Fusion For Cervical Spondylotic Myelopathy Research Articles

P54. Cervical disc arthroplasty versus anterior cervical discectomy with fusion for cervical spondylotic myelopathy with increased signal intensity on magnetic resonance imaging

BACKGROUND CONTEXT The clinical outcomes of cervical disc arthroplasty (CDA) versus anterior cervical discectomy with fusion (ACDF) for cervical spondylotic myelopathy (CSM) with with increased signal intensity (ISI) on T2-weighted images (T2WI) is still not clear. PURPOSE The purpose of this study was to compare the clinical outcomes and complications between the two methods for CSM with ISI on T2WI. STUDY DESIGN/SETTING A retrospective study. PATIENT SAMPLE A total of 64 patients. OUTCOME MEASURES The modified-Japanese Orthopedic Association (m-JOA) score, the Visual Analogue Scale (VAS) score, the Neck Disability Index(NDI) and the physical and mental component scores (PCS and MCS) of the Short-Form 36 (SF36) of the two groups were recorded. The cervical curvature, the hight of adjacent intervertebral disc, extension and flexion range of motion (ROM) of the two groups were recorded. The indicators and complications of the two groups were compared. METHODS We analyzed 32 patients with CSM with ISI on T2WI who underwent CDA from January 2015 to January 2017 (CDA Group). The modified-Japanese Orthopedic Association (m-JOA) score, the Visual Analogue Scale (VAS) score, the Neck Disability Index (NDI) and the physical and mental component scores (PCS and MCS) of the Short-Form 36 (SF36) of the two groups were recorded. The cervical curvature, the hight of adjacent intervertebral disc, extension and flexion range of motion (ROM) of the two groups were recorded. Propensity score matching identified 32 patients (ACDF Group) as controls, who underwent ACDF, from January 2010 to January 2015 using 6 independent variables (pre-operation): age, sex, m-JOA, SF36 PCS, SF36 MCS and tobacco use. RESULTS There were no statistical difference in the baseline of the two groups. At the last follow-up, the m-JOA, VAS, NDI and SF-36 (PCS and MCS) scores of the two groups were all significantly improved. But NDI and SF-36 PCS and SF-36 MCS were better in CDA Group at the final follow-up. The the height of adjacent intervertebral disc, extension and flexion ROM were lost in ACDF group. The complication rate was higher in the ACDF group. CONCLUSIONS Our results showed that both ACDF and CDA could achieve satisfactory neurological recovery for CSM with ISI on T2WI. But CDA had better clinical outcomes and lower complication rate at the final follow up. However, these results require further validation and investigation in high evidence researches. FDA DEVICE/DRUG STATUS Unavailable from authors at time of publication.

Independent Patient Risk Factors Associated With Increased Length of Hospital Stay, Unplanned Return to Operating Room, and 30-Day Readmission Rates After Posterior Cervical Fusion for Cervical Spondylotic Myelopathy

Abstract INTRODUCTION The aim of this study was to determine risk factors associated with readmissions, reoperation, and extended length of stay (LOS) following posterior cervical fusion (PCF) for spondylotic myelopathy. METHODS The National Surgical Quality Improvement Program from 2011 to 2016 was queried for all patients undergoing PCF with a diagnosis of spondylotic myelopathy. The inclusion criteria for this project were defined by the CPT code 22600 for PCF. Patients with a history of trauma, malignancy, and those with nonelective surgery were excluded. Patients without ICD9 (721.1) or ICD10 (M47.12) codes for myelopathy were also excluded. For analysis, patients were classified into 2 cohorts: patients who were readmitted, and those who were not readmitted. Patient demographics, comorbidities, intraoperative variables, and number of levels involved in surgery were collected. RESULTS A total of 893 patients with PCF for spondylotic myelopathy were identified, of which 816 (91.4%) were not readmitted and 77 (8.6%) were readmitted.The readmitted cohort was significantly older (No Readmission: 62.6 +/–10.8 vs Readmission: 65.5 +/– 10.8, P = .029). The readmitted population had a significantly higher proportion of dyspnea on exertion (No Readmission: 8.1% vs Readmission: 15.6%, P = .026) and COPD (No Readmission: 6.9% vs Readmission: 14.3%, P = .018). There were no differences in operative time (P = .762) or multilevel surgeries (P = .453) between the 2 cohorts. LOS was similar between readmitted and nonreadmitted patients (P = .640). Upon logistic regression controlling for demographics, comorbidities, surgery level, and operative time, multiple risk factors predicted extended LOS, including female gender, black race, noninsulin-dependent diabetes, chronic steroid use, and length of surgery. BMI and CHF predicted an unplanned return to the operating room. Age [OR: 1.03,95% CI (1.004-1.06), P = .025] was the single predictor of readmission. CONCLUSION Our study suggests that while there are a host of risk factors for both reoperation and extended LOS, increased age is likely the most significant risk factor for readmission following PCF.

