Treatment Of Cervical Stenosis Research Articles

Contemporary Practice Patterns in the Treatment of Cervical Stenosis and Central Cord Syndrome: A Survey of the Cervical Spine Research Society.

Cross-sectional study. To evaluate for areas of consensus and divergence of opinion within the spine community regarding the management of cervical spondylotic conditions and acute traumatic central cord syndrome (ATCCS) and the influence of the patient's age, disease severity, and myelomalacia. There is ongoing disagreement regarding the indications for, and urgency of, operative intervention in patients with mild degenerative myelopathy, moderate to severe radiculopathy, isolated axial symptomatology with evidence of spinal cord compression, and ATCCS without myelomalacia. A survey request was sent to 330 attendees of the Cervical Spine Research Society (CSRS) 2021 Annual Meeting to assess practice patterns regarding the treatment of cervical stenosis, myelopathy, radiculopathy, and ATCCS in 16 unique clinical vignettes with associated MRIs. Operative versus nonoperative treatment consensus was defined by a management option selected by >80% of survey participants. Overall, 116 meeting attendees completed the survey. Consensus supported nonoperative management for elderly patients with axial neck pain and adults with axial neck pain without myelomalacia. Operative management was indicated for adult patients with mild myelopathy and myelomalacia, adult patients with severe radiculopathy, elderly patients with severe radiculopathy and myelomalacia, and elderly ATCCS patients with pre-existing myelopathic symptoms. Treatment discrepancy in favor of nonoperative management was found for adult patients with isolated axial symptomatology and myelomalacia. Treatment discrepancy favored operative management for elderly patients with mild myelopathy, adult patients with mild myelopathy without myelomalacia, elderly patients with severe radiculopathy without myelomalacia, and elderly ATCCS patients without preceding symptoms. Although there is uncertainty regarding the treatment of mild myelopathy, operative intervention was favored for nonelderly patients with evidence of myelomalacia or radiculopathy and for elderly patients with ATCCS, especially if pre-injury myelopathic symptoms were present. Level V.

Early effects of unilateral biportal endoscopic posterior total laminectomy decompression in the treatment of cervical stenosis

To investigate the early efficacy and safety of unilateral biportal endoscopic posterior total laminectomy decompression in the treatment of cervical stenosis (CS). The clinical data of 28 patients with CS treated by unilateral biportal endoscopic posterior total laminectomy decompression from January 2021 to October 2022 in the Henan NO.3 Provincial People's Hospital were retrospectively analyzed. Of the patients, 16 were male and 12 were female, the mean age was (55.6±9.6) years. The CS occurred at C3-4 level in 1 cases, at C4-5 level in 3 cases, at C5-6 level in 16 cases and at C6-7 level in 8 cases. Each case was compared at the moment of pre-operation and final follow-up by the Japanese Orthopedic Association (JOA) score. The postoperative complications were recorded. The JOA improvement rate was computed at the final follow-up. As a result, all patients underwent successful surgery and were followed up for (11.6±4.7) months. The operation time was (43.0±5.3) min. Intraoperative blood loss (7.9±2.8) ml; Postoperative drainage volume (8.1±2.3) ml. The JOA score increased from 7.9±1.2 before surgery to 13.5±1.3 six months after surgery, and it was 13.7±1.2 at the last follow-up, the differences between postoperative and preoperative were both statistically significant (both P<0.001). No complications occurred, such as cerebrospinal fluid leakage, nerve injury and intraspinal hematoma. At the last follow-up, cervical spine X-ray or CT evaluation showed no instability in the operative segment. The overall curative effect was evaluated according to JOA score at the last follow-up: 16 cases got excellent outcome, 7 cases got good and 2 cases got medium outcome, with an excellent and good rate of 89.3% (25/28). This study shows that unilateral biportal endoscopic posterior total laminectomy decompression in the treatment of single-level cervical stenosis can achieve satisfactory efficacy, has no impact on spinal stability, and has a high safety.

