Abstract
Objective To explore the efficacy and safety of different surgical approaches of cervical spondylotic myelopathy, and the predictive factors for the outcome of surgery. Methods Clinical data of 68 consecutive patients who underwent surgical treatment from 2003-08-01 to 2006-12-01 were collected. The quantization of the efficacy of operation was made by applying Japanese Orthopedic Association (JOA) scoring system, based on which the recovery rate and satisfaction rate were calculated. In the patients who underwent anterior approach, we compared the recovery rate among the subgroups of different duration of symptoms, age at surgery and the severity of diseases. Any surgery-related complications were also noted. Results 73.5% (50/68) patients underwent anterior approach, with an average recovery rate of (68.21 ± 10.06)% and the satisfaction rate of 88.00%; 20.6% patients (14/68) underwent posterior approach, with an average recovery rate of (64.03 ± 7.07)% and the satisfaction rate of 100%. The recovery rate had no significant difference in the two approaches. Only 4 patients (5.9%) underwent anterior and posterior combined approach, and the recovery rate and the satisfaction rate were 65.10% and 100%, respectively. In the group of patients who accepted anterior approach, no significant differences were found in the recovery rates of different age subgroups and different duration of symptom subgroups; the significant differences recovery rates between the moderate and severe subgroups were identified. Minor complications, such as asymptomatic screw misplacement, transient dysphagia/odynophagia, pain related to the donor site and axial syndrome, were observed in a few patients. Conclusion The JOA score can be improved by applying the appropriate approaches and the high recovery and satisfaction rates can be achieved at the same time. The efficacies of anterior and posterior approaches were similar. The complications of surgery were minor. In the patients who underwent anterior approach, the severity of diseases was a predictive factor for the outcome of surgery.
Highlights
Cervical spondylotic myelopathy(CSM) accounts for 10% - 15% of cervical syndrome
Age-related disc degeneration leads to the collapse at the interspaces, degenerative endplate changes, osteophyte formation, arthritis, hypertrophy of the zygapophyseal and uncovertebral joints, thickening of the ligamentum flavum, and overlap and hypertrophy of the cervical facet complexes, which in turn causes the narrowing of the anterior-posterior diameter of the cervical spinal canal, the compression of spinal cord and the progressive vascular insufficiency
Kadanka et al [2] ran a prospective 3-year randomized study comparing conservative and surgical treatment of CSM. They found that patients should rather be treated conservatively if they a spinal transverse area larger than 70 mm2, were of older age, and had normal central motor conduction time, and surgery was more suitable for patients with clinically worse status and a lesser transverse area of spinal cord
Summary
Cervical spondylotic myelopathy(CSM) accounts for 10% - 15% of cervical syndrome. Its etiology is usually agerelated degenerative spondylosis. Age-related disc degeneration leads to the collapse at the interspaces, degenerative endplate changes, osteophyte formation, arthritis, hypertrophy of the zygapophyseal and uncovertebral joints, thickening of the ligamentum flavum, and overlap and hypertrophy of the cervical facet complexes, which in turn causes the narrowing of the anterior-posterior diameter of the cervical spinal canal, the compression of spinal cord and the progressive vascular insufficiency. All these result in the cervical myelopathy and a series of symptoms. Insidious onset, vulnerability of misdiagnoses and progress during an unpredictable time course are the main features of CSM
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