Procedure For Cervical Spondylotic Myelopathy Research Articles

Comparison of Postoperative Complications and Outcomes in Anterior Cervical Spine Surgery: Ossification of the Posterior Longitudinal Ligament Versus Cervical Spondylotic Myelopathy.

Retrospective cohort study. To compare the frequency of complications and outcomes between patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine and those with cervical spondylotic myelopathy (CSM) who underwent anterior surgery. Anterior cervical spine surgery for OPLL is an effective surgical procedure; however, it is complex and technically demanding compared with the procedure for CSM. Few reports have compared postoperative complications and clinical outcomes after anterior surgeries between the 2 pathologies. Among 1434 patients who underwent anterior cervical spine surgery at 3 spine centers within the same spine research group from January 2011 to March 2021, 333 patients with OPLL and 488 patients with CSM were retrospectively evaluated. Demographics, postoperative complications, and outcomes were reviewed by analyzing medical records. In-hospital and postdischarge postoperative complications were investigated. Postoperative outcomes were evaluated 1 year after the surgery using the Japanese Orthopaedic Association score. Patients with OPLL had more comorbid diabetes mellitus preoperatively than patients with CSM ( P <0.001). Anterior cervical corpectomies were more often performed in patients with OPLL than in those with CSM (73.3% and 14.5%). In-hospital complications, such as reoperation, cerebrospinal fluid leak, C5 palsy, graft complications, hoarseness, and upper airway complications, occurred significantly more often in patients with OPLL. Complications after discharge, such as complications of the graft bone/cage and hoarseness, were significantly more common in patients with OPLL. The recovery rate of the Japanese Orthopaedic Association score 1 year postoperatively was similar between patients with OPLL and those with CSM. The present study demonstrated that complications, both in-hospital and after discharge following anterior spine surgery, occurred more frequently in patients with OPLL than in those with CSM.

Relationship between cervical curvature and spinal cord drift distance after laminectomy via lateral mass screw fixation and its effect on clinical efficacy.

Background:Laminectomy with lateral mass screw fixation (LCS) is considered an effective surgical procedure for cervical spondylotic myelopathy. However, varying degrees of loss of the cervical curvature were noted in some patients postoperatively. The aim of this study was to observe the relationship between cervical curvature and spinal drift distance after LCS and to determine its effect on neurological function, axial symptoms, and C5 palsy.Methods:A total of 117 consecutive cervical spondylotic myelopathy patients with normal cervical curvature underwent LCS from April 2015 to May 2017 in our institution. Of these patients, 90 patients who accepted to undergo an integrated follow-up were enrolled in this study. The patients were divided into 3 groups based on their postoperative cervical curvature. In group A (28 patients), the cervical curvature became straight postoperatively (0°≤cervical spine angle≤5°); in group B (36 patients), the cervical curvature decreased (5°<cervical spine angle≤16.5°); and in group C (26 patients), the cervical curvature remained normal (cervical spine angle>16.5°). Spinal drift distance, neurological recovery, axial symptoms, and C5 palsy in the patients were recorded and analyzed.Results:Postoperative measurements showed that there was no significant difference in laminectomy width between the groups (P > .05). The cervical spine angle was 2.7° ± 0.5° in group A, 11.2° ± 2.6° in group B, and 20.8° ± 4.1° in group C (P < .05), while the spinal drift distance was 1.2 ± 0.2 mm, 1.8 ± 0.4 mm, and 3.0 ± 0.5 mm, respectively (P < .05). The postoperative Japanese Orthopedic Association score was significantly increased in all groups (P < .05), and there was no significant difference between the groups at different time points (P > .05). However, significant differences were noted between the groups in axial symptoms (P < .05), which were analyzed via the visual analog scale score. The occurrence of C5 palsy in groups A, B, and C was 7.1% (2/28), 8.3% (3/36), and 11.5% (3/26), respectively (P > .05).Conclusion:In LCS, the cervical curvature should be maintained at the normal angle to obtain a good spinal cord drift distance and a lower incidence of axial symptoms.

