Treatment of Multilevel Cervical Spondylotic Myeloradiculopathy With Posterior Decompression and Fusion With Lateral Mass Plate Fixation and Local Bone Graft

Huang, Russel C.; Girardi, Federico P.; Poynton, Ashley R.; Cammisa, Frank P.

doi:10.1097/00024720-200304000-00002

Cited by 86 publications

(61 citation statements)

References 34 publications

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“…6,17,18,25 However, such procedures are potentially associated with increased operative risk, including malpositioning of instrumentation 7,17 or postoperative sequelae, including screw pullout or screw fracture and pseudarthrosis. 7,18 As a result, the decision of whether to fuse the cervical spine during laminectomy for intradural tumors must take into account pre-and intraoperative variables to provide the patient with reasonable expectations for peri-and postoperative morbidity. nonlaminoplasty cases), our results suggest that patients with intradural tumors who undergo laminectomy of Ն 3 levels are at increased risk of requiring subsequent fusion compared with those patients in whom Յ 2 levels have been removed.…”

Section: Discussionmentioning

confidence: 99%

“…Although concomitant fusion procedures may permit more radical decompressions without concern for iatrogenically induced spinal instability, such procedures are not without their own associated risks, including instrumentation failure, damage to neurovascular structures with implantation, prolonged immobilization in patients not undergoing internal fixation, and potential for poor visualization if a tumor recurs due to hardware-associated imaging artifact. 7,15,17,18 Therefore, to more clearly identify those patients who might benefit from initial fusion procedures during cervical laminectomy for intradural tumor resection, factors associated with postoperative symptomatic cervical instability requiring subsequent fusion were assessed in an institutional cohort of patients harboring such lesions.…”

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confidence: 99%

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Factors associated with cervical instability requiring fusion after cervical laminectomy for intradural tumor resection

Sciubba¹,

Chaichana

Woodworth

et al. 2008

SPI

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Object The indications remain unclear for fusion at the time of cervical laminectomy for intradural tumor resection. To identify patients who may benefit from initial fusion, the authors assessed clinical, radiological/imaging, and operative factors associated with subsequent symptomatic cervical instability requiring fusion after cervical laminectomy for intradural tumor resection. Methods The authors reviewed 10 years of data obtained in patients who underwent cervical laminectomy without fusion for intradural tumor resection and who had normal spinal stability and alignment preoperatively. The association of pre- and intraoperative variables with the subsequent need for fusion for progressive symptomatic cervical instability was assessed using logistic regression analysis, and percentages were compared using Fisher exact tests when appropriate. Results Thirty-two patients (mean age 41 ± 17 years) underwent cervical laminectomy without fusion for resection of an intradural tumor (18 intramedullary and 14 extramedullary). Each increasing number of laminectomies performed was associated with a 3.1-fold increase in the likelihood of subsequent vertebral instability (odds ratio 3.114, 95% confidence interval 1.207–8.034, p = 0.02). At a mean follow-up interval of 25.2 months, 33% (4 of 12) of the patients who had undergone a ≥ 3-level laminectomy required subsequent fusion compared with 5% (1 of 20) who had undergone a ≤ 2-level laminectomy (p = 0.03). Four (36%) of 11 patients initially presenting with myelopathic motor disturbance required subsequent fusion compared with 1 (5%) of 21 presenting initially with myelopathic sensory or radicular symptoms (p = 0.02). Age, the presence of a syrinx, intramedullary tumor, C-2 laminectomy, C-7 laminectomy, and laminoplasty were not associated with subsequent symptomatic instability requiring fusion. Conclusions In the authors' experience with intradural cervical tumor resection, patients presenting with myelopathic motor symptoms or those undergoing a ≥ 3-level cervical laminectomy had an increased likelihood of developing subsequent symptomatic instability requiring fusion. A ≥ 3-level laminectomy with myelopathic motor symptoms may herald patients most likely to benefit from cervical fusion at the time of tumor resection.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Factors associated with cervical instability requiring fusion after cervical laminectomy for intradural tumor resection

Sciubba¹,

Chaichana

Woodworth

et al. 2008

SPI

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“…6,11,14,21,23,25,28,29 This large range in nonunion rates reflect variation in patient comorbidities, surgical indications, number of cervical spine levels fused, and the type of instrumentation and bone graft used. The introduction of lateral mass screw-rod fixation systems have biomechanically allowed a more rigid fixation for early bone fusions in the cervical spine.…”

Section: Discussionmentioning

confidence: 99%

“…Another form of autograft, local bone (morcelized lamina), has reduced non- union rates to 9.4%. 23 The use of allografts has avoided the complications from harvesting ICBG, 2,15,34,45 but has not reached the same fusion rates as ICBG. The introduction of BMP, however, has shown in clinical trails that it can be as effective in promoting excellent fusion rates as ICBG in the lumbar spine.…”

