Multisegmental Cervical Spondylotic Myelopathy and Radiculopathy Treated by Multilevel Oblique Corpectomies without Fusion

George, Bernard; Gauthier, Nathalie; Lot, Guillaume

doi:10.1097/00006123-199901000-00046

Cited by 96 publications

(66 citation statements)

References 98 publications

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“…Although the OCC was described more than a decade ago, [6] it has not gained popularity probably due to the demanding technique related to mobilization of the sympathetic chain and concomitant Horner's syndrome as well as the risk of vertebral artery injury. We found that in most cases the Horner's syndrome is temporary and our incidence of permanent Horner's syndrome was 8.2%, although patients were asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…Only a brief description of the technique of the OCC will be made here since it has been described in detail before [6]. Through a longitudinal skin incision along the anterior border of the right sternocleidomastoid muscle, the carotid sheath is retracted medially to expose the transverse processes of the cervical vertebrae.…”

Section: Operative Proceduresmentioning

confidence: 99%

“…The oblique cervical corpectomy (OCC) has slowly emerged as an established method of decompressing the spine in patients with cervical spondylotic myelopathy (CSM) [4][5][6][7][8][9][10]. The reason it is attractive that it allows for a long segment of decompression (up to five levels) without the need for a bone graft or instrumentation as its proponents claim that stability and sagittal alignment are maintained.…”

Section: Introductionmentioning

confidence: 99%

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Multilevel oblique corpectomy for cervical spondylotic myelopathy preserves segmental motion

et al. 2012

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Purpose To document the neurological outcome, spinal alignment and segmental range of movement after oblique cervical corpectomy (OCC) for cervical compressive myelopathy. Methods This retrospective study included 109 patients-93 with cervical spondylotic myelopathy and 16 with ossified posterior longitudinal ligament in whom spinal curvature and range of segmental movements were assessed on neutral and dynamic cervical radiographs. Neurological function was measured by Nurick's grade and modified Japanese Orthopedic Association (JOA) scores. Eighty-eight patients (81%) underwent either a single-or two-level corpectomy; the remaining (19%) undergoing three-or four-level corpectomies. The average duration of follow-up was 30.52 months. Results The Nurick's grade and the JOA scores showed statistically significant improvements after surgery (p \ 0.001). The mean postoperative segmental angle in the neutral position straightened by 4.7 ± 6.5°. The residual segmental range of movement for a single-level corpectomy was 16.7°(59.7% of the preoperative value), for two-level corpectomy it was 20.0°(67.2%) and for three-level corpectomies it was 22.9°(74.3%). 63% of patients with lordotic spines continued to have lordosis postoperatively while only one became kyphotic without clinical worsening. Four patients with preoperative kyphotic spines showed no change in spine curvature. None developed spinal instability. Conclusions The OCC preserves segmental motion in the short-term, however, the tendency towards straightening of the spine, albeit without clinical worsening, warrants serial follow-up imaging to determine whether this motion preservation is long lasting.

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Section: Discussionmentioning

confidence: 99%

Section: Operative Proceduresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multilevel oblique corpectomy for cervical spondylotic myelopathy preserves segmental motion

et al. 2012

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“…George et al [16] reported preservation of sagittal alignment in the majority of their cases with no more than a 5°kyphotic change at the operated segment. Because they restrict the use of the OCC to those patients who had collapsed hard discs they did not discuss preservation of motion as most of these spines were rigid.…”

Section: Discussionmentioning

confidence: 94%

“…The oblique corpectomy has been used for over two decades and provides adequate decompression without the need for a graft or a stabilization device [8][9][10][11][12][13][14][15]. George et al [16] introduced this procedure in 1992 and recommended it in patients with fused, degenerated spines in whom little movement was seen preoperatively. Since then, there is limited literature available on the results of oblique cervical corpectomy (OCC) and although good clinical outcomes have been reported, and there is insufficient data with regard to the maintenance of sagittal alignment and preservation of cervical motion [10][11][12]15].…”

