Outcomes for combined anterior and posterior surgical approaches for patients with multisegmental cervical spondylotic myelopathy

• Published in: Journal of clinical neuroscience 2009-03, Vol.16 (3), p.404-409
• Main Authors: Konya, Deniz, Ozgen, Serdar, Gercek, Arzu, Pamir, M. Necmettin
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cervical spondylotic myelopathy; Cervical Vertebrae - surgery; Disc herniation; Female; Follow-Up Studies; Fusion; Humans; Laminectomy - methods; Magnetic Resonance Imaging - methods; Male; Middle Aged; Neurology; Patient Satisfaction; Postoperative Complications; Retrospective Studies; Spinal Fusion - methods; Spinal Osteophytosis - diagnosis; Spinal Osteophytosis - pathology; Spinal Osteophytosis - surgery; Spondylosis - diagnosis; Spondylosis - surgery; Tomography, X-Ray Computed - methods; Treatment Outcome
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2008.07.070

Abstract Corpectomy is widely used to treat cervical spondylotic myelopathy (CSM). However, when this technique alone is performed at 1 or 2 levels for a multisegmental involvement (3 or more vertebrae), the incidence of post-operative complications is high. The optimal treatment for multisegmental CSM is still debatable. The aim of this study was to assess clinical and radiological outcomes for patients with multisegmental CSM who underwent combined anterior and posterior (AP) surgical approaches. Forty adults (17 women and 23 men; age range, 41–76 y) treated at our center between 2004 and 2007 were reviewed retrospectively. Their neurological function was assessed at different times using the Nurick classification (Grades 0 [root symptoms only] to 5 [wheelchair- or bed-bound]). Patients’ satisfaction with the surgery was evaluated using Odom’s criteria (poor, fair, good, or excellent). Pre-operatively, 20% of patients were assessed as Nurick Grade 0, 60% as Grade 1, and 20% as Grade 2. At the 1-year follow-up, only 10% of patients were assessed as Grade 1. At 1 year after surgery, 85% of patients rated their satisfaction with the operation as “excellent” and 15% rated it as “good”. These outcomes suggest that, when surgery is indicated and patients with multisegmental CSM are carefully selected, the combined AP approach yields symptom relief comparable to that of corpectomy alone and a lower incidence of post-operative complications.