Posterior Cervical Decompression and Instrumented Fusion for Cervical Spondylotic Myelopathy: 2-Dimensional Operative Video.

Cervical spondylotic myelopathy is a common cause of progressive quadriparesis in adults. It is characterized by compression of the cervical spinal cord due to degenerative changes including intervertebral disc protrusion, ligamentum flavum hypertrophy, and osteophyte formation. Clinically, patients can present with declining motor control in the extremities, gait imbalance, spasticity, hyperreflexia, or possibly frank weakness. Surgical treatment options include ventral and dorsal approaches, whose indications vary depending on spinal alignment, number of levels requiring decompression, the dorsal/ventral/circumferential location of compression, and patient-specific anatomic constraints. Posterior cervical decompression and instrumented fusion is a mainstay of treatment for cervical spondylotic myelopathy when a dorsal approach is indicated. In this video, we present a case of a 60-yr-old female who presented with signs and symptoms of cervical myelopathy, with MRI findings of C3 on C4 anterolisthesis and circumferential central stenosis worst at C4-5 and C5-6. We demonstrate the operative steps to complete a C3 to C6 decompression and instrumented fusion with lateral mass screws. Appropriate patient consent was obtained.

Outcome of Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy

Background: Cervical spondylotic myelopathy (CSM) is a progressive degenerative disease and the most common cause of cervical spinal cord dysfunction (SCD) in older patients. Anterior cervical discectomy andfusion (ACDF) is a common procedure for patients with severe neurological deterioration. The goals of this study were to evaluate the clinical and functional outcome, radiological fusion and operative complications in case of CSM who underwent ACDF by autogeneous-tricortical bone graft and stabilized with plate and screws.
 Methods: This prospective interventional study was carried out at National Institute of Traumatology and Orthopaedic Rehabilitation ( NITOR) and different private hospitals in Dhaka from January 2012 to December 2014. Within this period total 12 CSM patients were included as study sample. All were surgically treated by ACDF and stabilized by plate and screws. All patients were clinically and radiologically evaluated before and after surgery.
 Results: Single level ACDF by autograft and stabilization by plate and screws was done in 10 (83.33%) patients and 2 (16.67%) patients had two level fusion. The mean follow up period was 12 months. The satisfactory result was found in 10 (83.33%) patients. Post-operative complications were donor site morbidity in2 (16.67%) patients and transient dysphagia in 1 (8.33%) patient. The fusion rate was 100% in this series.
 Conclusion: ACDF with anterior plating for CSM is a safe and effective procedure. It results in highest fusion, least complication and relatively lower cost.
 Birdem Med J 2019; 9(2): 133-137

Clinical and Radiologic Results of Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy in Elderly Patients with T2-Weighted Increased Signal Intensity.

To investigate clinical and radiologic results of anterior cervical discectomy and fusion for cervical spondylotic myelopathy in elderly patients with T2-weighted increased signal intensity (ISI), focusing specifically on the quantitative analysis of ISI. We retrospectively reviewed 88 patients with cervical spondylotic myelopathy with ISI who underwent anterior cervical discectomy and fusion with a minimum 1-year follow-up. Patients were divided into 2 groups: patients older than 65 (elderly group, 36 patients) or younger (young group, 52 patients). The Japanese Orthopaedic Association (JOA) score was used to evaluate the neurologic status. The signal change ratio (SCR) was defined as the grayscale of ISI region divided by that at C7-T1 disc level. The C2-C7 sagittal alignment, range of motion, SCR, and ISI length were measured. There was no statistically significant difference between the 2 groups in C2-C7 sagittal alignment and range of motion. However, the JOA score at 1-year follow-up and recovery rate in elderly group were significantly lower than in young group (P < 0.001). SCR and ISI length were significantly greater in elderly group than in young group, whereas their changes were significantly lower in elderly group (P < 0.05). Multivariate logistic regression analysis showed that an older age, a lower preoperative JOA score, a greater preoperative SCR, and a longer preoperative ISI length at 1-year follow-up were negatively correlated with the clinical outcomes in the elderly group (P < 0.05). Compared with young patients with ISI, the elderly patients had a lower preoperative JOA score, a greater preoperative SCR, and a longer preoperative ISI length, indicating poor surgical outcomes.

