Surgical management of cervical myelopathy: indications and techniques for multilevel cervical discectomy

Hillard, Virany; Apfelbaum, Ronald I.

doi:10.1016/j.spinee.2006.05.005

Cited by 61 publications

(50 citation statements)

References 35 publications

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“…Although extensive research on the two approaches has been done [7][8][9][10][11][12][13][14][15][16][17][18], yet studies on the comparison of the two approaches are limited. Furthermore, a wide variation in patient population, study design and results exists.…”

Section: Introductionmentioning

confidence: 99%

Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review

Liu

Cheng

et al. 2010

Eur Spine J

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The objective of the study is to perform a systematic review to compare the clinical outcomes and complications of anterior surgery with posterior surgery for multilevel cervical myelopathy (MCM). MEDLINE, EM-BASE databases and other databases were searched for all the relevant original articles published from January 1991 to November 2009 comparing anterior with posterior surgery for MCM. Subgroup analysis was performed according to the follow-up years. The following end points were mainly evaluated: final follow-up JOA (Japanese Orthopaedic Association) scale, recovery rate and complication outcomes. Ten articles fulfilled all inclusion criteria. For multilevel CSM patients, the final follow-up JOA score for the anterior group was significantly higher than the posterior group (p \ 0.05, WMD 0.83 [0.24, 1.43] [31] which mean follow-up time was 6 years was enrolled in the 'follow-up time [5 years' subgroup. The results showed there was no significant difference in final follow-up JOA score and recovery rate between anterior and posterior group for patients with occupying ratio of OPLL \60% (p [ 0.05), while in patients with occupying ratio C60%, the final follow-up JOA score and recovery rate of anterior surgery were both superior to that of posterior surgery (p \ 0.05). For both multilevel CSM and OPLL patients, the complications for the anterior group were significantly more than the posterior group in the 'follow-up time B5 years' subgroup (p \ 0. 05, OR 7.33 [2.96, 18.20 (2011( ) 20:224-235 DOI 10.1007( /s00586-010-1486 OPLL patients with occupying ratio C60%, anterior surgery had superior clinical outcome to posterior surgery.Eur Spine J

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Section: Introductionmentioning

confidence: 99%

Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review

Liu

Cheng

et al. 2010

Eur Spine J

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“…The choice among anterior, posterior, or combined approaches for decompression of CSM is based primarily on (1) the location of compressive pathology, (2) the extent of the degenerative process (3) sagittal alignment of the cervical spine, (4) the presence of preoperative neck pain, (5) previous operations, and (6) the patient's age and overall medical conditions [1,4,5]. Generally, for patients with only 1 or 2-level CSM, the majority of surgeons prefer an anterior procedure [6,7].…”

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confidence: 99%

A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy

et al. 2011

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Background The optimal surgical approach for multilevel cervical spondylotic myelopathy (CSM) has not been defined, and the relative merits of multilevel anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy (2-level or skip 1-level corpectomy) and fusion (ACCF) remain controversial. However, few comparative studies have been conducted on these two surgical approaches. Methods This study retrospectively reviewed the case histories of 120 patients that underwent surgical treatment for 3-or 4-level CSM from July 2003 to June 2008. One hundred and twenty patients (81 male and 39 female) of mean age 58.3 ± 9.8 years (37-78) were included. The study compared perioperative parameters (blood loss, operation times), complications [surgery-related complications (CSF, hoarseness, epidural hematoma, C5-palsy, dysphagia), instrumentation and graft related complications (dislodgement, subsidence)], clinical parameters [Japanese Orthopedic Association (JOA) scores, Neck Dysfunciton Index (NDI) scores], and radiologic parameters (segmental lordosis, fusion rate). Results At a minimum of 2-year follow-up, both ACDF and ACCF groups demonstrated a significant increase in the JOA scores (preoperatively 9.25 ± 1.9 and 8.86 ± 1.9, postoperatively 13.86 ± 1.6 and 13.27 ± 1.8, respectively), segmental lordosis (preoperatively 9.79 ± 3.4 and 9.54 ± 3.0, postoperatively 17.75 ± 2.6 and 14.49 ± 2.5, respectively) and NDI scores (preoperatively 12.56 ± 3.0 and 12.21 ± 3.4, postoperatively 3.44 ± 1.7 and 5.68 ± 2.6, respectively). Six patients (2 dislodgement, 4 subsidence) in ACCF group had instrumentation and graft related-complications and they had no obvious neurological symptoms without a second operation. Blood loss (102.81 ± 51.3 and 149.05 ± 74, respectively, P = 0.000), NDI scores (P = 0.000), and instrumentation and graft related-complications (P = 0.032) were significantly lower in the ACDF group, whereas operation time (138.07 ± 30.9 and 125.08 ± 26.4, respectively, P = 0.021) and segmental lordosis (P = 0.000) were significantly greater in the ACDF group. Other parameters were not significantly different in the two groups. Conclusions Surgical managements of 3-or 4-level CSM by ACDF or ACCF showed no significant differences in terms of achieved clinical symptom improvements, with the exception of better postoperative NDI scores in ACDF. In addition, ACDF is better than ACCF in terms of blood loss, lordotic curvature improvement and instrumentation and graft related-complication rates, with the exception of operation times.

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“…Direct spinal cord decompression can be achieved with an intersegmental approach by utilizing the techniques described by Hillard and Apfelbaum, 23 and correction of kyphosis indirectly increases the space for the spinal cord. The significant improvement seen in Nurick grades following surgery is similar to that reported by others treating less extensive disease.…”

Section: Discussionmentioning

confidence: 99%

Total subaxial reconstruction

Traynelis¹

2010

SPI

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Object. Certain cervical spinal conditions require decompression and reconstruction of the entire subaxial cervical spine. There are limited data concerning the clinical details and outcomes of patients treated in this manner. The object of this study was to describe the specific technique employed to perform a total subaxial reconstruction and review the postoperative outcomes following surgery.Methods. The author performed a review of data prospectively collected in 27 consecutive patients undergoing complete anterior decompression and reconstruction of the anterior cervical spine and followed by posterior instrumented arthrodesis with or without decompression.Results. There were 16 men and 11 women whose mean age was 59 years (range 35-86 years). The minimum follow-up was 12 months and the mean follow-up period for all patients was 26 months. One patient underwent C2-7 surgery, and in all others the procedure crossed the cervicothoracic junction.Following surgery patients remained intubated for an average of 3.3 days (range 1-22 days). The mean hospital length of stay was 11 days (range 3-45 days). One patient died 6 weeks following an uneventful surgery. Pneumonia developed in 5 patients, 1 patient experienced a minor pulmonary embolism, and 2 patients had posterior wound infections. No patient was neurologically worse following surgery. A single patient presented with a C-8 radiculopathy 6 weeks after surgery. At final follow-up no patient complained of dysphagia when specifically questioned about this potential problem. In all patients solid fusions developed at each treated levels. Preoperatively the mean sagittal Cobb angle was 15.4° (kyphosis) and the postoperative mean angle was −10.9° (lordosis) representing a total average correction of over 25° (p < 0.0001). The mean preoperative Neck Disability Index was 27.6; this score decreased to 15.5 (p = 0.0008) postoperatively. The mean pre-and postoperative visual analog scale neck pain scores were 6.0 and 2

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Surgical management of cervical myelopathy: indications and techniques for multilevel cervical discectomy

Cited by 61 publications

References 35 publications

Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review

Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review

A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy

Total subaxial reconstruction

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