Efficacy and Safety of One-Stage Selective Discectomy Combined with Expansive Hemilaminectomy in Treatment of Cervical Spondylotic Myelopathy

• Published in: World neurosurgery 2016-10, Vol.94, p.507-512
• Main Authors: Bu, Guoyun, Shuang, Feng, Liu, Gang, Wu, Ye, Hou, Shuxun, Ren, Dongfeng, Shang, Weilin
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cervical spondylotic myelopathy; Cervical Vertebrae - surgery; Combined Modality Therapy - methods; Decompression, Surgical - methods; Diskectomy - methods; Efficacy; Female; Humans; Laminectomy - methods; Longitudinal Studies; Lordotic angle; Male; Middle Aged; Neurosurgery; One-stage selective discectomy combined with expansive hemilaminectomy; Retrospective Studies; Spinal Cord Compression - diagnosis; Spinal Cord Compression - etiology; Spinal Cord Compression - surgery; Spondylosis - complications; Spondylosis - diagnosis; Spondylosis - surgery; Treatment Outcome
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.06.051

Abstract Objectives We designed a novel surgical strategy named one-stage selective discectomy combined with expansive hemilaminectomy (OSDEHL) which might theoretically reduce the postoperative complications of Cervical Spondylotic Myelopathy (CSM). The objectives of this study is to evaluate its efficacy and safety. Methods 62 patients with CSM were enrolled in this study. The procedure includes selective discectomy with fusion at 1 or 2 segments of maximal cord compression and expansive hemilaminectomy on the symptomatic or severe side of the body. The neurological function was evaluated using the Japanese Orthopedics Association score (JOAs) before and after the surgery. Mid-sagittal dural sac diameter, dural sac transverse area at segments of discetomy on MRI, and the lordosis of C-spine on lateral plain film were measured. All patients were followed up more than one year. Results 88 discs and 272 hemilaminas were resected from 62 patients. JOAs was found to be improved from 8.7 ± 1.76 preoperatively to 13.4 ± 1.61 at one year follow-up ( P< 0.001). The mean mid-sagittal dural sac diameter, dural sac area and lordotic angle were also increased from 0.45 ± 0.10cm, 0.83 ± 0.14cm2 and 7.9 ± 2.60° to 0.81 ± 0.08cm, 0.96 ± 0.14cm2 and 11.7 ± 3.06° respectively ( P< 0.05). No case of postoperative axial pain, C5 palsy, nonunion, or kyphosis was reported. Conclusions OSDEHL is an effective surgical approach for treatment of CSM in patients whose neurological function, mid-sagittal dura sac diameter, and dura transverse area can be improved actually with few complications postoperatively.