Multilevel Cervical Myelopathy Research Articles

Long-Term Results Over 10 Years of Anterior Corpectomy and Fusion for Multilevel Cervical Myelopathy

Retrospective long-term outcome analysis over more than 10 years. To assess the long-term results of anterior corpectomy and fibular strut grafting over > or =4 disc levels for cervical myelopathy, and identify factors affecting the late deterioration in clinical outcome. Few studies have shown long-term results after anterior corpectomy and strut grafting. There is little detailed information about the long-term effects of multilevel anterior corpectomy and fusion for cervical myelopathy. A total of 31 cases were available for the 10-year follow-up after surgery (86% follow-up rate). Clinical results and radiographic measurements were obtained before surgery, 3 months after surgery, and at follow-up. There were 3 patients who had deterioration of the Japanese Orthopedic Association score of 1 point because of increasing hand numbness; 1 patient had adjacent disc degeneration, and 1 had pseudarthrosis without additional stenosis on magnetic resonance imaging. Adjacent disc degeneration did not affect the clinical results (P = 0.76). The long-term follow-up showed stable clinical results for more than 10 years, which depended on the thorough removal of the possible causes of the myelopathy, such as ossification of the posterior longitudinal ligament or a degenerated disc. Adjacent disc degeneration has minimal effects on the long-term clinical results after anterior long fusion.

Anterior decompression combined with corpectomies and discectomies in the management of multilevel cervical myelopathy: a hybrid decompression and fixation technique

The authors retrospectively evaluated the safety and efficacy of a decompression and fixation technique in the treatment of patients with multilevel cervical spondylotic myelopathy (CSM). The authors describe the "hybrid decompression fixation" technique, a procedure involving a combination of corpectomies and discectomies to preserve a vertebra intact within the area of the decompression, thus augmenting mechanical stability. The authors retrospectively reviewed outcomes in 25 patients with multilevel CSM in whom the hybrid technique was performed between 1999 and 2003. Twelve patients underwent a single-level corpectomy and three-level discectomies. In 13 patients a two-level corpectomy and adjacent four-level discectomies were conducted, leaving a vertebral bridge the middle. All patients underwent fusion involving placement of disc and vertebral body cages filled with autogenous local bone and supplemental anterior dynamic plate fixation. The mean preoperative Nurick grade was 3 and improvement in status was reflected by a postoperative decrease to 2.6 (p < 0.05). In one patient neurological deterioration was demonstrated. At the end of the follow-up period (mean 29 months) radiography revealed evidence of osseous fusion in 24 patients; fusion status could not be determined in one patient. No evidence of late-onset instrumentation-related failure was observed in any of the 25 patients. The authors found the hybrid technique to be safe and efficient for anterior decompression in patients with multilevel CSM. The use of this technique obviates the need for staged circumferential procedures.

Anterior corpectomy and fusion with fibular strut grafts for multilevel cervical myelopathy

The authors conducted a study to investigate the long-term results and postoperative complications of a new surgical technique, fibular strut graft-assisted anterior corpectomy and fusion for multilevel (> four) cervical myelopathy. Multilevel anterior corpectomy and subsequent strut graft placement is considered a challenging procedure because of complications relating to graft dislodgment, pseudarthrosis, greater operative duration, and increased blood loss. The study comprised 100 patients with cervical myelopathy who underwent anterior corpectomy and fusion and fibular strut graft placement at more than four disc space levels between 1989 and 1998. Single-screw fixation was used in conjunction with the autologous strut graft. Preoperative and postoperative plain radiographs, computerized tomography myelograms, and magnetic resonance images were obtained for assessment of fusion status. All complications and outcomes were analyzed based on clinical records to evaluate the results of the technique. There were no cases of graft dislodgment. The graft union rate was 85%. Analysis of clinical data showed that pseudarthrosis had no adverse effect on the clinical results. Adjacent-level disc degeneration occurred in 12% of patients, but in all cases the patients were asymptomatic. In 9% of cases C-5 palsy was observed but it recovered spontaneously. There were no infections and no case of neurological deterioration. With this new graft technique, graft dislodgment, the major complication associated with strut graft surgery, was resolved completely. This simple technique involving single-screw fixation provided good results when used in conjunction with anterior decompression and strut graft fixation with a very low incidence of complications.

