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Operative Techniques for Cervical Radiculopathy and Myelopathy

DOI: 10.1155/2012/916149

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The surgical treatment of cervical spondylosis and resulting cervical radiculopathy or myelopathy has evolved over the past century. Surgical options for dorsal decompression of the cervical spine includes the traditional laminectomy and laminoplasty, first described in Asia in the 1970's. More recently the dorsal approch has been explored in terms of minimally invasive options including foraminotomies for nerve root descompression. Ventral decompression and fusion techniques are also described in the article, including traditional anterior cervical discectomy and fusion, strut grafting and cervical disc arthroplasty. Overall, the outcome from surgery is determined by choosing the correct surgery for the correct patient and pathology and this is what we hope to explain in this brief review. 1. Introduction Cervical spondylosis is a common pathology, and the surgical treatment of the resulting radiculopathy, myelopathy, or myeloradiculopathy has evolved over the past century. The basic aim of all techniques is to decompress the affected neural structure. Advances in fixation techniques [1–3] and motion-preserving options [4–7] are more recent elements of this evolution. Once the decision is made to manage the patient operatively the principal decision is whether to choose the ventral or the dorsal approach. In cervical spondylosis several variables including the location of pathology (ventral, dorsal, circumferential); extent of pathology (limited to interspace, extensive behind vertebral body); the number of levels affected; the presence of instability or the presence of kyphotic deformity require consideration. In general, any procedure chosen should decompress the affected spinal cord or nerve roots, maintain or restore stability, and correct or prevent kyphotic deformity. 2. Dorsal Decompression A range of posterior surgical procedures exist, including laminectomy, laminoplasty, and laminectomy with posterior fusion. Until the 1960’s the traditional way to decompress the cervical spine in spondylotic patients was via a dorsal approach and a decompressive laminectomy. This surgery effectively enlarges the spinal canal area, allowing the spinal canal to drift away from ventral compression, however, while doing this it also destabilizes the dorsal structures and can lead to progressive kyphotic deformity. 3. Laminectomy A high speed drill is used to create a gutter, through the outer cortical bone and cancellous bone to the thin inner cortical bone at the junction of the lamina and the medial aspect of the lateral mass. Using a 1?mm Kerrison rongeur the


[1]  C. Faldini, D. Leonetti, M. Nanni et al., “Cervical disc herniation and cervical spondylosis surgically treated by Cloward procedure: a 10-year-minimum follow-up study,” Journal of Orthopaedics and Traumatology, vol. 11, no. 2, pp. 99–103, 2010.
[2]  B. Lied, P. A. Roenning, J. Sundseth, and E. Helseth, “Anterior cervical discectomy with fusion in patients with cervical disc degeneration: a prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage),” BMC Surgery, vol. 10, article 10, 2010.
[3]  P. K. Narotam, S. M. Pauley, and G. J. McGinn, “Titanium mesh cages for cervical spine stabilization after corpectomy: a clinical and radiological study,” Journal of neurosurgery, vol. 99, no. 2, pp. 172–180, 2003.
[4]  S. D. Boden, R. A. Balderston, J. G. Heller, E. N. Hanley Jr., and J. E. Zigler, “An AOA critical issue: disc replacements: this time will we really cure low-back and neck pain?” Journal of Bone and Joint Surgery—Series A, vol. 86, no. 2, pp. 411–422, 2004.
[5]  M. J. Cardoso and M. K. Rosner, “Multilevel cervical arthroplasty with artificial disc replacement,” Neurosurgical Focus, vol. 28, no. 5, p. E19, 2010.
[6]  E. L. Lin and J. C. Wang, “Total disc arthroplasty,” Journal of the American Academy of Orthopaedic Surgeons, vol. 14, pp. 705–714, 2006.
[7]  D. H. Yoon, S. Yi, H. C. Shin, K. N. Kim, and S. H. Kim, “Clinical and radiological results following cervical arthroplasty,” Acta Neurochirurgica, vol. 148, no. 9, pp. 943–950, 2006.
[8]  H. S. An, R. Gordin, and K. Renner, “Anatomic considerations for plate-screw fixation of the cervical spine,” Spine, vol. 16, supplement 10, pp. S548–S551, 1991.
[9]  W. B. Cherney, V. K. Sonntag, and R. A. Douglas, “Lateral mass posterior plating and facet fusion for cervical spine instability,” Barrow Neurological Institute, vol. 7, pp. 2–11, 1991.
[10]  P. R. Cooper, A. Cohen, A. Rosiello, and M. Koslow, “Posterior stabilization of cervical spine fractures and subluxations using plates and screws,” Neurosurgery, vol. 23, no. 3, pp. 300–306, 1988.
[11]  R. Roy-Camille, G. Saillant, and C. Mazel, “Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plates and screws,” in The Cervical Spine, Cervical Spine Research Society, Ed., pp. 390–306, J. B. Lippincott, Philadelphia, Pa, USA, 1989.
[12]  S. Hattori, “Cervical myelopathy,” Journal of the Japanese Orthopaedic Association, vol. 52, p. 581, 1978 (Japanese).
[13]  S. Hattori and S. Kawai, “Diagnosis of cervical spondylosis,” Orthopaedic Mook, vol. 6, p. 13, 1979 (Japanese).
[14]  S. Hattori, “Pathogenesis and surgical treatment of cervical spondylotic myelopathy,” in Proceedings of the Annual Meeting of the Japanese Orthopaedic Association, Tokyo, Japan, April 1980.
[15]  M. Oyama, S. Hattori, and N. Moriwaki, “A new method of cervical laminoplasty,” Central Japan Journal of Orthopaedic Surgery and Traumatology, vol. 16, pp. 792–794, 1973 (Japanese).
[16]  W. M. Yue, C. T. Tan, S. B. Tan, S. K. Tan, and B. K. Tay, “Results of cervical laminoplasty and a comparison between single and double trap-door techniques,” Journal of Spinal Disorders, vol. 13, no. 4, pp. 329–335, 2000.
[17]  S. Kokubun, T. Sato, Y. Ishii, and Y. Tanaka, “Cervical myelopathy in the Japanese,” Clinical Orthopaedics and Related Research, no. 323, pp. 129–138, 1996.
[18]  N. Nakano, T. Nakano, and K. Nakano, “Comparison of the results of laminectomy and open-door laminoplasty for cervical spondylotic myeloradiculopathy and ossification of the posterior longitudinal ligament,” Spine, vol. 13, no. 7, pp. 792–794, 1988.
[19]  A. S. Hilibrand, G. D. Carlson, M. A. