Surgical Management of Cervical Spondylotic Myelopathy

Abstract

Introduction: The surgical procedure by the anterior, posterior and combined antero-posterior approaches had applied for the treatment of cervical spondylotic myelopathy. 
 Methods: During the treatment process, all patients were pre-operatively as well post-operatively graded according to Japanese Orthopaedics Association. Several surgical methods such as anterior approach, posterior approach, and combined antero-posterior approach have been addressed for CSM patients, with the choice based on the pathogenesis of the myelopathy. The main indications for surgery were evidence of myelopathy on physical examinations, a JOA score below 13 points help with spinal cord compression observed on plain X-ray, CT scan, MRI studies. 
 Results: The pre-operative JOA scores were 7.60±1.23 in laminoplasty, 8.30±1.03 in diskectomy and corpectomy and 7.10±1.20 in combined antero-posterior approach patients. At the follow-up after three months the JOA scores were laminoplasty 13.30±1.30, diskectomy and corpectomy 13.55±1.15 and combined antero-posterior 13.50±1.08. The JOA recovery rate averaged, 61.08±11.25% in laminoplasty, 60.67±10.60% in diskectomy and corpectomy and 64.67±10.72% in combined anteroposterior approach. The high- signal intensity changed to normal in 18 out of 28 and no any kyphotic change and instability were found in cervical spine at the follow up. 
 Conclusions: Patients with OPLL (continuous, segmental and mixed type), stenosis of cervical spinal canal, multilevel cervical spondylosis, large and high ossification of IVDP with stenosis were improved with laminoplasty. Patients with PIVD, CSM with kyphosis, post laminectomy , OPLL herniated type, unstable vertebral alignment, stenosis by osteophytes, were improved with anterior approach . Ossified or deformed OPLL, unstable vertebral with stenosis ,OPLL or OYL with cervical meandearing (swan-neck) were improved with Combined anterior and posterior approach.
 Keywords: cervical spondylotic mylopathy, anterior cervical diskectomy and fusion, corpectomy.

Clinical outcome of anterior vs posterior approach for cervical spondylotic myelopathy

“…The affection of more than 3 segments with additional kyphosis is a clear indication for combined approach (Table 5). 3,[7][8][9][10][11][12][13]17,18 Clinical outcome can be achieved using both approaches, which is also reflected in the present study. Anterior pathologies that involve only 1 or 2 vertebral body levels usually proceed using an anterior approach, while in cases of more than 2 levels the posterior approach appears to be more suitable due to swallowing difficulty and construct failure.…”

“…9 Role of the spinal canal diameter Development of sever stenosis. 3,8,9 Canal diameter <11 mm and involvement of multiple. 3 Role of the localization of the deformity A good visualization of the anomaly found on the anterior section, spares the effort to go around the spinal cord.…”

“…3 One or two segments with a space-occupying lesion as osteophytes or disc tissue. 3,9 Herniated posterior longitudinal ligament. 9 Buckling of the ligamentum flavum or vertebral lamina ladder deformity in patients with hyperlordosis.…”

“…3,9 Herniated posterior longitudinal ligament. 9 Buckling of the ligamentum flavum or vertebral lamina ladder deformity in patients with hyperlordosis. 3 Role of the preoperative neck pain Disruption of posterior paraspinal by a posterior approach can aggravate the pain.…”

“…3 Kyphosis can diminish and in some cases be corrected in its whole. 8,9 Three or more segments without kyphosis. 3,8 Severe osteoporosis and stenosis of multiple segments.…”