Prospective study of surgical outcomes of cervical myelopathy based on its etiology, duration of affection and radiological patterns of compression

Authors

  • Rajdeepsinh P. Jadeja Department of Orthopedics, K. J. Somaiya Medical College, Hospital and Research Centre, Mumbai, Maharashtra, India
  • Nishat M. Goda Department of Orthopedics, K. J. Somaiya Medical College, Hospital and Research Centre, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20222699

Keywords:

Cervical spine, ACDF, mJOA, Nurick, ACCF

Abstract

Background: Cervical spondylotic myelopathy (CSM) is considered the commonest cause of spinal cord dysfunction in individuals above 55 years of age and if left untreated, permanent cord damage may occur. This could contribute to increased dependence and reduced quality of life in older individuals. A prospective cohort study done in patients with cervical myelopathy who were admitted and operated after considering inclusion and exclusion criteria.

Methods: A prospective cohort study done in patients with cervical myelopathy who were admitted and operated after considering inclusion and exclusion criteria. Total 30 patients included in study. patients were operated according to patterns of compression. Anterior/posterior decompression SOS instrumentation was done according to POC. Pre-op and post-op Nurick’s grading, pre-op and post-op modified Japanese orthopaedics association (mJOA) scores were used for comparison. Patients were followed up for period of 1 year from surgical intervention. Recovery rate calculated using preop and post op mJOA scores.

Results: Overall satisfactory surgical outcome found in patients of cervical myelopathy, out of 30 patients, 9 patients of pattern of compression I (POC I) had  recovery rate (RR) of (91.6±7.8) , 8 patients of POC II had RR of (78.4±14.8), 6 patients of POC III had RR of (73.5±11.1), 4 patients of POC IV had RR of (74.9±29.2), 3 patients of POC IVv had RR of (80.4±4.1).the assessment of the final outcome was done using mJOA scoring system  and Nurick’s grading system.

Conclusions: Anterior cervical discectomy and fusion (ACDF) for POC I (one- or two-level anterior cord compression) and POC II (one or two levels of anterior and posterior cord compression) give good surgical outcome. Cervical laminectomy and SOS instrumentation is recommended for POC III (3 levels of anterior cord compression), IV (3 or more levels of anterior compression and development of narrow canal with multiple posterior compression) and IV variant (similar to POC IV with one or two levels, being more significant than the others).earlier diagnosis, prompt radiological investigations, individualizing surgical protocol, proper surgical techniques and proper follow-up evaluation are key in management of patients of cervical myelopathy.

References

Montgomery DM, Brower RS. Cervical spondylotic myelopathy. Clinical syndrome and natural history. Orthop Clin North Am. 1992;23(3):487-93.

Baron EM, Young WF. Cervical spondylotic myelopathy: a brief review of its pathophysiology, clinical course, and diagnosis. Neurosurgery. 2007;60(1):S35-41.

Brain WR, Northfield D, Wilkinson M. The neurological manifestations of cervical spondylosis. Brain. 1952;75(2):187-225.

Furlan JC, Kalsi-Ryan S, Kailaya-Vasan A, Massicotte EM, Fehlings MG. Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: a prospective study of 81 cases. J Neurosurg Spine. 2011;14(3):348-55.

Sadasivan KK, Reddy RP, Albright JA. The natural history of cervical spondylotic myelopathy. Yale J Biol Med. 1993;66(3):235-42.

Hoff JT, Wilson CB. The pathophysiology of cervical spondylotic radiculopathy and myelopathy. Clin Neurosurg. 1977;24:474-87.

Shedid D, Benzel EC. Cervical Spondylosis Anatomy Pathophysiology and Biomechanics. Neurosurgery. 2007;60(1):S1-7-S1-13.

White AA 3rd, Panjabi MM. Biomechanical considerations in the surgical management of cervical spondylotic myelopathy. Spine (Phila Pa 1976). 1988;13(7):856-60.

Emery SE. Cervical spondylotic myelopathy: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9(6):376-88.

Morishita Y, Falakassa J, Naito M, Hymanson HJ, Taghavi C, Wang JC. The kinematic relationships of the upper cervical spine. Spine (Phila Pa 1976). 2009;34(24):2642-5.

Crandall PH, Batzdorf U. Cervical spondylotic myelopathy. J Neurosurg. 1966;25(1):57-66.

Abramovits JN, Srinivasan M. Painless arm weakness without leg symptoms in cervical spondylotic myelopathy. Poster exhibit at the Annual Meeting of the congress of Neurological Surgeons, Seattle, Washington. 1988;24-9.