P158. Results of open-door laminoplasty for cervical spondylotic myelopathy in a North American population

BACKGROUND CONTEXT: Cervical laminoplasty is an accepted technique for achieving canal expansion in patients with cervical spondylotic myelopathy. This technique has been studied extensively in certain patient populations, such as Asians and patients with ossification of the posterior longitudinal ligament. There are few reports, however, evaluating the results of cervical laminoplasty for multi-level cervical spondylosis and myelopathy in a North American population.

Hemilaminectomy with Contralateral Sublaminar for Decompression Multilevel Cervical Spondylotic Myelopathy

Objective: Cervical hemilaminectomy with contralateral sublaminar decompression for multilevel cervical myelopathy is reported with surgical results. Methods: A retrospective study was performed for 15 patients with multilevel cervical myelopathy who underwent cervical hemilaminectomy with contralateral sublaminar decompression at Cathay Medical Center in Taiwan between January 2001 and April 2003. All had undergone magnetic resonance imaging (MRI) scans preoperatively. All underwent MRI scans 6 months after the operation. The duration of follow-up ranged from 12 to 35 months (mean, 24 months). The radiological results were evaluated by the Pavlov ratio at the narrowest level. The clinical results were measured by the Nurick score. Results: The average duration of symptoms was 15 months (range, 6 months to 4 years). The mean operative levels are 4.6 (range, 3-5). The Nurick Functional Disability Score improved from 2.8 (range, 1-5) preoperatively to 1.8 (range 0-4) postoperatively. Improved muscle power of upper extremities was reported in 20%, and improvement in spastic gait, in 13%. Eleven patients (73%) showed improvement in symptoms of numbness and paresthesia. The average sagittal expansion improved from an average of 50% (range, 30-60%) to 70% (range, 55-80%). The average sagittal diameter improved from an average of 12.5 millimeters (range, 9.5-15 millimeters) to 15.5 millimeters (range, 14-19 millimeters). The mean increase in canal area at the narrowest level was 50% (range, 25-75%). Cervical hemilaminectomy with contralateral sublaminar decompression provided good surgical results in 60% of patients with minimal morbidities 3 months after the operation and 80% of patients at 12 months of follow-up or longer. Spinal stability was well maintained in all patients. Conclusions: Cervical hemilaminectomy with contralateral sublaminar decompression is a safe and effective procedure and can be performed in patients with multilevel cervical spondylotic myelopathy.

Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decompression and fusion with lateral mass plate fixation and local bone graft.

This is a retrospective review of 32 patients with multilevel cervical myelopathy treated by laminectomy and lateral mass plate fusion. The prognosis of surgically treated myelopathy is evaluated as well as prognostic factors for recovery of myelopathy. Diagnoses included cervical spondylosis or ossification of the posterior longitudinal ligament. Final follow-up was at 15.2 months (mean) postoperatively. Myelopathy was graded preoperatively and postoperatively by the system of Nurick. All patients had preoperative radiographs and magnetic resonance imaging (MRI). The presence of abnormal T2-weighted MRI signal (myelomalacia) was noted. Postoperative studies included flexion-extension radiographs to assess fusion and MRI to evaluate decompression of neural elements and resolution of myelomalacia. Severity of preoperative Nurick myelopathy, presence of myelomalacia, and age were evaluated as potential prognostic indicators for surgically treated myelopathy. Mean Nurick score improved from 2.6 (range 1-4) to 1.8 (range 0-3) postoperatively (p < 0.0001). Twenty-two patients (71%) had improvement in Nurick grade of at least one point, and nine showed no improvement. No patients had deterioration of Nurick grade. Preoperative myelomalacia was noted in 15 (47%) patients, and all 15 had residual myelomalacia postoperatively. Severe myelopathy, age, and myelomalacia had no prognostic value for improvement of myelopathy. Complications included pseudarthrosis (3%), wound infection (9%), and transient C5 palsy (6%). This study demonstrates excellent outcomes from laminectomy and fusion in multilevel cervical myelopathy. A high rate of improvement of myelopathy was observed, neurologic deterioration did not occur, and complication rates were low. Severe myelopathy and myelomalacia on preoperative MRI had no prognostic value.

