Results of Surgical Treatment for Degenerative Cervical Myelopathy

Kabak, Şevki; Tezer, Mehmet; Ufuk, Talu; Hamzaoğlu, Azmi; Sarıer, Mercan; Bilen, F. Erkal

doi:10.1097/01.brs.0000145412.93407.c3

Cited by 78 publications

(59 citation statements)

References 41 publications

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“…Oppositively, cervical lordosis is difficult to be reconstructed effectively using large cages or grafts in case of multilevel corpectoEur Spine J (2007) 16:2055-2071 2065 mies, because of the rectangular shape of most current devices or the design of the grafts [6,48,70]. Mean correction in patients with 2-and 3-level corpectomies was 6.8°in our series, resembling a similar value compared to other series [48,52,103], and mainly representing the lordotic shape of currently used ACPs (Fig. 7b).…”

Section: Influence Of Cervical Lordosissupporting

confidence: 77%

“…There is the potential for a higher rate of infection, surgical morbidity and increased inhospital stay. Posterior dissection can cause significant myofascial pain due to the stripping of the musculature from the posterior elements and axial neck pain [5,18,52,85,89,103,110,119]. Two of our three cases sustaining posterior fusion depicted severe and moderate posterior neck pain, respectively.…”

Section: Clinical Failures In Multilevel Anterior Cervical Constructsmentioning

confidence: 79%

“…In other surveys, normal TCL ranged between 10°and 34.5° [3,38,42,43,81]. As concerns postsurgical lordosis achieved, Sevki et al [103] reported on successful reconstructions and no loss of sagittal alignment following the use of constrained ACPs, TMC, and posterior arthrodesis in twelve 3-to 4-level corpectomies. Mean sagittal Cobb angle was 9°b efore surgery, and 16.9°at last follow-up.…”

Section: Influence Of Cervical Lordosismentioning

confidence: 99%

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4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

et al. 2007

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In the future, there will be an increased number of cervical revision surgeries, including 4-and more-levels. But, there is a paucity of literature concerning the geometrical and clinical outcome in these challenging reconstructions. To contribute to current knowledge, we want to share our experience with 4-and 5-level anterior cervical fusions in 26 cases in sight of a critical review of literature. At index procedure, almost 50% of our patients had previous cervical surgeries performed. Besides failed prior surgeries, indications included degenerative multilevel instability and spondylotic myelopathy with cervical kyphosis. An average of 4.1 levels was instrumented and fused using constrained (26.9%) and non-constrained (73.1%) screw-plate systems. At all, four patients had 3-level corpectomies, and three had additional posterior stabilization and fusion. Mean age of patients at index procedure was 54 years with a mean follow-up intervall of 30.9 months. Preoperative lordosis C2-7 was 6.5°in average, which measured a mean of 15.6°at last follow-up. Postoperative lordosis at fusion block was 14.4°in average, and 13.6°at last follow-up. In 34.6% of patients some kind of postoperative change in construct geometry was observed, but without any catastrophic construct failure. There were two delayed unions, but finally union rate was 100% without any need for the Halo device. Eleven patients (42.3%) showed an excellent outcome, twelve good (46.2%), one fair (3.8%), and two poor (7.7%). The study demonstrated that anterior-only instrumentations following segmental decompressions or use of the hybrid technique with discontinuous corpectomies can avoid the need for posterior supplemental surgery in 4-and 5-level surgeries. However, also the review of literature shows that decreased construct rigidity following more than 2-level corpectomies can demand 360°instrumentation and fusion. Concerning construct rigidity and radiolographic course, constrained plates did better than non-constrained ones. The discussion of our results are accompanied by a detailed review of literature, shedding light on the biomechanical challenges in multilevel cervical procedures and suggests conclusions.

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Section: Influence Of Cervical Lordosissupporting

confidence: 77%

Section: Clinical Failures In Multilevel Anterior Cervical Constructsmentioning

confidence: 79%

Section: Influence Of Cervical Lordosismentioning

confidence: 99%

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4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

et al. 2007

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“…Multilevel anterior discectomy and fusion is an alternative surgical method but it may be hard and dangerous when the disc height is greatly reduced. Recently anterior cervical corpectomy has been introduced for the treatment of patients with multilevel degenerative cervical myelopathy [2,3]. Several studies reported that anterior cervical corpectomy and fusion was an affective procedure with a more favorable neurological improvement when compared to posterior decompressive laminectomy or laminoplasty [4,12].…”

Section: Discussionmentioning

confidence: 99%

“…However, the incidence of surgical relatedbecause of the complicated pathological changes of the spine and the increased presence of comorbidities. Recently anterior cervical corpectomy, titanium mesh cage (TMC) supporting and anterior cervical plate fixation has become a widely used surgical procedure for the treatment of multilevel cervical spondylotic myelopathy [2][3][4]. It has also been regarded as a safe procedure even in the elderly population [4].…”

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confidence: 99%

Surgical results of anterior corpectomy in the aged patients with cervical myelopathy

Lü

et al. 2007

Eur Spine J

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Retrospective study on the results of anterior corpectomy for the treatment of cervical myelopathy in patients over 70 years old. To evaluate the surgical results of anterior corpectomy in aged patients with multilevel cervical myelopathy and to investigate the probable pathomechanism by radiographic study. There are few data focused on the surgical results and post-operative complications of anterior corpectomy in aged patients with cervical myelopathy. Twenty patients 70 years of age or older who underwent anterior corpectomy, titanium mesh cage (TMC) reconstruction and anterior plate fixation for the treatment of compressive cervical myelopathy were reviewed. The average age at the time of operation was 75 years. Neurologic deficits before and after surgery were assessed using a scoring system proposed by the Japanese Orthopedic Association (JOA Score). Clinical results and post-operative complications were compared with those of patients 69 years old or younger as a control. Pre-operative Radiologic evaluation of every patient consisted of anterior-posterior, lateral, bilateral oblique, flextion, and extension radiographs, computed tomography and magnetic resonance imaging of the cervical spine. Any factor causing spinal cord compression and the sign of cervical instability were recorded. Surgical-related complications occurred in seven patients in the aged group. The incidence of complications was 35% in the aged patient group and 9.7% in the control group respectively. Although the difference was striking, no statistical significance was found between the two groups. One patient died of respiratory failure resulting from pulmonary infection. The mortality rate was 5%. The pre-operative mean JOA score was 9.3 (from 3 to 14) in the aged patient group. Nineteen patients were followed at least 2 years and the mean JOA score was 13.4 (from 8 to 17). 68.4% of the aged patients achieved a good or excellent result. There was no statistical difference in the recovery rate of JOA score between the aged group (58.1%) and control group (67.0%). In the pre-operative radiographs, the incidence of cervical instability was much higher in the control group (32%) than in the aged group (5%) and multilevel cord compression caused by posterior disc space osteophytes was more common in the aged group. Anterior corpectomy combined with TMC fusion and plate fixation provides favorable neurologic recovery even in the patients over 70 years old. However, the incidence of surgical related complications shows a conspicuous increasing in the aged patients. Overcompensation mechanism for cervical instability is the probable cause of degenerative cervical spondylotic myelopathy in aged patients.

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Anterior versus posterior approach for multilevel cervical spondylotic myelopathy

Zhao

Tian

et al. 2016

Cochrane Database of Systematic Reviews

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Results of Surgical Treatment for Degenerative Cervical Myelopathy

Cited by 78 publications

References 41 publications

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

Surgical results of anterior corpectomy in the aged patients with cervical myelopathy

Anterior versus posterior approach for multilevel cervical spondylotic myelopathy

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