National Trends in Demographics and Outcomes Following Cervical Fusion for Cervical Spondylotic Myelopathy.

Study Design:Retrospective trends analysis.Objectives:Cervical fusion is a common adjunctive surgical modality used in the treatment of cervical spondylotic myelopathy (CSM). The purpose of this study was to quantify national trends in patient demographics, hospital characteristics, and outcomes in the surgical management of CSM.Methods:This was a retrospective study that used the National Inpatient Sample. The sample included all patients over 18 years of age with a diagnosis of CSM who underwent cervical fusion from 2003 to 2013. The outcome measures were in-hospital mortality, length of stay, and hospital charges. Chi-square tests were performed to compare categorical variables. Independent t tests were performed to compare continuous variables.Results:We identified 62 970 patients with CSM who underwent cervical fusion from 2003 to 2013. The number of fusions performed per year in the treatment of CSM increased from 3879 to 8181. The average age of all fusion patients increased from 58.2 to 60.6 years (P < .001). Length of stay did not change significantly from a mean of 3.7 days. In-hospital mortality decreased from 0.6% to 0.3% (P < .01). Hospital charges increased from $49 445 to $92 040 (P < .001).Conclusions:This study showed a dramatic increase in cervical fusions to treat CSM from 2003 to 2013 concomitant with increasing age of the patient population. Despite increases in average age and number of comorbidities, length of stay remained constant and a decrease in mortality was seen across the study period. However, hospital charges increased dramatically.

Cervical Paraspinal Muscle Atrophy Rates Following Laminoplasty and Laminectomy with Fusion for Cervical Spondylotic Myelopathy.

Cervical spondylotic myelopathy (CSM) is a disorder that can cause neurologic deterioration. Studies on paraspinal muscular atrophy (PMA) in the lumbar spine have shown that these changes are caused by several perioperative factors. It is possible that PMA in the cervical spine could behave similarly. In this retrospective study, we compared the degree of PMA after laminoplasty versus laminectomy and fusion (LF) using a standard posterior approach to the cervical spine. 18 laminoplasty and 43 LF patients were included in this study. For each patient, preoperative and postoperative MRI files were obtained and transferred into OsiriX imaging software. Atrophy rate was obtained and reported as percentage change in cross-sectional area of the cervical paraspinal muscles from preoperative to postoperative imaging. Mean cross-sectional cervical muscle atrophy rates were 6% and 13.1% for laminoplasty and LF, respectively, representing a 2.19 times increase in the degree of atrophy (P < 0.001). Independently, LF was associated with a 5.84% increase in the rate of PMA (P= 0.03). Involvement of C3 as the cephalad surgical level was associated with a 5.78% decrease in the rate of PMA (P= 0.03). For each degree increase in postoperative Cobb angle, there was a 0.66% decrease in the rate of PMA (P= 0.02). PMA should be part of the decision making process when a posterior approach is considered, inasmuch as this study demonstrates that cervical laminoplasty was associated with significantly lower rates of PMA compared with cervical laminectomy and fusion. Additionally, these results suggest that minimizing PMA may help preserve cervical lordosis.

Regression of Anterior Disk-Osteophyte Complex Following Cervical Laminectomy and Fusion for Cervical Spondylotic Myelopathy.