Laminoplasty versus corpectomy for multi-level cervical myelopathy

Laminoplasty versus corpectomy for multi-level cervical myelopathy

Corpectomies versus laminoplasty for multilevel cervical myelopathy: an independent matched cohort analysis

Charles C. Edwards, II, MD, Atlanta, GA, USA; John Heller, MD, Hidecki Morikami, Decatur, GA, USAIntroduction: The treatment of choice for multilevel cervical myelopathy remains a matter of investigation. For the decompression of three or more motion segments, multilevel corpectomies and laminoplasty have proven effective while avoiding the pitfalls of laminectomy. Direct clinical comparisons of these two procedures are few in number and limited by the heterogeneity in their patient groups. The purpose of this study is to compare the clinical and radiographic outcomes of corpectomy and laminoplasty using an independent matched-cohort analysis.Methods: Medical records of all patients treated for multilevel cervical myelopathy with either corpectomy or laminoplasty between 1992 and 1999 at our institution were reviewed. Thirty-four corpectomy and 51 laminoplasty patients fulfilled stringent inclusion and exclusion criteria. From this pool of eligible patients, 13 patients who underwent corpectomy were blindly matched with 13 patients that underwent laminoplasty based on known prognostic criteria. A single physician independently evaluated each patient and their radiographs at their latest follow-up appointment.Results: The cohorts were well matched by age, duration of symptoms, severity of myelopathy (Nurick grade), canal stenosis and preoperative sagittal alignment (C2–C7). The mean operative time, blood loss and hospital stay were nearly identical. The mean follow-up for corpectomy and laminoplasty were 3.7 and 3.0 years, respectively. Laminoplasty patients showed greater neurologic improvement (Nurick score 1.5 versus 1.0). Subjective improvements in strength, dexterity, sensation, pain and gait were similar for the two operations. The prevalence of axial discomfort at latest follow-up was the same for each cohort, but the analgesic requirements were greater for patients who underwent corpectomy. Sagittal motion from C2 to C7 decreased by 57% after corpectomy and by 46% after laminoplasty. One complication (transient C5 palsy) occurred in the laminoplasty group. Corpectomy complications included progression of myelopathy (one), persistent dysphagia (four), persistent dysphonia (two), significant subjacent disc degeneration (two) and nonunion (one).Conclusion: Corpectomy and laminoplasty reliably arrest myelopathic progression in multilevel cervical myelopathy and can lead to significant neurologic recovery and pain reduction in a majority of patients. The laminoplasty cohort required less pain medication at final follow-up than did the corpectomy patients. Given this and the higher prevalence of complications among corpectomy patients, we believe that laminoplasty may be the preferred treatment for multilevel cervical myelopathy in the absence of preoperative kyphosis.

Cervical spine multilevel decompression/reconstruction with anterior/posterior internal fixation

Cervical spine multilevel decompression/reconstruction with anterior/posterior internal fixation

Laminoplasty Versus Laminectomy and Fusion for Multilevel Cervical Myelopathy

A matched cohort clinical and radiographic retrospective analysis of laminoplasty and laminectomy with fusion for the treatment of multilevel cervical myelopathy. To compare the clinical and radiographic outcomes of two procedures increasingly used to treat multilevel cervical myelopathy. Traditional methods of treating multilevel cervical myelopathy (laminectomy and corpectomy) are reported to have a notable frequency of complications. Laminoplasty and laminectomy with fusion have been advocated as superior procedures. A comparative study of these two techniques has not been reported. Medical records of all patients treated for multilevel cervical myelopathy with either laminoplasty or laminectomy with fusion between 1994 and 1999 at our institution were reviewed. Thirteen patients that underwent laminectomy with fusion were matched with 13 patients that underwent laminoplasty. All patients and radiographs were independently evaluated at latest follow-up by a single physician. Cohorts were well matched based on patient age, duration of symptoms, and severity of myelopathy (Nurick grade) before surgery. Mean independent follow-up was similar (25.5 and 26.2 months). Both objective improvement in patient function (Nurick score) and the number of patients reporting subjective improvement in strength, dexterity, sensation, pain, and gait tended to be greater in the laminoplasty cohort. Whereas no complications occurred in the laminoplasty cohort, there were 14 complications in 9 patients that underwent laminectomy with fusion patients. Complications included progression of myelopathy, nonunion, instrumentation failure, development of a significant kyphotic alignment, persistent bone graft harvest site pain, subjacent degeneration requiring reoperation, and deep infection. The marked difference in complications and functional improvement between these matched cohorts suggests that laminoplasty may be preferable to laminectomy with fusion as a posterior procedure for multilevel cervical myelopathy.