Section: Discussionmentioning

confidence: 99%

Reoperation rates for symptomatic nonunions in posterior cervical (subaxial) fusions with and without bone morphogenetic protein in a cohort of 1158 patients

Guppy

Harris

Chen

et al. 2016

SPI

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OBJECTIVE Bone morphogenetic protein (BMP) was first approved in 2002 for use in single-level anterior lumbar fusions as an alternative to iliac crest grafts. Subsequent studies have concluded that BMP provides superior fusions rates and therefore reduces reoperations for nonunions. The purpose of this study was to determine the reoperation rates for symptomatic nonunions in posterior cervical (subaxial) spinal fusions with and without the use of BMP and to determine if the nonunion rates are statistically significantly different between the two groups. METHODS Between January 2009 and September 2013, the authors identified 1158 posterior cervical spinal fusion cases in the subaxial spine (C2–7) from a large spine registry (Kaiser Permanente). Patient characteristics, diagnoses, operative times, lengths of stay, and reoperations were extracted from the registry. Reoperations for symptomatic nonunions were adjudicated via chart review. Logistic regression was conducted to produce estimates of odds ratios (OR) and 95% confidence intervals (CIs). Kaplan-Meier curves for the non-BMP and BMP groups were generated and compared using the log-rank test. RESULTS In this cohort there were 1158 patients (19.3% with BMP) with a median follow up of 1.7 years (interquartile range [IQR] 0.7–2.9 years) and median duration to operative nonunion of 0.63 years (IQR 0.44–1.57 years). Kaplan-Meier curves showed no significant difference in reoperation rates for nonunions using the log-rank test (p = 0.179). In a subset of patients with more than 1 year of follow-up, 788 patients were identified (22.5% with BMP) with a median follow-up duration of 2.5 years (IQR 1.7–3.4 years) and a median time to operative nonunion of 0.73 years (IQR 0.44–1.57 years). There was no statistically significant difference in the symptomatic operative nonunion rates for posterior cervical (subaxial) fusions with BMP compared with non-BMP (1.1% vs 0.7%; crude OR 1.73, 95% CI 0.32–9.55, p = 0.527) for more than 1 year of follow-up. CONCLUSIONS This study presents the largest series of patients using BMP in posterior cervical (subaxial) spinal fusions. Reoperation rates for symptomatic nonunions with more than 1 year of follow-up were found to be 1.1% with BMP and 0.7% without BMP. There was no significant difference in the reoperation rates for symptomatic nonunions with or without BMP.

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“…The ventral approach refers to multilevel discectomy and/or corpectomy with instrumented fusion, whereas the dorsal approach refers to midline cervical laminectomy and fu sion. 8,18 Each of these approaches has unique advantages and disadvantages. Although a dorsal approach is techni cally easier and avoids the morbidity associated with a ventral approach, it can cause significant postoperative muscular pain and is limited to patients who have either neutral or lordotic alignment.…”

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confidence: 99%

Ventral fusion versus dorsal fusion: determining the optimal treatment for cervical spondylotic myelopathy

Alvin

Lubelski

Benzel

et al. 2013

FOC

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Cervical spondylotic myelopathy (CSM) often can be surgically treated by either ventral or dorsal decompression and fusion. However, there is a lack of high-level evidence on the relative advantages and disadvantages for these treatments of CSM. The authors' goal was to provide a comprehensive review of the relative benefits of ventral versus dorsal fusion in terms of quality of life (QOL) outcomes, complications, and costs. They reviewed 7 studies on CSM published between 2003 and 2013 and summarized the findings for each category. Both procedures have been shown to lead to statistically significant improvement in clinical outcomes for patients. Ventral fusion surgery has been shown to yield better QOL outcomes than dorsal fusion surgery. Complication rates for ventral fusion surgery range from 11% to 13.6%, whereas those for dorsal fusion surgery range from 16.4% to 19%. Larger randomized controlled trials are needed, with particular emphasis on QOL and minimum clinically important differences.

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Treatment of Multilevel Cervical Spondylotic Myeloradiculopathy With Posterior Decompression and Fusion With Lateral Mass Plate Fixation and Local Bone Graft

Cited by 86 publications

References 34 publications

Factors associated with cervical instability requiring fusion after cervical laminectomy for intradural tumor resection

Factors associated with cervical instability requiring fusion after cervical laminectomy for intradural tumor resection

Reoperation rates for symptomatic nonunions in posterior cervical (subaxial) fusions with and without bone morphogenetic protein in a cohort of 1158 patients

Ventral fusion versus dorsal fusion: determining the optimal treatment for cervical spondylotic myelopathy

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