Section: Introductionmentioning

confidence: 99%

Reduction in range of cervical motion on serial long-term follow-up in patients undergoing oblique corpectomy for cervical spondylotic myelopathy

et al. 2013

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Purpose To determine whether motion preservation following oblique cervical corpectomy (OCC) for cervical spondylotic myelopathy (CSM) persists with serial followup. Methods We included 28 patients with preoperative and at least two serial follow-up neutral and dynamic cervical spine radiographs who underwent OCC for CSM. Patients with an ossified posterior longitudinal ligament (OPLL) were excluded. Changes in sagittal curvature, segmental and whole spine range of motion (ROM) were measured. Nathan's system graded anterior osteophyte formation. Neurological function was measured by Nurick's grade and modified Japanese Orthopedic Association (JOA) scores. ResultsThe majority (23 patients) had a single or 2-level corpectomy. The average duration of follow-up was 45 months. The Nurick's grade and the JOA scores showed statistically significant improvements after surgery (p \ 0.001). 17 % of patients with preoperative lordotic spines had a loss of lordosis at last follow-up, but with no clinical worsening. 77 % of the whole spine ROM and 62 % of segmental ROM was preserved at last follow-up. The whole spine and segmental ROM decreased by 11.2°a nd 10.9°, respectively (p B 0.001). Patients with a greater range of segmental movement preoperatively had a statistically greater range of movement at follow-up. The analysis of serial radiographs indicated that the range of movement of the whole spine and the range of movement at the segmental spine levels significantly reduced during the follow-up period. Nathan's grade showed increase in osteophytosis in more than two-thirds of the patients (p B 0.01). The whole spine range of movement at followup significantly correlated with Nathan's grade. Conclusions Although the OCC preserves segmental and whole spine ROM, serial measurements show a progressive decrease in ROM albeit without clinical worsening. The reduction in this ROM is probably related to degenerative ossification of spinal ligaments.

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Clinical importance of ligamentous and osseous structures in the cervical uncovertebral foraminal region

Yılmazlar¹,

Kocaelı²,

Uz³

et al. 2003

Clinical Anatomy

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The vertebral artery, cervical spinal nerves, spinal nerve roots, and the bony and ligamentous tissue related to the cervical vertebrae are structures whose anatomy determines the path of a surgical approach. Defining the anatomy and, in particular, determining the precise location of vulnerable structures at the intervertebral foramen and the uncovertebral foraminal region (UVFR), a region defined by the uncinate process anteriorly, the facet joint posteriorly and the foramen transversarium laterally, has critical significance when selecting the safest surgical approach. We studied the anatomy of the vertebral artery, cervical spinal nerves, and spinal nerve roots within the UVFR in six cadaver specimens. We also obtained measurements of bony structures in 35 dry cervical vertebral columns, from C3-C7. The uncinate process (UP) projects superiorly from the posterolateral aspect of each cervical vertebral body, except for the first and second vertebrae. Because the posterior part of the UP lies adjacent to the vertebral artery, spinal nerve, and spinal nerve roots, its resection creates sufficient space to decompress these structures directly. The posterolateral surface of the UP is covered by ligamentous tissue that originates from the posterior longitudinal ligament and protects the neural and vascular structures during their decompression in the UVFR.

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Multisegmental Cervical Spondylotic Myelopathy and Radiculopathy Treated by Multilevel Oblique Corpectomies without Fusion

Abstract: MOC is a safe and efficient technique. It must be applied for patients with anterior compression and straight or kyphotic axis of the spine. No fusion is required regardless of the number of levels, providing there are no soft discs and there is no preoperative instability.

Cited by 96 publications

References 98 publications

Multilevel oblique corpectomy for cervical spondylotic myelopathy preserves segmental motion

Multilevel oblique corpectomy for cervical spondylotic myelopathy preserves segmental motion

Reduction in range of cervical motion on serial long-term follow-up in patients undergoing oblique corpectomy for cervical spondylotic myelopathy

Clinical importance of ligamentous and osseous structures in the cervical uncovertebral foraminal region

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