A retrospective case-control study. To investigate whether posterior cervical laminectomy and fusion modifies the natural course of anterior disk-osteophyte complex in patients with multilevel cervical spondylotic myelopathy. Dorsal migration of the spinal cord is the main purported mechanism of spinal cord decompression following cervical laminectomy and fusion but other potential mechanisms have received scant attention in the literature. This study was conducted to investigate whether cervical laminectomy and fusion affects the size of anterior disk-osteophyte complex. The medical records and radiographic imaging of 44 patients who underwent cervical laminectomy and fusion for cervical spondylotic myelopathy between 2006 and 2013 were analyzed. The size of the anterior disk-osteophyte complex was measured preoperatively and postoperatively on MR images taken at an interval of >3 months apart. A control group consisted of 20 nonoperatively treated advanced cervical spondylosis patients. Patients in the control met the same inclusion and exclusion criteria and also had sequential magnetic resonance imaging (MRI) taken at an interval of >3 months apart. The nonoperative and operative groups were statistically similar in the pertinent patient demographics and characteristics including sex, age, time to second MRI, size of anterior disk-osteophyte complex on baseline MRI, mean number of levels affected, and percentage of patients with T2 signal change. As expected the mJOA scores were significantly lower in the operative versus nonoperative cohort (13.6 vs. 16.5, P<0.01). A significant decrease in the size of anterior disk osteophyte was observed in the operative group postoperatively (P<0.01). In comparison, there was no statistically significant change in the size of the anterior disk-osteophyte complex in the control group (P>0.05). The magnitude of the change in disk size between the 2 groups was statistically significant (P<0.01). The findings of this study suggest that regression of anterior disk-osteophyte complex occurs following cervical laminectomy and fusion, and likely provides another mechanism of spinal cord decompression.

Regression of Disc-Osteophyte Complexes Following Laminoplasty Versus Laminectomy with Fusion for Cervical Spondylotic Myelopathy.

Laminectomy with fusion (LF) and laminoplasty are two posterior-based surgical approaches for the surgical treatment of cervical spondylotic myelopathy (CSM). The decompressive effect of these approaches is thought to be primarily related to the dorsal drift of the spinal cord away from ventral compressive structures. A lesser known mechanism of spinal cord decompression following cervical LF is regression of the ventral disc osteophyte complexes which is postulated to result from the alteration of motion across the fused motion segment. The goal of this study was to determine whether regression of the ventral disc-osteophyte complexes occur following laminoplasty and compare the magnitude of this occurrence to cervical laminectomy and fusion. Seventy patients with CSM who underwent pre- and postoperative magnetic resonance imaging (MRI) and were treated with either laminoplasty or LF. The size of the disc-osteophyte complex at all operative levels were measured on pre- and postoperative MRI using digital calipers. The laminoplasty group consisted of 25 patients with an average age of 54.9 and a mean of 3.24 surgical levels while the LF group consisted of 45 patients with an average age of 65.4 and a mean of 3.44 surgical levels (age, p < 0.0001; levels, p= 0.46). The average time interval between pre- and post-operative MRI was 16.2 and 15.6 months in the laminoplasty and LF groups, respectively (p = 0.91). The average time interval between surgery and post-operative MRI was 10.1 and 10.7 months in the laminoplasty and LF groups, respectively (p = 0.86). When comparing pre- and post-operative MRI, there was a 9.59% decrease in disc-osteophyte complex size from 3.84mm ± 0.74 to 3.47mm ± 0.86 in the laminoplasty group compared to a 35.4% decrease in disc-osteophyte complex size from 4.60mm ± 1.06 to 2.98mm ± 1.33 in LF group (laminoplasty, p < 0.0001; LF, p = 0.0067). Using logistic regression analysis, LF, increased time interval between surgery and post-operative MRI, high cobb angle, and straight sagittal alignment were all independently associated with increased disc-osteophyte complex regression (p < 0.05). No differences in functional outcomes (as defined by mJOA scores) was found between the two surgical techniques. In patients with CSM that had a posterior surgical approach, LF is associated with a larger interval regression in disc-osteophyte complex size compared to laminoplasty. This is likely related to the loss of motion of the cervical spine after surgery as governed by Wolff's law and the Heuter-Volkmann's principle. Although the decompressive effect of LF and laminoplasty is primarily related to the dorsal drift of the spinal cord away from ventral compressive structures, disc-osteophyte complex regression likely provides another mechanism of spinal cord decompression.

Four-level anterior cervical discectomy and fusion for cervical spondylotic myelopathy.