Laparoscopic transfundal approach to cervical dilation: a novel treatment for cervical stenosis and cervical factor infertility

To demonstrate a novel technique used to restore cervical patency in a patient with severe iatrogenic cervical stenosis. Surgical video case report. A single academic institution. We highlight the case of a 35-year-old nulliparous woman with a history of primary infertility. Her past medical history was significant for focal, invasive, well-differentiated squamous cell carcinoma of the cervix, for which she underwent a loop electrosurgical excision procedure. During her infertility assessment, she was found to have an extremely stenotic cervix that was refractory to conventional treatment options. This video highlights our innovative laparoscopic transfundal technique used to restore her cervical patency. None, as this is a descriptive case report. Postoperatively, the patient had continued cervical patency for >1 year with successful fertility treatment resulting in pregnancy. To our knowledge, this is the first case report describing a laparoscopic transfundal approach used to reestablish cervical patency. This approach may be considered for patients with cervical stenosis who have not responded to standard conservative therapies.

Indications and Outcomes for Contemporaneous Anteroposterior Surgery in Cervical Stenosis and Myelopathy: Single Center Experience

Anterior or posterior approaches have been shown to be effective in the treatment of cervical stenosis and myelopathy (CSM). There exists, however, a group of patients in whom both the anterior and posterior approaches are necessary to treat the stenosis and deformity. To better identify the indications and outcomes of the contemporaneous anterior+ posterior approaches (CAP), we retrospectively reviewed the records of patients who have been treated with this method. Between 2006 and 2018, 37 patients were treated with CAP for kyphosis, stenosis, and subluxation, with a median follow-up of 20 months (range: 5-112 months). We examined their radiographic metrics, health-related outcomes, and complications. The indication for CAP was severe kyphosis in 12 cases, severe stenosis in 9, and subluxation in 7. Proximal junctional kyphosis was the indication in 4 cases, failure of instrumentation with kyphosis in 3 cases, and adjacent segment degeneration in 2. Kyphosis was corrected in all. Nine patients suffered a total of 14 complications. Six patients developed dysphagia, 2 developed spinal fluid leaks, 1 meningitis, 2 wound dehiscence, and 1 C5 palsy. None were life-threatening and all resolved with appropriate management. The CAP approach, undertaken in cases of CSM associated with severe kyphosis, stenosis, and subluxation, led to a significant correction in kyphosis. There was total of 14 complications, comparable to previously published reports.

P129. Clinical outcomes following anterior cervical discectomy and fusion for patients with central versus foraminal stenosis

BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) is an effective surgical option for the treatment of cervical stenosis. However, the adequacy of decompression and stabilization for patients with central stenosis versus foraminal stenosis has been debated. Many advocate for the use or addition of a posterior cervical approach to the neural foramen to ensure adequacy of decompression. However, this may be associated with a number of adverse effects, including inadequacy of central or anterior decompression, when indicated, and persistent postoperative neck pain. PURPOSE The aim of this study was to assess the effectiveness of ACDF alone across a number of postoperative clinical outcome measures for patients with central stenosis, foraminal stenosis or both. STUDY DESIGN/SETTING Retrospective cohort analysis. PATIENT SAMPLE Analysis was conducted of patients who underwent ACDF for cervical radiculopathy or myelopathy between 2008 and 2015 by one of two senior spine surgeons at our institution. Patients were excluded from analysis if they were under 18 years of age, had a previous operation to the cervical spine, or did not meet a minimum of six months follow-up. OUTCOME MEASURES Preoperative magnetic resonance imaging (MRI) was assessed to determine the location of neural stenosis and compression. Stenosis that occurred medial to the facet or uncovertebral joint in the axial plane was identified as central, whereas stenosis that occurred at, or lateral to, the facet and uncovertebral joints was identified as foraminal. Sagittal measures on plain films were also measured and analyzed, including cervical lordosis, sagittal vertical axis, fusion and T1 angles. Patient reported outcome measures included visual analogue scale (VAS) neck, VAS-arm and neck disability index (NDI). Objective outcome measures included the incidence of adjacent segment disease (ASD), fusion, subsidence and reoperation rate. METHODS Anteroposterior (AP) and lateral cervical radiographs were obtained during the preoperative, immediate postoperative (2-week postoperative follow-up appointment), and final follow-up period along with patient reported outcomes. Bivariate and multivariate analyses were performed to account for baseline differences in patient factors. RESULTS In total, 381 patients met our inclusion criteria. Of these, 126 had central stenosis, 96 had foraminal stenosis, and 159 had both. Average length of follow-up was 28.2 (range 6-101) months. The central stenosis-only and foraminal stenosis-only cohorts had a significantly greater percentage of females compared to the cohort with both central and foraminal stenosis (56.35% and 54.74% versus 40.25%, respectively), with no additional baseline differences between groups. There were no significant differences in the amount of change in the sagittal plane from preoperative to postoperative between cohorts on multivariate analysis. Each cohort experienced considerable improvements in patient reported outcome measures, however, there were no significant differences in preoperative or postoperative VAS-neck, VAS-arm, or NDI scores between groups. Similarly, there were no significant differences in the incidence of ASD, fusion, subsidence, or reoperation rate between groups. CONCLUSIONS Our findings suggest that ACDF offers adequate decompression and stabilization for patients with cervical stenosis, regardless of the location of neural compression as central, foraminal or a combination of both. These data may help to better guide preoperative planning and consideration of surgical approach to the affected level(s). FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Anterior and Posterior Approaches for Cervical Myelopathy: Clinical and Radiographic Outcomes.