Epstein JA. Management of cervical spinal stenosis, spondylosis, and myeloradiculopathy. In Contemporary Neurosurgery, edited by G. T. Tindall. Baltimore, Williams and Wilkins, 1985;2:1-6

Hayashi H, Okada K, Hamada M, Tada Koichi, Ueno R. Etiologic factors of myelopathy. A radiographic evaluation of the aging changes in the cervical spine. C/in. Orthop.1987;214:200-9.

Okamoto N, Murakami Y, Baba I, Kubo T. H-reflex of the upper extremities in cervical myelopathy. Int Orthop. 1980;4(3):193-203.

Crandall H, Gregorius FK. Long term follow-up of surgical treatment of cervical spondylotic myelopathy. Spine 1977;2:13946.

Matz PG, Pritchard PR, Hadley MN. Anterior cervical approach for treatment of cervical myelopathy. Neurosurgery 2007;60(1):S64-70.

Mummaneni PV, Haid Jr RW, Rodts Jr GE. Combined ventral and dorsal surgery for myelopathy and myeloradiculopathy. Neurosurgery. 2007;60(1):S82-9.

Kandziora F, Pflugmacher R, Schafer J, Born C, Duda G, Hass NP et al. Biomechanical comparison of cervical spine interbody fusion cages. Spine. 2001;26:1850-7.

Zhang L, Zeitoun D, Rangel A, Lazennec JY, Catonne Y, Pascal-Moussellard H. Preoperative evaluation of the cervical spondylotic myelopathy with Flexion-extension magnetic resonance imaging. About a prospective study in fifty patients. Spine (Phila Pa 1976). 2011;36:E1134-9.

Highsmith JM, Dhall SS, Haid Jr RW, Rodts Jr GE, Mummnenin PV. Treatment of cervical stenotic myelopathy: A cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion. J Neurosurg Spine. 2011;14:619-25.

Liu JK, Das K. Posterior fusion of the subaxial cervical spine: Indications and techniques. Neurosurg Focus. 2001;10:E7.

Chen Y, Guo Y, Lu X, Chen D, Song D, Shi J et al. Surgical strategy for multilevel severe ossification of the posterior longitudinal ligament in the cervical spine. J Spinal Disord Tech. 2011;24:24-30.

Komotar RJ, Mocco J, Kaiser MG. Surgical management of cervical myelopathy: Indications and techniques for laminectomy and fusion. Spine J. 2006;6(6):252S-67S.

Hirabayashi K, Watanabe K, Wakano K, Suzuki N, Satomi K, Ishii Y. Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine (Phila Pa 1976). 1983:8:693-9.

Takayasu M, Hara M, Yamauchi K, Yoshida M, Yoshida J. Transarticular screw fixation in the middle and lower cervical spine. Technical note. J Neurosurg. 2003;99 (1):132-6.

Matsumoto M, Nojiri K, Chiba K, Toyama Y, Fukui Y, Kamata M. Open-door laminoplasty for cervical myelopathy resulting from adjacent-segment disease in patients with previous anterior cervical decompression and fusion. Spine (Phila Pa 1976). 2006;31:1332-7.

Wang XY, Dai YL, Xu HZ, Chi YL. Prediction of spinal canal expansion following cervical laminoplasty: A computer-simulated comparison between single and double-door techniques. Spine (Phila Pa 1976). 2006;31:2863-70.

Seichi A, Hoshino Y, Kimura A. Neurological complications of cervical laminoplasty for patients with ossification of the posterior longitudinal ligament-a multi-institutional retrospective study. Spine (Phila Pa 1976). 2011;36(15):E998-E1003.

Sakaura H, Hosono N, Mukai Y, Ishii T, Yoshikawa H. C5 palsy after decompression surgery for cervical myelopathy: review of the literature. Spine (Phila Pa 1976). 2003;28(21):2447-51.

Hukuda S, Mochizuki T, Ogata M, Shichikawa K, Shimomura Y. Operations for cervical spondylotic myelopathy. A comparison of the results of anterior and posterior procedures. J Bone Joint Surg Br. 1985;67(4):609-15.

Edwards CC 2nd, Riew KD, Anderson PA, Hilibrand AS, Vaccaro AF. Cervical myelopathy. current diagnostic and treatment strategies. Spine J. 2003;3(1):68-81.

Bapat MR, Chaudhary K, Sharma A, Laheri V. Surgical approach to cervical spondylotic myelopathy on the basis of radiological patterns of compression: prospective analysis of 129 cases. Eur Spine J. 2008;17(12):1651-63.

Rupp FW, Benzel EC, Baldwin NG. Cervical spondylotic myelopathy treated with corpectomy: technique and results in 44 patients. Neurosurg Focus. 1996;1(6):e5.

Orr RD, Zdeblick TA. Cervical spondylotic myelopathy. Approaches to surgical treatment. Clin Orthop Relat Res. 1999;(359):58-66.

Geck MJ, Eismont FJ. Surgical options for the treatment of cervical spondylotic myelopathy. Orthop Clin North Am. 2002;33(2):329-48.

Bernhardt M, White AA 3rd. Evaluation and management of cervical spondylotic myelopathy. Instr Course Lect. 1995;44:99-110.

Rushton SA, Albert TJ. Cervical degenerative disease: rationale for selecting the appropriate fusion technique (anterior, posterior, and 360 degree). Orthop Clin North Am. 1998;29:755-77.

Emery SE, Bolesta MJ, Banks MA. Robinson anterior cervical fusion comparison of the standard and modified techniques. Spine. 1994;19:660-63.

Benzel EC, Baldwin NG. Cervical spondylotic myelopathy: surgical decision making. Neurosurg Focus. 1996;1:e1.

Bernhardt M, White AA 3rd. Evaluation and management of cervical spondylotic myelopathy. Instr Course Lect. 1995;44:99-110.

Rushton SA, Albert TJ. Cervical degenerative disease: rationale for selecting the appropriate fusion technique (Anterior, posterior, and 360 degree). Orthop Clin North Am. 1998;29(4):755-77.

Papadopoulos EC, Huang RC, Girardi FP, Synnott K, Cammisa FP Jr. Three-level anterior cervical discectomy and fusion with plate fixation: radiographic and clinical results. Spine (Phila Pa 1976). 2006;31(8):897-902.

Swank ML, Lowery GL, Bhat AL, McDonough RF. Anterior cervical allograft arthrodesis and instrumentation: multilevel interbody grafting or strut graft reconstruction. Eur Spine J. 1997;6(2):138-43.

Vaccaro AR, Falatyn SP, Scuderi GJ. Early failure of long segment anterior cervical plate fixation. J Spinal Disord. 1998;11(5):410-5.

Fye MA, Emery SE, Palumbo MA, Bohlman HH. Increased rate of arthrodesis with strut grafting after multilevel anterior cervical decompression. Spine (Phila Pa 1976). 2002;27(2):146-51.

Kaptain GJ, Simmons NE, Replogle RE, Pobereskin L. Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg. 2000;93(2):199-204.

Morimoto T, Okuno S, Nakase H, Kawaguchi S, Sakaki T. Cervical myelopathy due to dynamic compression by the laminectomy membrane: dynamic MR imaging study. J Spinal Disord. 1999;12(2):172-3.

Hilibrand AS, Palumbo MA, Bohlman HH. Increased rate of arthrodesis with strut grafting after multilevel anterior cervical decompression. Spine (Phila Pa 1976). 2002;27(2):146-151.

Naderi S, Alberstone CD. Cervical spondylotic myelopathy treated with corpectomy: technique and results in 44 patients. Neurosurg Focus. 1996;1(6):e5.

Law MD Jr. Evaluation and management of cervical spondylotic myelopathy. Instr Course Lect. 1995;44:99-110.

Yasuoka S, Peterson HA, MacCarty CS. Incidence of spinal column deformity after multilevel laminectomy in children and adults. J Neurosurg. 1982;57(4):441-5.

Carol MP, Ducker TB. Cervical spondylitic myelopathies: surgical treatment. J Spinal Disord. 1988;1(1):59-65.

Epstein JA. The surgical management of cervical spinal stenosis, spondylosis, and myeloradiculopathy by means of the posterior approach. Spine (Phila Pa 1976). 1988;13(7):864-9.

Lao L, Zhong G, Li X, Qian L, Liu Z. Laminoplasty versus laminectomy for multi-level cervical spondylotic myelopathy: a systematic review of the literature. J Orthop Surg Res. 2013;8:45.

Galbraith JG, Butler JS, Dolan AM, O'Byrne JM. Operative outcomes for cervical myelopathy and radiculopathy. Adv Orthop. 2012;2012:919153.

Williams KE. Functional outcome of corpectomy in cervical spondylotic myelopathy. Indian J Orthop. 2009;43(2):205-9.

Cheung WY, Arvinte D, Wong YW, Luk KD, Cheung KM. Neurological recovery after surgical decompression in patients with cervical spondylotic myelopathy-a prospective study. Int Orthop. 2008;32(2):273-8.

Oh MC, Zhang HY, Park JY, Kim KS. Two-level anterior cervical discectomy versus one-level corpectomy in cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2009;34(7):692-6.

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Published

2022-10-27

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Original Research Articles