To review the outcome of 32 consecutive patients who underwent 4-level anterior cervical discectomy and fusion (ACDF) with cages and plates and were followed up for at least 5 years. Records of 19 men and 13 women aged 48 to 69 years who underwent 4-level ACDF with cages and plates for myelopathy (n=11) or myeloradiculopathy (n=21) at C3 to C7 by a single surgeon and were followed up for a minimum of 5 years were reviewed. Clinical outcome was assessed using the visual analogue scale (VAS), Neck Disability Index (NDI), and modified Japanese Orthopaedic Association (JOA) score for pain or myelopathic symptoms. Radiographic evaluation included fusion rate, range of motion, cervical lordosis (C2-to-C7 Cobb angle), and disc height. The mean follow-up was 66 months. All patients had good recovery of muscle strength and resolution of limb sensory disturbance, except for 4 who still had some numbness. The mean VAS for neck and arm pain improved from 14.2 to 6.84 (p=0.012); the mean NDI improved from 31.62 to 12.17 (p<0.01); and the mean JOA score improved from 10.1 to 13.9 (p=0.027). The mean percentage of recovery was 62.9. The mean Cobb angle improved from 10.24º to 1.28º (p=0.019); the mean disc height improved from 4.12 to 6.58 mm (p<0.01). 30 (94%) patients achieved solid fusion. Multilevel ACDF using PEEK cages and plates is safe and effective for multilevel cervical spondylotic myelopathy and achieves satisfactory mid-term outcome.

頚椎症性脊髄症に対する前方除圧固定術の治療成績

頚椎症性脊髄症に対して行われた前方除圧固定術の治療成績を, 固定方法, 固定椎間数について検討した. 対象は, 術後1年以上が経過し, 現在も経過観察できている330例である. 頚椎症治療判定基準 (Japanese Orthopaedics Association score), C2-7 Cobb angle, C2-7 sagittal vertical axis, 椎間高 (inter-vertebral space) を術前後で評価した.

118 Propensity Matched Analysis of Outcomes and Hospital Charges for Anterior vs Posterior Cervical Fusion for Cervical Spondylotic Myelopathy

118 Propensity Matched Analysis of Outcomes and Hospital Charges for Anterior vs Posterior Cervical Fusion for Cervical Spondylotic Myelopathy

Lamifuse: results of a randomized controlled trial comparing laminectomy with and without fusion for cervical spondylotic myelopathy.

Cervical spondylotic myelopathy (CSM) is often encountered in daily practice. In this randomized controlled trial, laminectomy without fusion is compared with laminectomy followed by fusion. Patients with clinical signs and symptoms of CSM were included. At regular follow-up moments a Modified Japanese Orthopedic Association (mJOA) Score, a Short Form (36) (SF-36) and upright cervical radiographs to measure the angle between C2 and C7, were obtained. Nine patients were included in each group (total 18 patients). At the last follow-up, a difference in mJOA or SF-36 could not be established. However, it was clearly shown that a more successful outcome, as measured by mJOA and SF-36, was obtained in patients who had fewer complaints preoperatively. A difference in clinical outcome or quality of life between the groups did not exist. It was clearly shown that the outcome of the patients was strongly dependent on the preoperative clinical situation.

Clinical Outcome after Laminectomy without Fusion for Cervical Spondylotic Myelopathy

Dorsal decompression in patients, presenting with cervical spondylotic myelopathy with no signs of instability, is a standard surgical option. Laminectomy or laminoplasty is applied to reduce the pressure on the myelon. The aim of this study was to evaluate the clinical outcome in a consecutive series of patients. This retrospective study included a total of 65 patients who underwent laminectomy or laminoplasty at a single or more levels, without fusion for cervical spondylotic myelopathy, during an 8-year period (2000-2007). The clinical data evaluation included pre- and postoperative patient history and neurological and surgical variables. The radiological assessment included MRI, CT, and plain anterior-posterior, lateral, and lateral flexion-extension X-rays. The mean follow-up time was 15 months. Improvement of gait disturbance was documented in 74% of the patients concerned. Radicular pain in the upper limbs (UL) and lower limbs (LL) improved in 87% and 50% of the patients, respectively. Sensory deficits improved in the UL and LL in 76% and 54%, respectively. Motor deficits improved in the UL and LL in 70% and 56% of the patients, respectively. Clinical deterioration after surgery was documented in one patient. Based on our results, laminectomy without fusion can be advocated as a safe and effective surgical strategy to treat cervical spondylotic myelopathy in patients without preoperative instability. In these patients, the occurrence of post-procedural clinical deterioration and instability was low, and overall improvement of neurological deficits and amelioration of radicular pain can be expected in a significant number of patients.

Clinical results of cervical laminectomy and fusion for the treatment of cervical spondylotic myelopathy in 58 consecutive patients.

