multilevel CDM who had undergone laminoplasty (Group LP, 36 patients), laminectomy (Group LC, 30 patients), or laminectomy with lateral mass screw fixation (Group LCS, 32 patients) between January 2000 and January 2005. Loss of curvature index (CI) was measured according to the preoperative and final follow-up radiographic parameters. The recovery rate was calculated based on the Japanese Orthopedic Association (JOA) score. Axial symptom severity was quantified by Neck Disability Index (NDI).ResultsAnalysis of final follow-up data showed significant differences among the three groups regarding loss of CI (F = 41.46, P < 0.001) between preoperative and final follow-up JOA scores (P < 0.001), final follow-up JOA score (F = 7.81, P < 0.001), recovery rate (F = 12.98, P < 0.001) and axial symptom severity (χ 2 = 18.04, P < 0.001). Loss of CI showed negative association with neurological recovery (r = −0.555, P < 0.001) and positive correlation with axial symptom severity (r = 0.696, P < 0.001).ConclusionsExcellent neurological improvement was obtained by LP and LCS for patients with multilevel CDM, while loss of CI in groups LP and LC caused a high incidence of axial symptoms. Loss of CI was correlated with poor neurological recovery and axial symptom severity. Lateral mass screw fixation can effectively prevent loss of postoperative cervical curvature and reduce incidence of axial symptoms.

Highlights

Multilevel cervical degenerative myelopathy (CDM) is usually treated by different posterior decompression techniques
No significant differences in preoperative Japanese Orthopedic Association (JOA) scores among the three groups and in final follow-up JOA scores between groups LP and LC ? Screw (LCS) were noted
The present study showed that axial symptom severity was positively correlated with loss of CI, which meant that the symptoms would get worse if the cervical curvature index was more severely lost

Summary

Introduction

Multilevel cervical degenerative myelopathy (CDM) is usually treated by different posterior decompression techniques. Laminoplasty has been considered as an effective and safe method to widen the spinal canal dimensions without removing the dorsal elements of the cervical spine [1, 2]. Laminectomy allows adequate decompression of the spinal cord, and can be performed safely and . Some late operation-related complications have been observed in laminoplasty and laminectomy, which include segmental instability, loss of cervical lordosis, neurological deterioration and axial symptoms [4,5,6,7,8,9]. Several studies have shown that the remaining anterior compression might hinder the neurological recovery, if the segmental instability and kyphotic deformity were not

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