Indications for circumferential surgery for cervical spondylotic myelopathy

Kim, Paul K.; Alexander, J. Trent

doi:10.1016/j.spinee.2006.04.025

Cited by 41 publications

(30 citation statements)

References 39 publications

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“…An anterior-only approach with multilevel corpectomy has been fraught with early mechanical failures with graft and implant dislodgement [3031]. A combined anterior and posterior procedure has been found to decrease the mechanical failures with good fusion rates and neurological outcome [32]. Wen et al [33] compared the efficacy of anterior-posterior combined surgery with anterior or posterior alone surgeries in a 255 patient series.…”

Section: Discussionmentioning

confidence: 99%

Addressing Stretch Myelopathy in Multilevel Cervical Kyphosis with Posterior Surgery Using Cervical Pedicle Screws

et al. 2016

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Study DesignTechnique description and retrospective data analysis.PurposeTo describe the technique of cervical kyphosis correction with partial facetectomies and evaluate the outcome of single-stage posterior decompression and kyphosis correction in multilevel cervical myelopathy.Overview of LiteratureKyphosis correction in multilevel cervical myelopathy involves anterior and posterior surgery. With the advent of cervical pedicle screw-rod instrumentation, single-stage posterior kyphosis correction is feasible and can address stretch myelopathy by posterior shortening.MethodsNine patients underwent single-stage posterior decompression and kyphosis correction for multilevel cervical myelopathy using cervical pedicle screw instrumentation from March 2011 to February 2014 and were evaluated preoperatively and postoperatively with modified Japanese Orthopaedic Association (mJOA) scoring and computed tomography scans for radiological measurements. Kyphosis assessment was made with Ishihara curvature index and C2–C7 Cobb's angle. The linear length of the spinal canal and the actual spinal canal length were also evaluated. The average follow-up was 40.56 months (range, 20 to 53 months).ResultsThe average preoperative C2–7 Cobb's angle of 6.3° (1° to 12°) improved to 2° (10° to −9°). Ishihara index improved from −15.8% (−30.5% to −4.7%) to −3.66% (−14.5% to +12.6%). The actual spinal canal length decreased from 83.64 mm (range, 76.8 to 91.82 mm) to 82.68 mm (range, 75.85 to 90.78 mm). The preoperative mJOA score of 7.8 (range, 3 to 11) improved to 15.0 (range, 13 to 17).ConclusionsSingle-stage posterior decompression and kyphosis correction using cervical pedicle screws for multilevel cervical myelopathy may address stretch myelopathy, in addition to decompression in the transverse plane. However, cervical lordosis was not achieved with this method as predictably as by the anterior approach. The present study shows evidence of mild shortening of cervical spinal canal and a positive correlation between canal shortening and clinical improvement.

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Section: Discussionmentioning

confidence: 99%

Addressing Stretch Myelopathy in Multilevel Cervical Kyphosis with Posterior Surgery Using Cervical Pedicle Screws

et al. 2016

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“…11 Reports have suggested that treatment of multilevel or unstable cervical disease using an isolated anterior approach can be associated with high rates of pseudarthrosis and graft dislodgement. 25,30,34 In addition to allowing for direct anterior and posterior decompression of the spinal canal, a combined approach also permits circumferential fixation for restoration of lordosis.…”

Section: Discussionmentioning

confidence: 99%

Dysphagia following combined anterior-posterior cervical spine surgeries

Chen

Saulle

et al. 2013

SPI

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C ompliCations related to cervical spine surgery are well documented in the literature, including dysphagia, dysphonia, wound infection, neurological deficit, delayed C-5 palsy, adjacent-level disease, instrumentation failure, and pseudarthrosis. 4,7 Among these, dysphagia has been a consistently recognized early complication following anterior cervical spine surgery, and its reported incidence is highly variable, ranging from 1% to as high as 79%. 2,3,5,6,10,14,22,24,28,33 This variation is in part attributed to how dysphagia is defined by investigators and the threshold of severity at which it is considered to be a complication. Fortunately, most studies show dysphagia to be typically a transient phenomenon following anterior cervical surgery. 2,22,31 The pathophysiology of dysphagia following cervical spine surgery remains poorly understood. Several factors have been suggested to be related to the development of postsurgical dysphagia, including patient age, female sex, obesity, length of surgery, specific spinal level(s) of surgery, multilevel surgery, use of instrumen- Object. This study was undertaken to evaluate the incidence of and risk factors associated with the development of dysphagia following same-day combined anterior-posterior cervical spine surgeries.Methods. The records of 30 consecutive patients who underwent same-day combined anterior-posterior cervical spine surgery were reviewed. The presence of dysphagia was assessed by a formalized screening protocol using history/clinical presentation and a bedside swallowing test, followed by formal evaluation by speech and language pathologists and/or fiberoptic endoscopic evaluation of swallowing/modified barium swallow when necessary. Age, sex, previous cervical surgeries, diagnoses, duration of procedure, specific vertebral levels and number of levels operated on, degree of sagittal curve correction, use of anterior plate, estimated blood loss, use of recombinant human bone morphogenetic protein-2 (rhBMP-2), and length of hospital stay following procedures were analyzed.Results. In the immediate postoperative period, 13 patients (43.3%) developed dysphagia. Outpatient follow-up data were available for 11 patients with dysphagia, and within this subset, all cases of dysphagia resolved subjectively within 12 months following surgery. The mean numbers of anterior levels surgically treated in patients with and without dysphagia were 5.1 and 4.0, respectively (p = 0.004). All patients (100%) with dysphagia had an anterior procedure that extended above C-4, compared with 58.8% of patients without dysphagia (p = 0.010). Patients with dysphagia had significantly greater mean correction of C2-7 lordosis than patients without dysphagia (p = 0.020). The postoperative sagittal occiput-C2 angle and the change in this angle were not significantly associated with the occurrence of dysphagia (p = 0.530 and p = 0.711, respectively). Patients with postoperative dysphagia had significantly longer hospital stays than those who did not develop dysphagia (p = 0.004). No ...

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“…21,22 These circumferential procedures are more technically demanding with significant manipulation of soft tissues and prolonged surgical time and local bleeding. Medically related complications were also higher in the combined group as well, and included post hemorrhagic anemia, respiratory distress syndrome and postoperative shock.…”

Section: Discussionmentioning

confidence: 99%

“…Poor bone quality limits the ability of stand-alone anterior or posterior fixation devices to maintain correction. 19,21,22 The combined technique has limited information available in the literature. Available studies compare anterior vs. posterior techniques 13,18,23 or just posterior approach surgeries 24 but not circumferential procedures.…”

Section: Discussionmentioning

confidence: 99%

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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Indications for circumferential surgery for cervical spondylotic myelopathy

Cited by 41 publications

References 39 publications

Addressing Stretch Myelopathy in Multilevel Cervical Kyphosis with Posterior Surgery Using Cervical Pedicle Screws

Addressing Stretch Myelopathy in Multilevel Cervical Kyphosis with Posterior Surgery Using Cervical Pedicle Screws

Dysphagia following combined anterior-posterior cervical spine surgeries

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

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