Background:There are a number of surgical treatment options for cervical spondylotic myelopathy (CSM). In this study, the authors present their clinical results with cervical laminectomy and fusion for the treatment of patients with CSM.Methods:This retrospective study included 58 consecutive patients who underwent cervical laminectomy and fusion for CSM. There were 38 males and 20 females, with a mean age of 64 (range 42-92) years. The Japanese orthopedic association score (mJOA) scale was used as the functional outcome measurement. Both the absolute increase in mJOA and the neurological recovery rate of mJOA were analyzed. The mean clinical follow-up was 17 months (range 5-52 months).Results:There was a statistically significant improvement between mean preoperative (13.2, range 7-17) and postoperative (16.1, range 11-18) mJOA scores following surgery. The average improvement in mJOA score was 2.9 points. The mean neurological recovery rate was 56.6%. Overall 85.5% of patients improved with surgery (n = 51) and the remaining 14.5% of patients had no change in their mJOA score after surgery (n = 7). Fusion was documented in all 58 patients. There was a 10.3% overall complication rate (n = 6). The most common complications were C5 nerve palsies which occurred in 6.9% of the cohort (n = 4); all completely resolved.Conclusion:Cervical laminectomy and fusion is a safe and efficacious procedure for the treatment of CSM. The clinical outcomes appear to be quite reproducible, and this technique is an important part of a spine surgeon's armamentarium.

Alternative Procedures for the Treatment of Cervical Spondylotic Myelopathy

In Brief Study Design. Systematic review. Objective. To perform an evidence synthesis of the literature assessing the efficacy of arthroplasty, oblique corpectomy without fusion, and skip laminectomy to treat symptomatic cervical spondylotic myelopathy (CSM). Summary of Background Data. Traditionally, patients with symptomatic cervical spinal cord compression due to degenerative disease have been treated with anterior or posterior approaches or both. Recent reports suggest that there are several nontraditional management strategies that merit attention. The anterior procedures include decompression and anterior reconstruction with an artificial disc and oblique corpectomy without fusion. A posterior option is decompression, using the skip laminectomy technique. Methods. We conducted a systematic search in MEDLINE and the Cochrane Collaboration Library for literature published through October 15, 2012, on human studies published in the English language containing abstracts to answer the following key questions: (1) Is there evidence that artificial disc replacement after neural decompression results in equal or improved outcomes compared with anterior cervical decompression and fusion for CSM? (2) Describe the outcomes of oblique corpectomy without fusion for CSM? (3) Is there evidence that skip laminectomy results in equal or improved outcomes compared with laminoplasty for CSM? Results. The initial literature search yielded 141 unique, potentially relevant citations, which were evaluated against the inclusion/exclusion criteria set a priori. A total of 10 studies were selected for inclusion. For question 1, 2 studies suggested that neurological outcomes favored artificial disc replacement compared with anterior cervical decompression and fusion, whereas functional and pain outcomes were inconsistently reported. For question 2, 5 reported case series suggested favorable neurological, functional, and pain outcomes associated with oblique corpectomy in subjects with CSM, compared with the pretreatment condition. For question 3, 3 studies comparing laminoplasty with skip laminectomy suggested similar neurological outcomes between treatment groups, although functional and pain outcomes were inconsistently reported. Conclusion. A paucity of high-quality literature exists regarding treatment outcomes associated with arthroplasty, oblique corpectomy without fusion, and skip laminectomy for symptomatic CSM. Comparative prospective studies with long-term follow-up and standardized outcome measures are needed to assess treatment outcomes associated with these alternative techniques appropriately. Evidence-Based Clinical Recommendations. Recommendation 1. No recommendation can be made from comparative literature regarding treatment outcomes comparing ADR with ACDF for CSM. Overall Strength of Evidence. Insufficient Strength of Recommendation. Strong Recommendation 2. No recommendation can be made from comparative literature regarding treatment outcomes comparing laminoplasty with skip laminectomy for CSM. Overall Strength of Evidence. Low Strength of Recommendation. Strong Summary Statements. Oblique corpectomy is an option in selected cases of CSM. It should not be considered a first-line treatment strategy because of the relatively high morbidity associated with this procedure. A systematic review of the literature was performed to assess the efficacy of arthroplasty, oblique corpectomy without fusion, and skip laminectomy for cervical spondylotic myelopathy. The authors found a relative lack of high-quality data comparing these so-called “alternative” techniques with standard surgical decompression with or without fusion.

