Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome after anterior or posterior decompression.
نویسندگان
چکیده
OBJECT The effects of sagittal kyphotic deformities or mechanical stress on the development of cervical spondylotic myelopathy, or the reduction and fusion of kyphotic sagittal alignment have not been consistently documented. The aim in this study was to determine the effects of kyphotic sagittal alignment of the cervical spine in terms of neurological morbidity and outcome after 2 types of surgical intervention. METHODS The authors retrospectively reviewed the records of 476 patients who underwent cervical spine surgeries for spondylotic myelopathy between 1993 and 2006 at their university medical center. Among these were identified 43 patients-30 men and 13 women, with a mean age of 58.8 years-who had cervical kyphosis exceeding 10 degrees on preoperative sagittal lateral radiographs obtained in the neutral position, and their cases were analyzed in this study. Anterior decompression with interbody fusion was conducted in 28 patients, and en bloc open-door C3-7 laminoplasty in 15 patients. Both pre- and postoperative neurological, radiographic, and MR imaging findings were assessed in both surgical groups. RESULTS The mean preoperative kyphotic angle in all 43 patients was 15.9 +/- 5.9 degrees in the neutral position. Segmental instability was noted in 26 patients (61%) and reversed dynamic spinal canal stenosis at the level above the local kyphosis in 22 (51%). Preoperative T2-weighted MR images showed high-intensity signal within the cord at and around the level of maximal compression or segmental instability in 28 patients (65%). The mean kyphotic angle in both the neutral and flexion positions was significantly smaller at 4-6 weeks after surgery in the anterior spondylectomy group than in the laminoplasty group (p < 0.001). Furthermore, the angle in the neutral position was significantly smaller on follow-up in the anterior spondylectomy group than in the laminoplasty group (p = 0.034). The transverse area of the spinal cord was significantly larger in the anterior spondylectomy group than in the laminoplasty group on follow-up (p = 0.037). Preoperative neurological scores (assessed using the Japanese Orthopaedic Association scale) and improvement on follow-up > or = 2 years after treatment (average 3.3 years) were not significantly different between the 2 groups; however, there was a significant difference in Japanese Orthopaedic Association score at 4-6 weeks postoperatively (p = 0.047). CONCLUSIONS Kyphotic deformity and mechanical stress in the cervical spine may play an important role in neurological dysfunction. In a select group of patients with kyphotic deformity > or = 10 degrees , adequate correction of local sagittal alignment may help to maximize the chance of neurological improvement.
منابع مشابه
Cervical Spondylotic Myelopathy Associated with Kyphosis or Sagittal Sigmoid Alignment: Outcome after Anterior or Posterior Decompression Journal of Neurosurgery: Spine
Object. The effects of sagittal kyphotic deformities or mechanical stress on the development of cervical spondylotic myelopathy, or the reduction and fusion of kyphotic sagittal alignment have not been consistently documented. The aim in this study was to determine the effects of kyphotic sagittal alignment of the cervical spine in terms of neurological morbidity and outcome after 2 types of su...
متن کاملPosterior cervical decompression and fusion for circumferential spondylotic cervical stenosis: review of 50 consecutive cases.
PURPOSE OF STUDY This study presents a clinical and radiological evaluation of 50 consecutive patients with symptomatic spondylotic cervical myelopathy and circumferential spinal cord compression who were managed with a single stage wide posterior laminectomy and lateral mass instrumented fusion. METHODS USED 50 consecutive patients (33 male, 17 female) over a 4 year period presenting with sy...
متن کاملCervical spondylotic myelopathy: a review of surgical indications and decision making.
Cervical spondylotic myelopathy (CSM) is frequently underdiagnosed and undertreated. The key to the initial diagnosis is a careful neurologic examination. The physical findings may be subtle, thus a high index of suspicion is helpful. Poor prognostic indicators and, therefore, absolute indications for surgery are: 1. Progression of signs and symptoms. 2. Presence of myelopathy for six months or...
متن کاملDoes Segmental Kyphosis Affect Surgical Outcome after a Posterior Decompressive Laminectomy in Multisegmental Cervical Spondylotic Myelopathy?
STUDY DESIGN Retrospective analysis. PURPOSE To compare results of laminectomy in multisegmental compressive cervical myelopathy (CSM) with lordosis versus segmental kyphosis. OVERVIEW OF LITERATURE Laminectomy is an established procedure for decompression in CSM with cervical lordosis. However in patients with segmental kyphosis, it is associated with risk of progression of kyphosis and po...
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We evaluated the specific pattern of pre- and postoperative neurological signs and symptoms of cervical spondylotic myelopathy (CSM) to determine [mdings which had a predictive value for surgical outcome. Consecutive patients with CSM caused by osteophytic ridge or intervertebral disc herniation who underwent anterior cervical decompression and fusion in Loghman Hakim Hospital from 1999-200...
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ورودعنوان ژورنال:
- Journal of neurosurgery. Spine
دوره 11 5 شماره
صفحات -
تاریخ انتشار 2009