Selective dorsal decompression of degenerative cervical canal stenosis

Abstract

Hypertrophy of the dorsal ligaments is one reason for central stenosis of the cervical spinal canal. Selective decompression techniques without stabilization and fusion could be a sufficient alternative surgical treatment option. This article presents the results of an observational study on 17 patients after treatment with selective decompression and undercutting of the cervical laminae and medial joint portion. The Japanese Orthopedic Association (JOA) score, the neck pain disability index (NPDI) and arm and neck pain on a visual analogue scale (VAS) were compared preoperatively and postoperatively (mean follow-up period was 14 months, minimum 12 months). The reduction of the stenosis and degree of adjacent level disease were measured using presurgical and postsurgical magnetic resonance imaging (MRI). The segmental and regional lordosis and range of motion were determined using the Cobb method on plain standing lateral radiographs. There were no complications and no revision surgery was necessary. All clinical parameters improved significantly. The stenosis was significantly decompressed and no progression of myelopathy was observed on MRI. The sagittal parameters and degree of adjacent level degeneration remained unchanged. The clinical and radiological results of this non-fusion technique are convincing. Selective decompression is therefore an alternative to laminectomy and fusion as well as laminoplasty.