Single- and multi-level anterior decompression and fusion for cervical spondylotic myelopathy – A long term follow-up with a minimum of 5 years

ObjectiveCervical spondylotic myelopathy (CSM) is a common disease leading to significant neurological disability. We compared patients suffering from a single- and a multi-level pathology to analyze the influence of the natural course of the disease on the long-term outcome after surgery. MethodsWe analyzed the records of 52 patients with CSM after surgery. The neurological status of the patients was assessed by the modified Japanese Orthopaedic Association Scale (mJOAS). X-rays were conducted before and after surgery. Results52 patients were treated by a single-level (n=27) or a multi-level approach (n=25) more than 5 years ago. A significant improvement of the neurological status could be seen even 5 years or more after surgery in both groups without differences. After one year no further improvement could be observed. In the single-level group a trend to a subsequent loss of lordotic correction could be seen. Anterior plates were only used in the multi-level group. ConclusionThe anterior approach is an effective procedure to improve the symptoms of a CSM for many years. The risk of a multi-level pathology does not appear to exceed the risks of a single-level pathology concerning clinical long-term outcome after surgery. The clinical success is not hindered by a loss of correction in this specific setting.

Long Term Results of Anterior Corpectomy and Fusion for Cervical Spondylotic Myelopathy

BackgroundResults showed good clinical outcomes of anterior corpectomy and fusion (ACCF) for patients with cervical spondylotic myelopathy (CSM) during a short term follow-up; however, studies assessing long term results are relatively scarce. In this study we intended to assess the long term clinical and radiographic outcomes, find out the factors that may affect the long term clinical outcome and evaluate the incidence of adjacent segment disease (ASD).MethodsThis is a retrospective study of 145 consecutive CSM patients on ACCF treatment with a minimum follow-up of 5 years. Clinical data were collected from medical and operative records. Patients were evaluated by using the Japanese Orthopedic Association (JOA) scoring system preoperatively and during the follow-up. X-rays results of cervical spine were obtained from all patients. Correlations between the long term clinical outcome and various factors were also analyzed.FindingsNinety-three males and fifty-two females completed the follow-up. The mean age at operation was 51.0 years, and the mean follow-up period was 102.1 months. Both postoperative sagittal segmental alignment (SSA) and the sagittal alignment of the whole cervical spine (SACS) increased significantly in terms of cervical lordosis. The mean increase of JOA was 3.8±1.3 postoperatively, and the overall recovery rate was 62.5%. Logistic regression analysis showed that preoperative duration of symptoms >12 months, high-intensity signal in spinal cord and preoperative JOA score ≤9 were important predictors of the fair recovery rate (≤50%). Repeated surgery due to ASD was performed in 7 (4.8%) cases.ConclusionsACCF with anterior plate fixation is a reliable and effective method for treating CSM in terms of JOA score and the recovery rate. The correction of cervical alignment and the repeated surgery rate for ASD are also considered to be satisfactory.

Cervical Spondylotic Myelopathy Treated with Multilevel Oblique Corpectomy. A Review of 29 Cases.

Study Design: We reviewed our surgical experience and results in 29 patients operated upon by multiple oblique corpectomy without fusion for cervical spondylotic myelopathy. Objective: To review the safety, efficacy and surgical experience of multiple oblique corpectomy in carefully selected 29 patients, through anterolateral corridor to thecervical spine without the need for vertebral fusion or stabilization. Methods: Between March 2007 and April 2011, 29 patients have been treated with multiple oblique corpectomy technique for cervical spondylotic myelopathy.The functional status was assessed using the modified Japanese Orthopedic Association Score preoperatively and at 1,6,12 months postoperatively. Radiological Assessment was done preoperatively with MRI, CT scan and plain radiograph, and postoperatively on the following 1,6,12 months after surgery and routinely prior to discharge. Results: Among the 29 patients (19 males and 10 females) with a mean preoperative duration of symptoms for of 11.7 months. Satisfactory significant recovery occurred in 20 patients, 5 patients had no clinical improvement and 4 patients had variable degrees of clinical deterioration. Only one patient showed an evidence of spinal instability postoperatively. Conclusion: The multiple oblique corpectomy is a safe and effective technique in removal of the anterior compressing spurs to the spinal cord. No fusion is required regardless the number of the levels. The short recovery period, few complications rate with satisfactory significant outcome make this technique a better surgical option for cervical spondylotic myelopathy in selected patients.(2012ESJ003)

A case of treatment of retro-odontoid pseudotumor after en-bloc open-door laminoplasty and anterior fusion for cervical spondylotic myelopathy

A case of treatment of retro-odontoid pseudotumor after en-bloc open-door laminoplasty and anterior fusion for cervical spondylotic myelopathy