A retrospective cohort study. The aim of this study was to identify advantages and disadvantages of the anterior and posterior approaches in the treatment of cervical stenosis and myelopathy. Both anterior and posterior surgical approaches for cervical stenosis and myelopathy have been shown to result in improvement in health-related outcomes. Despite the evidence, controversy remains regarding the best approach to achieve decompression and correct deformity. We retrospectively reviewed patients with cervical stenosis and myelopathy who had undergone anterior cervical fusion and instrumentation (n = 38) or posterior cervical laminectomy and instrumentation (n = 51) with at least 6 months of follow-up. Plain radiographs, magnetic resonance imaging, and computed tomography scans, as well as health-related outcomes, including Visual Analog Scale for neck pain, Japanese Orthopedic Association score for myelopathy, Neck Disability Index, and Short Form-36 Health Survey, were collated before surgery and at follow-up (median 12.0 and 12.1 months for anterior and posterior group, respectively). Both anterior and posterior approaches were associated with significant improvements in all studied quality of life parameters with the exception of general health in the anterior group and energy and fatigue in the posterior group. In the anterior group, follow-up assessment revealed a significant increase in C2-7 lordosis. Both approaches were accompanied by significant increases in C2-7 sagittal balance [sagittal vertical axis (SVA)]. There were two complications in the anterior group and nine complications in the posterior group; the incidence of complications between the two groups was not significantly different. When the benefits of one approach over the other are not self-evident, the anterior approach is recommended, as it was associated with a shorter hospital stay and more successful restoration of cervical lordosis than posterior surgery. 3.

SURGICAL TREATMENT OF CERVICAL STENOSIS IN PATIENTS WITH MUCOPOLYSACCHARIDOSIS: SYSTEMATIC REVIEW

A multidisciplinary approach to treatment of patients with mucopolysaccharidosis allows to achieve good results. However, progressive spinal canal stenosis at the level of the craniovertebral junction, characteristic of this disease, leads to neurological signs, as well as a decrease in quality and length of life. The solution to this problem is a difficult challenge for spinal surgeons, as it is associated with a high risk of complications. There is also a wide range of opinions and approaches to the surgical treatment of this group of patients.Using the referred Reporting Items for Systematic Review and Meta-Analysis» (PRISMA) protocol, a PubMed and eLIBRARY search was conducted using keywords to find articles describing patients with mucopolysaccharidosis who underwent surgical treatment for cervical stenosis. In this review, information on demographic parameters, surgical technique and the results of cervical stenosis treatment in patients with mucopolysaccharidosis is collected and analyzed.

Clinical Outcomes of Cervical Laminoplasty: Results at Two Years.

