Surgical Management of Recurrent Compressive Myelopathy after Anterior Cervical Discectomy and Fusion

Abstract

IntroductionRecurrent myelopathy after anterior cervical discectomy and fusion is a rare condition, the literature in this entity were limited. This recurrence may occur at the same level or in adjacent level/s, usually the proximal level, the compressing element either anteriorly by a newly prolapsed disc or posteriorly by enfolding of the ligamentum flavum Material and MethodsFrom 2008 to 2012, 9 cases of recurrent cervical myelopathy were treated surgically at Bab El-Sheria university hospital, all of them had an anterior cervical discectomy before with a good improvement after surgery. All patients were evaluated clinically by both JAO score and Nurick's grades and radiologically by plain X-ray and MRI, In MRI the pattern of compression were evaluated in T2 waited image and the cord was evaluated according Yasutsugu classification.. 6 out of the 9 cases were operated through anterior approach and 3 via posterior approach. The mean follow up period was 30.7 months. ResultsAll cases in this study were improved clinically and radiologically, the average time of surgery were 65 minutes (45–80), the average blood loss 140cc (100–170cc), non of patient develop any major complication, only 4 cases suffering mild dysphagia which improved spontaneously, Improvement of JAO score was evaluated by the Recovery rate (RR), according to Hirabayashi's method. All patients were satisfied as they regain all or most of their previous activity and work. 7 out of 9 cases (77.8) classified as excellent result according to improvement of JAO, RR ˃ 70%. Other 2 cases classified as good result ConclusionExcellent results could be obtained through this procedure, improvement in clinical outcome and cord condition was evident.