Cervical Laminectomy with Lateral Mass Screw Fixation in Cervical Spondylotic Myelopathy

Abstract

Background:Anterior cervical decompression and fusion is the standard procedure used for treating patients with cervical myelopathy. However, these procedures are associated with complications such as pseudarthrosis, construct failure, and neurological complications. Posterior cervical laminectomy and instrumentation is an alternative procedure to treat multilevel cervical myelopathy. In this study, we raised questions whether instrumentation is required at all levels and whether stabilizing the spine in neutral or lordotic contour with indirect decompression leads to neurological improvement with radiological evidence of anterior decompression. The results of posterior cervical laminectomy and instrumentation with lateral mass screw in terms of radiological and functional outcome in patients with multilevel cervical myelopathy are prospectively evaluated.Materials and Methods:In this prospective study conducted between June 2006 and December 2015, we have evaluated 112 patients with multilevel cervical myelopathy who underwent multilevel cervical laminectomy and instrumentation with lateral mass screw. All patients were evaluated preoperatively and postoperatively with Nurick's grading and Modified Japanese Orthopaedic Association (mJOA) scale for neurological function. Cooper scale and British Medical Research Council grading system for motor function. Curvature index was used to measure the alignment of cervical spine preoperatively and postoperatively. Alignment of the cervical spine was done preoperatively and postoperatively by calculating the curvature index. Axial MRI was used to calculate the severity of compression preoperatively which was calculated as per Singh's criteria and postoperatively to assess the adequacy of decompression at the operated level.Results:In our study, there were 112 patients including 99 males and 13 females, with mean age of 59.53 years. The mean duration of followup of patients was 33.24 months. In total, cervical laminectomy was performed at 342 levels in 112 patients with an average of 3.05 laminectomies, and in total, 112 lateral mass screws were inserted. On postoperative followup, the mJOA and Nurick's grading showed improvement in all cases as compared to preoperative findings. The mean mJOA improved significantly from 8.56 preoperatively to 13.57 postoperatively (P < 0.001). The mean Nurick's grading also improved significantly from 2.59 preoperatively to 0.66 postoperatively (P < 0.001). The mean Cooper scale also showed significant improvement in both upper and lower limbs postoperatively (P < 0.001). The mean preoperative Cooper scale was 1.75 and postoperative was 0.31 for upper limbs, and the mean Cooper scale was 2.14 preoperatively and 0.56 postoperatively for lower limbs. X-rays done on routine followups showed good alignment of the cervical spine with maintenance of curvature index in all patients. The mean grade of compression as seen on preoperative MRI was 2.46 which reduced significantly postoperatively to 0.16 (P < 0.001).Conclusion:The multilevel cervical...

The Essence of Clinical Practice Guidelines for Cervical Spondylotic Myelopathy, 2020

“…In recent years, fusion procedures have increased primarily among reports from overseas. Posterior decompression combined with fusion using posterior instrumentation along with laminoplasty and laminectomy might be more beneficial than using laminoplasty alone in restoring normal cervical lordosis 130) , stabilizing intervertebral mobility, and preventing postoperative kyphosis deformity 131) . However, compared with laminoplasty, it has been reported that the incidence of postoperative neurological complications is higher in laminectomy combined with fusion 132) .…”

Results of Laminectomy With Lateral Masses Fixation in Treatment of Multilevel Cervical Degenerative Diseases

“…Основными факторами, влияющими на клинический исход после ламинэктомии и винтовой фиксации за боковые массы, являются: эффективная декомпрессия спинного мозга и его корешков, плотная фиксация винта в боковой массе и отсутствие его миграции в полость межпозвонкового диска и/или позвоночный канал [22].…”

“…По данным Singrakhia et al [22], среднее улучшение по шкале mJOA составило с 8,56 до 13,57, по шкале Nurick с 2,59 до 0,66, изменения по шкале Cooper с 1,75 до 0,31 для верхних конечностей и с 2,14 до 0,56 для нижних конечностей.…”

A meta-analysis of prospective studies comparing the results of laminoplasty and laminectomy with instrumental fixation in the surgical treatment of patients with multilevel degenerative cervical spine diseases

“…В настоящее время отсутствует приоритетность в определении оптимального способа задней декомпрессии и стабилизации, a используемые хирургические методики имеют специфические преимущества и недостатки [12,13]. Так, ЛФ позволяется уменьшить послеоперационную нестабильность и дооперационный кифоз [14,15]. В свою очередь ЛП обеспечивает сохранение естественной биомеханики шейного отдела, целостность задних анатомических структур и физиологического лордоза [16,17].…”