Laminoplasty is an established treatment for cervical myelopathy. Multiple variations have emerged, many advocating the use of allograft, but controversy persists. To assess medium-term clinical outcomes in patients who underwent laminoplasty with autograft at our institution. Thirty-two consecutive patients (19 male, 13 female, average age 66 yr) from our prospective outcome registry that underwent cervical laminoplasty between 2009 and 2013 were reviewed. Computed tomography (CT) scan was performed immediately postoperatively and at 6-mo follow-up. Parameters included patient perception of outcome, Nurick score, Neck Disability Index (NDI), visual analog scale for neck pain, and SF-36. On retrospective analysis, all patients felt improved at 3 mo postoperatively; at 2 yr, this rate was 91%. Improvements were seen in Nurick scores, from 3.16 ± 0.9 preoperatively to 1.94 ± 0.8 at 2 yr; NDI score from 28.7% ± 9% preoperatively to 20.8% ± 9.6% at 2 yr; visual analog scale from 2.8 ± 1.2 preoperatively to 1.7 ± 0.9 at 2 yr; and SF-36 physical component summary from 27.9 ± 10 preoperatively to 37.8 ± 11.9 at 2 yr. All values reached significance at all follow-up points ( P < .05) with the exception of 6-mo NDI values ( P = .062). No C5 palsy, graft complications, or reclosure was observed in any patient during the follow-up period. Laminoplasty with autograft is a safe and effective method to treat cervical myelopathy, with good medium-term clinical outcome. No reclosures were observed. Bony fusion was seen in all cases on CT scan. Our study found good outcomes in the performance of open-door laminoplasty without hardware, in the treatment of cervical stenosis.

Minimally Invasive Uniportal Multilevel Cervical Decompression versus Laminoplasty in Treatment for Cervical Stenosis. Clinical and Radiological Results

Introduction There are many options to decompress the cervical spine on posterior way, the open door laminoplasty is an effective procedure to get the goal in multilevel disease; however, the muscular injury is a big problem in traditional surgery, the minimally invasive procedures can achieve optimal decompression without muscle injury with less pain and improvement in short time. Patients and Methods We present a study with 20 patients, 10 of them underwent traditional open door laminoplasty and the other patients underwent minimally invasive uniportal multilevel minimally invasive decompression. We use VAS, neck disability index, and Nurick clinical scale with follow-up of 12 months. Results On laminoplasty, VAS pre-op mean was 8 and 5 on 12 months; for MIS decompression VAS pre-op mean was 9 and 2 on 12 months. Neck disability index on the first group was mean 19 pre-op and 15 post-op 12 months and MIS group was 20 pre-op and 10 post-op 12 months. The Nurick clinical scale on laminoplasty and patients with MIS show improvement of one level on both groups. The surgical time, blood loss, hospital discharge, and return to daily activities shows superiority on MIS group. Conclusion Our conclusions about the minimally invasive procedures can achieve the similar results than traditional procedures without muscular injury and let a better time to recovery and return to daily activities.

Successful Pregnancy Following Treatment of Cervical Stenosis from a Previous Cervical Loop Excision

Background: Cervical stenosis as a result of a loop excision procedure is a rare but late complication of this procedure. For women desiring pregnancy, in vitro fertilization (IVF) embryo transfer is very challenging. Case: A 35-year-old woman para 1001 presented with secondary amenorrhea from cervical stenosis 2 years after a normal spontaneous vaginal delivery, as a result of a loop excision procedure of the cervix performed 6 weeks postpartum. Results: Her cervical stenosis was resolved by a novel cervical procedure resulting in a successful transcervical IVF embryo transfer. Conclusions: Cervical factors accounts for 5% of all referrals for infertility. A novel procedure to resolve cervical stenosis and a resultant successful transcervical embryo transfer is reported. (J GYNCOL SURG 28:23)

Interventional Radiology Wire-Guided Balloon Dilataion for Treatment of Cervical Stenosis

Interventional Radiology Wire-Guided Balloon Dilataion for Treatment of Cervical Stenosis

Laminoplasty outcomes: is there a difference between patients with degenerative stenosis and those with ossification of the posterior longitudinal ligament?

