Anterior Versus Posterior Surgical Approaches to Treat Cervical Spondylotic Myelopathy

Fehlings, Michael G.; Barry, Sean; Kopjar, Branko; Yoon, S. Tim; Arnold, Paul M.; Massicotte, Eric M.; Vaccaro, Alexander R.; Brodke, Darrel S.; Shaffrey, Christopher I.; Smith, Justin S.; Woodard, Eric J.; Banco, Robert; Chapman, Jens R.; Janssen, Michael; Bono, Christopher M.; Sasso, Rick C.; Dekutoski, Mark B.; Gokaslan, Ziya L.

doi:10.1097/brs.0000000000000047

Cited by 204 publications

(70 citation statements)

References 10 publications

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“…Moreover, compression in the present model is only mediated from posterior, whereas in human CSM it can occur selectively anterior, posterior, or circumferentially. The method of decompression in the present model is consistent with a posterior decompression in human patients, which has been shown to be comparable to anterior decompression in terms of post-operative outcome [15, 32]. …”

Section: Discussionsupporting

confidence: 62%

Axonal plasticity underpins the functional recovery following surgical decompression in a rat model of cervical spondylotic myelopathy

Dhillon

Parker

Syed

et al. 2016

acta neuropathol commun

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Cervical spondylotic myelopathy (CSM) is the most common spinal cord disorder and a major cause of disability in adults. Improvements following surgical decompression are limited and patients often remain severely disabled. Post mortem studies indicate that CSM is associated with profound axonal loss. However, our understanding of the pathophysiology of CSM remains limited.To investigate the hypothesis that axonal plasticity plays a role in the recovery following surgical decompression, we adopted a novel preclinical model of mild to moderate CSM. Spinal cord compression resulted in significant locomotor deterioration, increased expression of the axonal injury marker APP, and loss of serotonergic fibres. Surgical decompression partially reversed the deficits and attenuated APP expression. Decompression was also associated with axonal sprouting, reflected in the restoration of serotonergic fibres and an increase of GAP43 expression. The re-expression of synaptophysin indicated the restoration of functional synapses following decompression. Promoting axonal plasticity may therefore be a therapeutic strategy for promoting neurological recovery in CSM.Electronic supplementary materialThe online version of this article (doi:10.1186/s40478-016-0359-7) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 62%

Axonal plasticity underpins the functional recovery following surgical decompression in a rat model of cervical spondylotic myelopathy

Dhillon

Parker

Syed

et al. 2016

acta neuropathol commun

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“…However, debate persists about selecting anterior or posterior approaches [491011]. Many studies have shown good clinical and radiological outcomes with anterior, posterior or combined approaches.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have shown good clinical and radiological outcomes with anterior, posterior or combined approaches. Notwithstanding the general agreement about the most appropriate approach, such as posterior approach for multi-level involvement and anterior approach for kyphotic deformity, definite guidelines have not been established [911]. In some cases, radiological patterns have been used to select a surgical approach for cervical spondylotic myelopathy, although definite conclusions have never been reached [12].…”

Section: Discussionmentioning

confidence: 99%

Agreement on the Level Selection in Laminoplasty among Experienced Surgeons: A Survey-Based Study

et al. 2016

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Study DesignSurvey based study.PurposeTo assess the degree of agreement in level selection of laminoplasty (LP) for the selected cervical myeloradiculopathy cases between experienced spine surgeons.Overview of LiteratureAlthough, cervical LP is a widely used surgical technique for multi-level spinal cord compression, until now there is no consensus about how many segments or which segments should be opened to achieve a satisfactory decompression.MethodsThorough clinical and radiographic data (plain X-ray, computed tomography, and magnetic resonance imaging) of 30 patients who had cervical myelopathy were prepared. The data were provided to three independent spine surgeons with over 10 years experience in operation of their own practices. They were questioned about the most preferable surgical method and suitable decompression levels. The second survey was carried out after 6 months with the same cases. If the level difference between respondents was a half level or below, agreement was considered acceptable. The intraobserver and interobserver agreements in level selection were assessed by kappa statistics.ResultsThree respondents selected LP as an option for 6, 8, and 22 cases in the first survey and 10, 21, and 24 cases in the second survey. The reasons for selection of LP were levels of ossification of the posterior longitudinal ligament (p=0.004), segmental kyphotic deformity (p=0.036) and mean compression score (p=0.041). Intraobserver agreement showed variable results. Interobserver agreement was poor to fair by perfect matching (kappa=0.111–0.304) and fair to moderate by acceptable matching (kappa=0.308–0.625).ConclusionsThe degree of agreement for level selection of LP was not high even though experienced surgeons would choose the opening segments on the basis of same criteria. These results suggest that more specific guidelines in determination of levels for LP should be required to decrease unnecessary wide decompression according to individual variance.

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“…12 Secondly, modern studies demonstrate improvement in mJOA and SF-36 PCS scores following surgery for CSM. 12,22 The mean mJOA scores for patients in the Kadanka studies did not improve following surgery and it is unclear what the reasons were for the lack of improvement.…”

Section: Comparative Studies - Mixed Results For Surgerymentioning

confidence: 99%

“…They observed a 2.5-3.5 point improvement in mJOA following surgery (regardless of approach) and also significant improvements in the SF-36 PCS scores. 22 Although non-operative treatment was not compared to surgical treatment in these studies, the number of patients studied was larger than previous RCTs and the study used validated outcomes tools to demonstrate the treatment effect of surgery.…”

Section: Modern Prospective Studiesmentioning

confidence: 99%

Surgery vs Conservative Care for Cervical Spondylotic Myelopathy

et al. 2015

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Anterior Versus Posterior Surgical Approaches to Treat Cervical Spondylotic Myelopathy

Abstract: 3.

Cited by 204 publications

References 10 publications

Axonal plasticity underpins the functional recovery following surgical decompression in a rat model of cervical spondylotic myelopathy

Axonal plasticity underpins the functional recovery following surgical decompression in a rat model of cervical spondylotic myelopathy

Agreement on the Level Selection in Laminoplasty among Experienced Surgeons: A Survey-Based Study

Surgery vs Conservative Care for Cervical Spondylotic Myelopathy

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