Decompression For Cervical Spondylotic Myelopathy Research Articles

Principles from clinical trials relevant to clinical practice: Part II.

Principles from clinical trials relevant to clinical practice: Part II.

Posterior approaches for the surgical treatment for multilevel cervical spondylotic myelopathy: laminoplasty versus laminectomy

Posterior approaches for the decompression of cervical spondylotic myelopathy are commonly used for cases of multilevel stenosis. An important prerequisite to the successful performance of a posterior decompressive procedure is the presence of a neutral to lordotic sagittal alignment. Although laminectomy is the historical point of reference, its success is limited by a tendency to produce segmental instability, loss of lordosis, and, in some cases, late neurologic deterioration. Laminectomy with concurrent lateral mass fusion has been advocated as a means of mitigating the destabilizing effect of laminectomy. Laminoplasty has a well-documented long-term success in providing for adequate cord decompression, producing a sustained functional improvement in a majority of patients and avoiding the need for fusion. The success of laminoplasty and other posterior procedures must be balanced against the potential for postoperative axial discomfort, radiculopathy, and decrease in lordosis.

Laminectomy in the Cervical Spine: Indications, Surgical Techniques, and Avoidance of Complications

LEARNING OBJECTIVES: After reading this article the participant should be able to: Recognize the clinical and radiological aspects of cervical spondylotic myelopathy. Define the indications and techniques of surgical decompression for cervical spondylotic myelopathy. List the possible complications and steps to achieve complication avoidance in the treatment of cervical spondylotic myelopathy.

Laminectomy in the Cervical Spine: Indications, Surgical Techniques, and Avoidance of Complications

Learning Objectives: After reading this article the participant should be able to: 1. Recognize the clinical and radiological aspects of cervical spondylotic myelopathy. 2. Define the indications and techniques of surgical decompression for cervical spondylotic myelopathy. 3. List the possible complications and steps to achieve complication avoidance in the treatment of cervical spondylotic myelopathy.

Long-term follow-up results of posterior decompression for cervical spondylotic myelopathy

Long-term follow-up results of posterior decompression for cervical spondylotic myelopathy

Posterior approach to the degenerative cervical spine

The posterior approach to the cervical spine was the only method of access to the spinal canal until the anterior approach was developed by Robinson and Smith, and Cloward. With the accumulation of experience in posterior decompression for cervical spondylotic myelopathy (CSM), successful laminectomy was guaranteed only when lordotic alignment of the cervical spine, wide and extensive laminectomy for adequate posterior shift of the spinal cord, and stability of the spine were ensured after surgery. The thick scar formation occasionally seen subsequent to postlaminectomy hematoma could lead to an unfavorable outcome. The insertion of surgical instruments, such as a Kerrison rongeur or a curette, into the spinal canal without being aware of how narrow the canal is, or uneven decompression of the spinal cord during resection of the laminae can impinge on or distort the spinal cord and result in deterioration of neurological function. Several authors have pointed out that postoperative loss of neural function is a hazard of surgical intervention. Owing to the poor results of conventional laminectomy for cervical compression myelopathy related to the problems mentioned above, Kirita developed extensive simultaneous decompression laminectomy to avoid distortion of the spinal cord by the edges of the resected laminae. Hattori devised an expansive Z-shaped laminoplasty in which the posterior wall of the spinal canal was preserved by Z-plasty of the prepared laminae. This was an attempt to prevent the invasion of scar tissue, i.e., the so-called laminectomy membrane, which was believed to be a cause of late neurological regression. He also expected that the laminae reconstructed by Z-plasty would provide support for the spine. The introduction of high-speed air-drills allowed successful development of this procedure. In 1977, Hirabayashi introduced an epoch-making laminoplasty, the expansive open-door laminoplasty. He described the advantages of this procedure as: possibility of decompressing multiple levels of the spinal cord simultaneously, better postoperative support of the neck, allowing earlier mobilization of the patients, prevention of postoperative kyphotic deformity of the cervical spine, and reduced mobility of the cervical spine postoperatively, which helps to prevent late neurological deterioration and progression of OPLL. Subsequent to the Hirabayashi laminoplasty, various modifications and supplementary procedures have been devised for further improvement of the safety and efficacy of decompression, and for improved stability of the spine. Aims, advantages and disadvantages of laminoplasty: The aims of the laminoplasty are to expand the spinal canal, to secure spinal stability and to spare the protective function of the spine. Preservation of mobility of the spine is also a goal of this procedure for multiple level involvement. Decompression can be extended along the nerve root by facetectomy. Preservation of the posterior spinal structures permits reinsertion of the nuchal muscles and the spinal ligaments after they have been totally or partially detached. This prevents kyphosis or listhesis of the cervical spine, which often develops after laminectomy, particularly in subjects below 50 years of age. Reconstructive procedures for reattaching muscles and/or ligaments to the spinous processes are added to the laminoplasty, improving the dynamic or ligamentous stability of the spine.

Cervical Spondylotic Stenosis and Myelopathy: Evaluation With Computed Tomographic Myelography

To determine which components of cervical spondylosis are most frequently present in patients with myelopathy. We reviewed the findings in 93 patients who underwent surgical decompression for cervical spondylotic myelopathy between January 1986 and December 1989 at Mayo Clinic Rochester. All 93 patients (72 men and 21 women) underwent computed tomographic (CT) myelography. In addition, magnetic resonance imaging scans were available in 25 patients, and plain CT scans were obtained in 2. A review of CT myelograms revealed that all neurocompressive intraspinal spondylotic changes were reflected in the shape of the spinal cord. Among the 93 patients with myelopathy, the configuration of the spinal cord could be categorized into primarily three dominant types: A (severe encroachment that compressed the cord into the shape of a banana; N = 40), B (moderate encroachment that produced less prominent compression; N = 23), and C (moderate bilateral uncovertebral spurs; N = 12). As a comparison group, 30 patients with similar spinal cord deformities but without progressive myelopathy were analyzed. Correlation of the two groups showed that myelopathy was present in up to 98% of patients with type A spinal cord, in 75% with type B, and in 71% with type C. The findings on magnetic resonance imaging were similar to those on CT myelography, but the bony spondylotic components were less readily seen. The precise pathophysiologic mechanism of myelopathy in spondylosis remains an enigma. Although the bulk of the data on our patients supports direct compression, we believe that the cause is multifactorial.

Surgical Treatment of Cervical Spondylotic Myelopathy in Elderly Patients

A retrospective study was carried out of the outcome of surgical decompression of cervical spondylotic myelopathy in 21 elderly patients. The presenting symptoms and signs were similar to those in younger patients. The indication for surgery was recent progressive neurological deficit. Assessment of pre-operative state was based on information from hospital records. Post-operative evaluation was made from a home visit in 17 cases (mean age 71) after a mean post-operative period of 19 months (3 patients had died in the interim and one had emigrated). Objective functional improvement was found in the upper limb in 58% and in the lower limb in 71%; the remainder were unchanged. Surgical decompression in cervical spondylotic myelopathy is a safe procedure, which benefits appropriately selected elderly.