Two common causes of cervical myelopathy include degenerative stenosis and ossification of the posterior longitudinal ligament (OPLL). It has been postulated that patients with OPLL have more complications and worse outcomes than those with degenerative stenosis. The authors sought to compare the surgical results of laminoplasty in the treatment of cervical stenosis with myelopathy due to either degenerative changes or segmental OPLL. The authors conducted a retrospective review of 40 instrumented laminoplasty cases performed at a single institution over a 4-year period to treat cervical myelopathy without kyphosis. Twelve of these patients had degenerative cervical stenotic myelopathy ([CSM]; degenerative group), and the remaining 28 had segmental OPLL (OPLL group). The 2 groups had statistically similar demographic characteristics and number of treated levels (mean 3.9 surgically treated levels; p > 0.05). The authors collected perioperative and follow-up data, including radiographic results. The overall clinical follow-up rate was 88%, and the mean clinical follow-up duration was 16.4 months. The mean radiographic follow-up rate was 83%, and the mean length of radiographic follow-up was 9.3 months. There were no significant differences in the estimated blood loss (EBL) or length of hospital stay (LOS) between the groups (p > 0.05). The mean EBL and LOS for the degenerative group were 206 ml and 3.7 days, respectively. The mean EBL and LOS for the OPLL group were 155 ml and 4 days, respectively. There was a statistically significant improvement of more than one grade in the Nurick score for both groups following surgery (p < 0.05). The Nurick score improvement was not statistically different between the groups (p > 0.05). The visual analog scale (VAS) neck pain scores were similar between groups pre- and postoperatively (p > 0.05). The complication rates were not statistically different between groups either (p > 0.05). Radiographically, both groups lost extension range of motion (ROM) following laminoplasty, but this change was not statistically significant (p > 0.05). Patients with CSM due to either degenerative disease or segmental OPLL have similar perioperative results and neurological outcomes with laminoplasty. The VAS neck pain scores did not improve significantly with laminoplasty for either group. Laminoplasty may limit extension ROM.

The surgical care on the single cervical open-door laminoplasty with Centerpiece plate fixation

Objective To summarize the C3～7 the single cervical open-door laminoplasty with Centerpiece plate ( posterior cervical laminoplasty plate and screw fixation system) internal fixation surgery and nursing characteristics. Methods The surgeries in our hospital from August 2009 to January 2010 was investigate, which were 19 cases of cervical stenosis with posterior C3～7 single cervical open-door laminoplasty and Centerpiece plate fixation. The focused process was discussed, such as preoperative dynamic systems preparation, surgical position, the frame of the placement and intraoperative open the door and plate fixation device. Results 19 cases of posterior C3～7 single cervical open-door laminoplasty and Centerpiece plate fixation surgeries were uneventful and none of the reason for body position and power systems affected the surgical process. Operative time was 95～130 minutes, with an average time of 105 minutes; intraoperative blood loss was 290 ml; intraoperative C-arm X-ray confirmed Centerpiece plate in a good position. However, 1 patient appeared cerebral fluid leakage after operation and 7 patients appeared mild pain in the shoulder and neck accompanied by stiffness symptoms. There were no spinal cord injuries and complications such as hematoma. After 1 to 6 months follow-up there were no screw fixation instability, loosening, plate shift, and lamina phenomena occurred and the neurological function in patients recovered well. Conclusions The single cervical open-door cervical laminoplasty with Centerpiece plate technique is the better treatment of cervical stenosis as a surgical method. Mastering the use of Mayfield head frame, displaying good posture, getting a good knowledge of surgical procedures, preparing and using well the power system contribute to the operation completed successfully. Key words: Cervical spinal canal stenosis; Single open-door laminoplasty; Centerpiece plate; Surgical care

Hysteroscopic Cervical Fiber Ablation for the Treatment of Cervical Stenosis

Hysteroscopic Cervical Fiber Ablation for the Treatment of Cervical Stenosis

Does laminectomy still hold a place in the treatment of cervical stenosis? When is it necessary to add a fixation after and or laminoplasty?

Does laminectomy still hold a place in the treatment of cervical stenosis? When is it necessary to add a fixation after and or laminoplasty?