Clinical results of median corpectomy in cervical spondylotic patients with myelopathy

Abstract

ABSTRACTis the most frequent cause of acquired spastic paraparesis and myelopathy in the advanced age group (11,26). CSM results in serious loss of function in the elderly and consumption of health resources. Misdiagnosis of this condition has decreased substantially as direct radiography, computerized tomography (CT) and magnetic resonance imaging (MRI) are used more widely. However, there is no consensus on the optimal treatment. Discussion is focused on whether the treat- █ InTRODuCTIOnCervical spondylosis is a progressive and degenerative condition that starts from the intervertebral disc and continues with the hypertrophy of osseous and connective tissue surrounding the spinal canal (20). Cervical spondylotic myelopathy (CSM) is a neurologic disorder resulting from chronic compression of medulla spinalis and nerve roots in the spinal canal that has been narrowed down due to spondylosis (36,39). CSM AIM: To determine the factors in choosing the right surgical technique for patients with cervical spondylotic myelopathy. MATERIAl and METhODS:60 patients were operated with anterior median corpectomy and anterior fusion for cervical myelopathy in Ankara Atatürk Education and Research Hospital between the years 2006-2011. All data were obtained from patient files retrospectively. Patients were evaluated in the preoperative and early postoperative stages and 45 days after discharge by referring to their neurological examinations, Japanese Orthopaedic Association (JOA) and Nurick scores and radiological findings. RESulTS:The average age of the patients was 53.8 ± 9.9 years (38-78) and 45 were male (75%) and 15 were female (25%). Diabetics made up 16.7% (n=10) of the group and nondiabetics 83.3% (n=50). Of the nondiabetic patients, the Nurick score on the first month after surgery was statistically lower than the preoperative and after 24 hours Nurick score (p<0.001). In the patients in the group that had 1 or 2 myelopathic findings, the Nurick score on the first month after surgery was statistically lower than the preoperative and after 24 hours Nurick score (p<0.001). The JOA score one month after surgery was statistically lower in patients with myelomalacia than in patients without myelomalacia (p=0.002).COnCluSIOn: Median corpectomy and anterior fusion technique had better scores in patients that had few and early myelopathic symptoms, no myelomalacia on MRI, and no systemic disease.

Significance of Preoperative Prone Position Computed Tomography in Free Hand Subaxial Cervical Pedicular Screwing

“…The subaxial cervical posterior pedicle screwing technique provides a powerful construct in stabilising the cervical vertebrae [13][14][15]28) . It also gives extreme manoeuvrability in correcting vertebral deformities.…”