Cervical Spondylotic Myelopathy: Factors in Choosing the Surgical Approach

Yalamanchili, Praveen; Vives, Michael J.; Chaudhary, Saad B.

doi:10.1155/2012/783762

Cited by 62 publications

(48 citation statements)

References 34 publications

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Section: Introductionmentioning

confidence: 99%

“…[1–3] The aim of surgery is to decompress spinal cord and preserve the stability of the spinal column. [3–7] However, the selection of optimal surgical treatment for CCM remains controversial. [4,5,8–11] Surgeries, widely used in clinic mainly involved anterior and posterior approaches, including anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), anterior corpectomy combined with discectomy (ACCDF), laminoplasty (LP), and laminectomy with fusion (LF).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of complications after surgery in treatment for cervical compressive myelopathy

et al. 2017

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Purpose:We aim to perform a meta-analysis on prevalence of all kinds of operation-related complications following surgery treating cervical compressive myelopathy (CCM) and to provide reference for surgeons making surgical plan.Methods:An extensive search of literature was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on incidence of operation-related complications from January 2007 to November 2016. Data was calculated and data analysis was conducted with STATA 12.0 and Revman 5.3.Results:A total of 107 studies included 1705 of 8612 patients (20.1%, 95% CI 17.3%–22.8%) on overall complications. The incidence of C5 plasy, cerebrospinal fluid (CSF), infection, axial pain, dysphagia, hoarseness, fusion failure, graft subsidence, graft dislodgment, and epidural hematoma is 5.3% (95% CI 4.3%–6.2%), 1.9% (95% CI 1.3%–2.4%), 2.8% (95% CI 1.7%–4.0%), 15.6% (95% CI 11.7%–19.5%), 16.8% (95% CI 13.6%–19.9%), 4.0% (95% CI 2.3%–5.7%), 2.6% (95% CI 0.2%–4.9%), 3.7% (95% CI 2.0%–5.5%), 3.4% (95% CI 2.0%–4.8%), 1.1% (95% CI 0.7%–1.5%), respectively. Patients with ossification of posterior longitudinal ligament (OPLL) (6.3%) had a higher prevalence of C5 plasy than those with cervical spondylotic myelopathy (CSM) (4.1%), and a similar trend in CSF (12.2% vs 0.9%). Individuals after laminectomy and fusion (LF) had highest rate of C5 plasy (15.2%), while those who underwent anterior cervical discectomy and fusion (ACDF) had the lowest prevalence (2.0%). Compared with patients after other surgical options, individuals after anterior cervical corpectomy and fusion (ACCF) have the highest rate of CSF (4.2%), infection (14.2%), and epidural hematoma (3.1%). Patients after ACDF (4.8%) had a higher prevalence of hoarseness than those with ACCF (3.0%), and a similar trend for dysphagia between anterior corpectomy combined with discectomy (ACCDF) and ACCF (16.8% vs 9.9%).Conclusions:Based on our meta-analysis, patients with OPLL have a higher incidence of C5 palsy and CSF. Patients after LF have a higher incidence of C5 palsy, ACCDF have a higher incidence of dysphagia, ACCF have a higher incidence of CSF and infection and ACDF have a higher incidence of hoarseness. These figures may be useful in the estimation of the probability of complications following cervical surgery.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence of complications after surgery in treatment for cervical compressive myelopathy

et al. 2017

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“…16 However, the more limited surgical exposure compared with ACCF places this technique at higher risk of incomplete decompression, and the increased number of fusion surfaces in multilevel ACDF can lead to a higher risk of pseudarthrosis. 14,16 Patient-rated outcome has rarely been examined in the aforementioned studies. In this comparative effectiveness study, we analyzed the patient-rated outcomes and radiographic outcomes of patients who had undergone ACDF or ACCF for the treatment of cervical spondylotic myelopathy.…”

mentioning

confidence: 99%

A comparative effectiveness study of patient-rated and radiographic outcome after 2 types of decompression with fusion for spondylotic myelopathy: anterior cervical discectomy versus corpectomy