P43. Magnetic resonance imaging is inadequate to assess cervical sagittal alignment parameters

<h3>BACKGROUND CONTEXT</h3> Cervical sagittal alignment (CSA) parameters are helpful in determining the surgical technique used to treat cervical spondylotic myelopathy. Upright lateral radiographs are routinely used to measure CSA parameters, but obtaining adequate imaging is difficult. Utilizing magnetic resonance imaging (MRI) to evaluate sagittal parameters has been explored; however, the impact of positional changes on these parameters has not been elucidated. <h3>PURPOSE</h3> To evaluate CSA parameter measurement reliability and correlation between XR and MRI modalities in patients undergoing posterior decompressive procedures for cervical spondylotic myelopathy. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> We evaluated adult patients who had undergone laminoplasty or laminectomy and fusion for cervical spondylotic myelopathy between 2017 and 2019 and who had cervical spine XR and MRI within a 6-month timespan of one another. <h3>OUTCOME MEASURES</h3> Outcomes of interest included intra- and interobserver reliability assessment of C2-C7 sagittal angle, C2-C7 sagittal vertical axis (SVA), and T1 tilt measurements as well as correlations in these parameters between imaging modalities. <h3>METHODS</h3> Two clinicians completed two independent rounds of C2-C7 sagittal angle, C2-C7 sagittal vertical axis (SVA), and T1 tilt measurements; intra- and interobserver reliability were assessed by intraclass correlation coefficient (ICC). Correlations between imaging modalities were analyzed using parametric and nonparametric statistical tests. <h3>RESULTS</h3> Intra- and interobserver reliabilities were highly correlated with correlations greater than 0.85 across all permutations; ICCs were highest with MRI measurements. The C2-C7 sagittal angle was highly correlated between XR and MRI at 0.76 with no significant difference (p = 0.46). Weaker correlations existed for C2-C7 SVA (0.48) and T1 tilt (0.62) measurements with significant differences observed in the mean values between the two imaging modalities (p < 0.01). <h3>CONCLUSIONS</h3> The C2-C7 sagittal angle is highly correlated and not significantly different between upright XR and supine MR images. However, cervical SVA and T1 tilt change with patient position. As MRI does not accurately reflect the CSA in the upright position, upright lateral radiographs should be obtained to assess global sagittal alignment when planning posterior based cervical fusions. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Laminoplasty—an underutilized procedure for cervical spondylotic myelopathy

Cervical laminoplasty (LP) and laminectomy and fusion (LF) are commonly used surgical techniques for cervical spondylotic myelopathy (CSM). Several recent studies have demonstrated superior perioperative metrics and decreased overall costs with LP, yet LF is performed far more often in the United States. To determine the percentage of patients with CSM who are radiographically candidates for LP. Retrospective comparative cohort study. Patients >18 years old who underwent LF or LP for CSM at 2 large academic institutions from 2017 to 2019. Candidacy for LP based on radiographic criteria. Radiographs were assessed by 2 spine surgeons not involved in the care of the patients to determine the C2-C7 Cobb angle and the presence and extent of cervical instability. Patients with kyphosis >13°, > 3.5 mm of listhesis on static imaging, or > 2.5 mm of motion on flexion-extension or standing-supine films were not considered candidates for LP. Intraclass coefficient (ICC) was calculated to assess the interobserver reliability of angular measurements and the presence of instability. The percentage of patients for whom LP was contraindicated was calculated. One hundred eight patients underwent LF while 142 underwent LP. Of the 108 patients who underwent LF, 79.6% were radiographically deemed candidates for LP, as were all 142 patients who underwent LP. The ICC for C2-C7 alignment was 0.90; there was 97% agreement with respect to the presence of instability. In 250 patients with CSM, 228 (91.2%) were radiographically candidates for LP. These data suggest that LP may be an underutilized procedure for the treatment for CSM.

Cervical laminoplasty: indication, technique, complications.

Cervical laminoplasty is a non-fusion, decompression procedure for cervical spondylotic myelopathy (CSM). It is most commonly indicated for patients with multilevel stenosis who have preserved sagittal alignment and minimal to no axial neck pain related to spondylosis. Expansion of the laminar arch can allow for direct and indirect decompression of the spinal canal. Relative contraindications include those patients with significant preoperative neck pain, kyphotic alignment and substantial instability. Potential advantages over laminectomy and fusion include avoiding fusion-related complications, and the preservation of motion. Important technical considerations include meticulous extensor muscle management, with special attention being given to preserving the soft tissue attachments to C2. In the properly selected patient, outcomes are comparable, and in some studies superior, to other operations for CSM.

Evaluating Single-Surgeon Bias Toward Recommending Corrective Procedures for Cervical Spondylotic Myelopathy Based on Demographic Factors and Comorbidities in a 484-Patient Cohort.

Study Design:Retrospective case series.Objectives:An increasing focus has been placed on removing implicit (unconscious) bias from the surgical selection process. In spine surgery, there is the potential for implicit bias to affect the decision to either operate on a patient or not, given lack of definitive surgical indications for many elective procedures. The objective of this study was to analyze the surgical decision making of a single spine surgeon in an effort to understand surgical decision-making trends based on certain demographic factors.Methods:This was a retrospective study of 484 patients who had undergone a corrective procedure for cervical myelopathy by an orthopedic spine surgeon at our institution. The preoperative modified Japanese Orthopaedic Association score served as the metric of severity of disease for cervical myelopathy. The factors that have been associated with implicit bias that were evaluated were smoking status, narcotic use status, gender, body mass index, and age.Results:Multivariate linear regression analysis showed that even after controlling for comorbidities and confounders, the only variable which predicted likelihood to operate on a patient of a milder symptomology was age (odds ratio [OR] = −0.138; (confidence interval [CI] = −0.034 to −0.006). The other factors (smoking status, narcotic use status, gender, and body mass index) were not associated with surgical decision making.Conclusions:Our study demonstrates absence of association between commonly studied areas of implicit bias and the decision to operate on a patient with milder symptomology at initial presentation of cervical spondylotic myelopathy.

Cervical spondylotic myelopathy: the relevance of the spinal cord back shift after posterior multilevel decompression. A systematic review.

Spinal cord back shift has been considered the desired end point of posterior decompression procedures for cervical spondylotic myelopathy (CSM). However, the association with postoperative outcomes has not been definitively demonstrated. The aim of this review is to obtain an overview of the current knowledge on the spinal back shift after posterior decompression to clarify the main controversial aspects and provide recommendations for further studies on the subject. A comprehensive quantitative review of the literature was performed. Bibliographic databases were searched using the following keywords: spinal cord drift, spinal cord shift, CSM, ossification of posterior longitudinal ligament, posterior decompression, laminoplasty, laminectomy and fusion. Twelve eligible studies were included. The authors measured the spinal cord back shift in different ways, using the posterior edge, the center or the anterior margin of the spinal cord as reference points. Six studies analyzed the correlation between the spinal cord back shift and the recovery rate, but their results were discordant. The correlation between the posterior cord migration and cervical alignment was not confirmed in all studies. There is a need for a consensus on the best way to measure the spinal cord back shift. The action of multiple factors on spinal cord back shift can explain the difference in the results collected from the studies. We recommend further studies to clarify the behavior of the spinal cord after posterior decompression and its clinical meaning.

Benefit of degenerative posterior longitudinal ligament removal during anterior decompression in cervical spondylotic myelopathy.

It remains controversial whether degenerative posterior longitudinal ligaments should be removed during anterior decompression procedures for cervical spondylotic myelopathy. Few data are available from studies that have compared removing and retaining the degenerative posterior longitudinal ligament. The goal of this retrospective study was to evaluate the benefit of degenerative posterior longitudinal ligament removal during such operations. Clinical data on 130 patients with confirmed degenerative posterior longitudinal ligament who underwent anterior cervical decompression surgery were retrospectively reviewed. All procedures were performed by the same senior orthopedic surgeon at the authors' spinal surgery center. The degenerative posterior longitudinal ligament was removed in 62 patients (group A) and retained in 68 patients (group B). The 130 patients were followed for 36 months. The Japanese Orthopedic Association score improved from 9.0±2.7 to 14.7±1.5 in group A and from 9.4±2.6 to 14.1±1.7 in group B (P=.028). The recovery rate for spinal cord neurologic function was 66.7% in group A and 61.3% in group B (P=.031). Operating time was longer (P=.002) and the sagittal median diameter of the vertebral canal was enhanced in group A (P<.001). Narrowing of previously enlarged canals occurred at a significantly higher rate in group B (P=.044). No significant difference was found in the rates of common complications between groups. Removal of the degenerative posterior longitudinal ligament in anterior decompression procedures for cervical spondylotic myelopathy appeared to be beneficial and provided more complete decompression and better postoperative outcomes than surgery without removal of the ligament. Although this procedure was generally safe, it required longer operating times, was more technically challenging, and required more experienced surgeons than surgery without removal of the ligament.

Cervical degenerative disease: systematic review of economic analyses.

Systematic review. To perform an evidence-based synthesis of the literature assessing the cost-effectiveness of surgery for patients with symptomatic cervical degenerative disc disease (DDD). Cervical DDD is a common cause of clinical syndromes such as neck pain, cervical radiculopathy, and myelopathy. The appropriate surgical intervention(s) for a given problem is controversial, especially with regard to quality-of-life outcomes, complications, and costs. Although there have been many studies comparing outcomes and complications, relatively few have compared costs and, more importantly, cost-effectiveness of the interventions. We conducted a systematic search in PubMed/MEDLINE, EMBASE, the Cochrane Collaboration Library, the Cost-Effectiveness Analysis registry database, and the National Health Service Economic Evaluation Database for full economic evaluations published through January 16, 2014. Identification of full economic evaluations that were explicitly designed to evaluate and synthesize the costs and consequences of surgical procedures or surgical intervention with nonsurgical management in patients with cervical DDD were considered for inclusion, based on 4 key questions. Five studies were included, each specific to 1 or more of our focus questions. Two studies suggested that cervical disc replacement may be more cost-effective compared with anterior cervical discectomy and fusion. Two studies comparing anterior with posterior surgical procedures for cervical spondylotic myelopathy suggested that anterior surgery was more cost-effective than posterior surgery. One study suggested that posterior cervical foraminotomy had a greater net economic benefit than anterior cervical discectomy and fusion in a military population with unilateral cervical radiculopathy. No studies assessed the cost-effectiveness of surgical intervention compared with nonoperative treatment of cervical myelopathy or radiculopathy, although it is acknowledged that existing studies demonstrate the cost-effectiveness of surgical intervention for these 2 clinical entities. A paucity of high-quality economic literature exists regarding cost-effectiveness of surgical intervention for cervical DDD. Future research is necessary to validate the findings of the few studies that do exist to guide decisions for surgery by the physician and patient with respect to cost-effectiveness. 2.

Long-term follow-up results of the Cloward procedure for cervical spondylotic myelopathy

To assess the long-term results of anterior cervical discectomy and fusion using the Cloward procedure for the treatment of cervical spondylotic myelopathy, and to identify possible clinical outcome predictors. A total of 14 cases with a 10-year postoperative follow-up were available (82.4 % of the surviving patients). Patients underwent preoperative and postoperative neurological examination. The symptom severity was graded according to the Nurick scale. MRI measurements were obtained preoperatively. Cervical spine radiographs were obtained preoperatively and at the time of follow-up. The mean improvement of the clinical status of patients on the Nurick scale was 1.43 ± 0.51 (range 1-2) with respect to the baseline values (p < 0.001), with a 62.5 % recovery rate. A positive association between the improvement of the Nurick scale and the length of follow-up was detected with an age-adjusted univariate analysis (p = 0.042). The Nurick grade improvement was also directly related to preoperative lower limb hyperreflexia (p = 0.039), spasticity (p = 0.017), and bladder dysfunction (p = 0.048). At the time of follow-up, an adjacent discopathy was noted above and below the operated level(s) in eight and six patients, respectively. The Cloward technique is a safe and effective procedure for the treatment of cervical spondylotic myelopathy. The patients' preoperative neurological status and the length of follow-up affect the grade of postoperative ambulatory improvement.

A Segmental Partial Laminectomy for Cervical Spondylotic Myelopathy

A comparative study regarding the clinical outcome of the 2-different surgical procedures for patients with cervical spondylotic myelopathy (CSM). To describe the anatomic basis of a segmental partial laminectomy (SPL) for the treatment of cervical spondylotic myelopathy and to compare the clinical outcome with traditional C3 to C7 expansive open-door laminoplasty (ELAP). Laminoplasty has been widely accepted for the treatment of CSM. However, some disadvantages have also been recognized. To resolve these problems, a SPL was performed. No previous studies have been reported regarding this surgical procedure. A total of 13 human cadavers were studied to analyze the spinal cord compression of cervical spondylosis. Twenty-six patients who underwent a SPL and 13 age- and gender-matched patients who underwent traditional C3-C7 ELAP were analyzed for their Japanese Orthopedic Association score, axial neck pain, and radiographic parameters (lordotic angle and ROM of cervical spine). Based on cadaver studies, compression of the spinal cord was present in the articular segment, but not in the intraosseous segment. The removal of the ligamentum flavum and the superior edge of the lower lamina was sufficient for minimum posterior decompression of the cervical spinal cord.In comparison with the ELAP, the patients who underwent an SPL showed a similar recovery of the Japanese Orthopedic Association score, but the maintenance of the sagittal alignment and the range of motion were better after the SPL and postoperative neck and/or shoulder complaints also seemed to be reduced. A SPL, may therefore, be a useful and effective surgical procedure for cervical spondylotic myelopathy.

Intraoperative neurophysiologic monitoring: focus on cervical myelopathy and related issues

The use of neurophysiologic monitoring during surgical procedures for cervical spondylotic myelopathy (CSM) is controversial. The aim of this article is to review the literature regarding various monitoring techniques as applied to the patient with CSM. A systematic literature review. Neurophysiologic monitoring is a diagnostic tool for assessment of neurologic function during cervical spine surgery. Recording of somatosensory evoked potentials (SSEPs), transcranial electrical motor evoked potentials (tceMEPs), and electromyograms (EMGs) may be useful as these monitoring modalities provide complementary information.

Laminectomy and Posterior Cervical Plating for Multilevel Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament: Effects on Cervical Alignment, Spinal Cord Compression, and Neurological Outcome

Multilevel anterior decompressive procedures for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament may be associated with a high incidence of neurological morbidity, construct failure, and pseudoarthrosis. We theorized that laminectomy and stabilization of the cervical spine with lateral mass plates would obviate the disadvantages of anterior decompression, prevent the development of kyphotic deformity frequently seen after uninstrumented laminectomy, decompress the spinal cord, and produce neurological results equal or superior to those achieved by multilevel anterior procedures. We retrospectively reviewed the records of 38 patients who underwent laminectomy and lateral mass plating for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament between January 1994 and November 2001. Seventy-six percent of patients had spondylosis, 18% had ossification of the posterior longitudinal ligament, and 5% had both. Clinical presentation included upper extremity sensory complaints (89%), gait difficulty (70%), and hand use deterioration (67%). Spasticity was present in 83%, and weakness of one or more muscle groups was seen in 79%. Spinal cord signal abnormality on sagittal T2-weighted magnetic resonance imaging (MRI) was seen in 68%. Neurological evaluation was performed using a modification of the Japanese Orthopedic Association Scale for functional assessment of myelopathy, the Cooper Scale for separate evaluation of upper and lower extremity motor function, and a five-point scale for evaluation of strength in individual muscle groups. Lateral cervical spine x-rays were analyzed using a curvature index to determine maintenance of alignment. Each surgically decompressed level was graded on a four-point scale using axial MRI to assess the adequacy of decompression. Late follow-up was conducted by telephone interview. Laminectomy was performed at a mean 4.6 levels. Follow-up was obtained at a mean of 30.2 months after the procedure. The score on the modified Japanese Orthopedic Association scale improved in 97% of patients from a mean of 12.9 preoperatively to 15.58 postoperatively (P < 0.0001). In the upper extremities, function measured by the Cooper Scale improved from 1.8 to 0.7 (P < 0.0001), and in the lower extremities, function improved from 1.0 to 0.4 (P < 0.0002). There was a statistically significant improvement in strength in the triceps (P < 0.0001), iliopsoas (P < 0.0002), and hand intrinsic muscles (P < 0.0001). X-rays obtained at a mean of 5.9 months after surgery revealed no change in spinal alignment as measured by the curvature index. There was a decrease in the mean preoperative compression grade from 2.46 preoperatively to 0.16 postoperatively (P < 0.0001). There was no correlation between neurological outcome and the presence of spinal cord signal change on T2-weighted MRI scans, patient age, duration of symptoms, or preoperative medical comorbidity. Multilevel laminectomy and instrumentation with lateral mass plates is associated with minimal morbidity, provides excellent decompression of the spinal cord (as visualized on MRI), produces immediate stability of the cervical spine, prevents kyphotic deformity, and precludes further development of spondylosis at fused levels. Neurological outcome is equal or superior to multilevel anterior procedures and prevents spinal deformity associated with laminoplasty or noninstrumented laminectomy.

Laminectomy and Posterior Cervical Plating for Multilevel Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament: Effects on Cervical Alignment, Spinal Cord Compression, and Neurological Outcome

Abstract OBJECTIVE Multilevel anterior decompressive procedures for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament may be associated with a high incidence of neurological morbidity, construct failure, and pseudoarthrosis. We theorized that laminectomy and stabilization of the cervical spine with lateral mass plates would obviate the disadvantages of anterior decompression, prevent the development of kyphotic deformity frequently seen after uninstrumented laminectomy, decompress the spinal cord, and produce neurological results equal or superior to those achieved by multilevel anterior procedures. METHODS We retrospectively reviewed the records of 38 patients who underwent laminectomy and lateral mass plating for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament between January 1994 and November 2001. Seventy-six percent of patients had spondylosis, 18% had ossification of the posterior longitudinal ligament, and 5% had both. Clinical presentation included upper extremity sensory complaints (89%), gait difficulty (70%), and hand use deterioration (67%). Spasticity was present in 83%, and weakness of one or more muscle groups was seen in 79%. Spinal cord signal abnormality on sagittal T2-weighted magnetic resonance imaging (MRI) was seen in 68%. Neurological evaluation was performed using a modification of the Japanese Orthopedic Association Scale for functional assessment of myelopathy, the Cooper Scale for separate evaluation of upper and lower extremity motor function, and a five-point scale for evaluation of strength in individual muscle groups. Lateral cervical spine x-rays were analyzed using a curvature index to determine maintenance of alignment. Each surgically decompressed level was graded on a four-point scale using axial MRI to assess the adequacy of decompression. Late follow-up was conducted by telephone interview. RESULTS Laminectomy was performed at a mean 4.6 levels. Follow-up was obtained at a mean of 30.2 months after the procedure. The score on the modified Japanese Orthopedic Association scale improved in 97% of patients from a mean of 12.9 preoperatively to 15.58 postoperatively (P&amp;lt; 0.0001). In the upper extremities, function measured by the Cooper Scale improved from 1.8 to 0.7 (P&amp;lt; 0.0001), and in the lower extremities, function improved from 1.0 to 0.4 (P&amp;lt; 0.0002). There was a statistically significant improvement in strength in the triceps (P&amp;lt; 0.0001), iliopsoas (P&amp;lt; 0.0002), and hand intrinsic muscles (P&amp;lt; 0.0001). X-rays obtained at a mean of 5.9 months after surgery revealed no change in spinal alignment as measured by the curvature index. There was a decrease in the mean preoperative compression grade from 2.46 preoperatively to 0.16 postoperatively (P&amp;lt; 0.0001). There was no correlation between neurological outcome and the presence of spinal cord signal change on T2-weighted MRI scans, patient age, duration of symptoms, or preoperative medical comorbidity. CONCLUSION Multilevel laminectomy and instrumentation with lateral mass plates is associated with minimal morbidity, provides excellent decompression of the spinal cord (as visualized on MRI), produces immediate stability of the cervical spine, prevents kyphotic deformity, and precludes further development of spondylosis at fused levels. Neurological outcome is equal or superior to multilevel anterior procedures and prevents spinal deformity associated with laminoplasty or noninstrumented laminectomy.

Anterior Subaxial Decompression for Cervical Spondylotic Myelopathy

Decompression of the subaxial cervical spinal cord in the presence of a cervical kyphosis can be accomplished only by the strategy called multilevel corpectomy. Our experience with >200 such procedures for cervical spondylotic myelopathy indicates that the width of decompression should be limited, whereas the length should be liberal. The routine use of plating and exclusive use of autogenous bone grafts are not usually necessary for acceptable outcomes. Soft-tissue morbidity can be minimal by regular release of retractors, and orthosis in the otherwise stable neck need not be complex.

Surgical Decompressive Procedures for Cervical Spondylotic Myelopathy A Study Using Magnetic Resonance Imaging

Twenty-two patients who underwent a surgical decompressive procedure for cervical spondylotic myelopathy were studied with magnetic resonance imaging to evaluate the effectiveness of their decompressive procedures. Twelve patients were judged as adequately decompressed by magnetic resonance imaging criteria. Ten patients exhibited evidence of residual cord indentation. This along with cord atrophy, gliosis, and abnormal spine curvature presumably contributed to residual deficit in several patients. One patient underwent a second decompressive procedure for residual cord indentation, which subsequently improved, as seen on his second postoperative magnetic resonance image. Magnetic resonance imaging was useful in distinguishing mechanical problems from intrinsic cord damage or atrophy. Magnetic resonance imaging should be used after operation in patients with residual deficit to detect patients who may be considered for a second decompressive procedure.

Surgical Decompressiye Procedures for Cervical Spondylotic Myelopathy A Study Using Magnetic Resonance Imaging

Surgical Decompressiye Procedures for Cervical Spondylotic Myelopathy A Study Using Magnetic Resonance Imaging

Anterior cervical arthrodesis with heterolo graft and human fibrin glue in the surgical treatment of myelopathy due to spondylosis: Preliminary note

The use of fibrin glue to fix heterologous bone dowels in the recipient site in Cloward's procedure for cervical spondylotic myelopathy is described. The procedure ensures immediate and satisfactory spinal stability without need for any postoperative contention device. It has been successful in 18 patients with 26 intervertebral spaces operated upon, as demonstrated by early and late dynamic X-rays study.