Role of Anterior Decompression in Cervical Spondylosis Myelopathy: a Report of 64 Cases

The management of cervical spondylosis has evolved over the past decades. Surgical decompressive and stabilization techniques have become more widely accepted for use in patients with intractable pain or neurological deficits. Advances in neuroimaging, surgical technique, and surgery-related technology including the operating microscope and anterior fixation devices have all contributed to the expanding role of surgery for the treatment of this condition. This study was conducted to evaluate the efficacy of corpectomy to achieve anterior decompression of neural elements or to remove anterior lesions. Between 2000 and 2004, 143 patients underwent anterior cervical decompression for the treatment of cervical spondylotic myelopathy (CSM). The author evaluates 64 of 143 cases as mentioned above comprise 1-level lesion (11 cases), 2-level lesions (37 cases), and 3-level lesions (11 cases). Ten patients presented with neck pain, 11 with arm pain, 22 with difficulty to walk, 6 with upper limb weakness, and 15 with sensory symptoms. Myelopathy severity was graded using the Harsh functional myelopathy grading system. Autograft (iliac crest) was used in all cases. The average follow-up duration was 25 months (range 8 – 48 months), symptomatic improvement was achieved. Harsh scores reflected improvement for 95.31 % of patients, 3.25 % with persistent of symptom and only one patient showing worsening. Preoperative myelopathy severity was not correlated with age or gender but was correlated with number of levels of spinal cord compression. The outcome, postoperative myelopathy severity, hospital stay and operating time also were not correlated with age or gender but significantly correlated with duration of symptoms, number of levels of spinal cord compression, preoperative myelopathy severity, and number of levels decompressed. Anterior cervical decompression has an important role in the management of CSM. Following treatment in this series, radiculopathy always improved and myelopathy was reversed in most patients.