Burkhardt

Mannion

Marbacher

et al. 2013

FOC

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Object Both anterior cervical discectomy with fusion (ACDF) and anterior cervical corpectomy with fusion (ACCF) are used to treat cervical spondylotic myelopathy; however, there is currently no evidence for the superiority of one over the other in terms of patient-rated outcomes. This comparative effectiveness study compared the patient-rated and radiographic outcomes of 2-level ACDF versus 1-level ACCF. Methods This single-center study was nested within the EuroSpine Spine Tango data acquisition system. Inclusion criteria were the following: consecutive patients presenting with signs of cervical spondylotic myelopathy who underwent 2-level ACDF or 1-level ACCF between 2004 and 2011. Before and 12 months after surgery, patients completed the multidimensional Core Outcome Measures Index (COMI) and also rated global treatment outcome and satisfaction with care on 5-point Likert scales. Cervical lordosis, segmental height, and fusion rate were assessed radiographically before and immediately after surgery and at the last follow-up (20.4 ± 13.7 months, mean ± SD). Results In total, 118 consecutive patients (80 in the ACDF group and 38 in the ACCF group) were included. Age, sex, comorbidity, baseline symptoms, baseline radiographic data, operation duration, and complication rates did not differ significantly between the 2 groups. Blood loss was significantly (p < 0.04) lower in the ACDF group. Postoperative mean segmental height was significantly (p = 0.0006) greater for ACDF (42.0 ± 4.2 mm, mean ± SD) than for ACCF (39.0 ± 4.0 mm), and global average lordosis improved to a significantly (p = 0.003) greater extent in ACDF (by 1.6° ± 4.1°) than in ACCF (by −1.0° ± 4.0°). Fusion rates for ACDF were 97.5% and for ACCF were 94.7% (p = 0.59). The 12-month patient-rated outcomes did not differ significantly between ACDF and ACCF: 82.4% and 68.6% had a good global outcome (operation helped/helped a lot) (p = 0.10), 86.5% and 82.9% were satisfied/very satisfied with care (p = 0.62), and the reduction in the multidimensional COMI was 2.8 ± 2.7 and 2.2 ± 3 points (p = 0.30), respectively. The postoperative increase in lordosis angle showed low but significant correlations with the improvement in arm pain (r = 0.25, p = 0.014), highest pain (r = 0.25, p = 0.013), and function (r = 0.24, p = 0.016). Conclusions Both ACDF and ACCF are safe and effective in the treatment of cervical spondylotic myelopathy, indicated by similarly good patient-rated outcomes 1 year after surgery. This precludes any conclusions regarding the superiority of one technique over the other, although it should be noted that ACDF resulted in less blood loss and greater improvements in cervical lordosis and segmental height than ACCF. Patients with improved lordosis angle had a better clinical outcome.

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“…However, these variables are frequently equivocal, and surgeon training and patient preference are often the deciding factor for treatment rendered. Previous investigations into different cervical techniques fail to show superiority of a specific superior approach 8 and a recent publication from a large, prospective multicenter study validated the relative equivalence between anterior and posterior treatment for CSM that many spine surgeons think exists. 5,9 This study, as well as several previous lesser quality series, demonstrate that when the choice of anterior and posterior surgery is decided by the surgeon, patients experience significant, and similar improvements with regard to neurological, functional, and quality-of-life outcomes with comparable and very low rates of neurological complication.…”

Section: Introductionmentioning

confidence: 98%

Perioperative Risks Associated with Cervical Spondylotic Myelopathy Based on Surgical Treatment Strategies

et al. 2015

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BackgroundFew studies have provided nationwide estimates of patient characteristics and procedure-related complications, or examined postsurgical outcomes for patients with cervical spondylotic myelopathy (CSM) comparatively with respect to surgical approach. The objective of this study is to identify patients at risk for morbidity and mortality directly related with the selected approach, report an overall nation-wide complication rate for each approach against which surgeons can compare themselves, and direct future research to improve patient outcomes.

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Cervical Spondylotic Myelopathy: Factors in Choosing the Surgical Approach

Cited by 62 publications

References 34 publications

Prevalence of complications after surgery in treatment for cervical compressive myelopathy

Prevalence of complications after surgery in treatment for cervical compressive myelopathy

A comparative effectiveness study of patient-rated and radiographic outcome after 2 types of decompression with fusion for spondylotic myelopathy: anterior cervical discectomy versus corpectomy

Perioperative Risks Associated with Cervical Spondylotic Myelopathy Based on Surgical Treatment Strategies

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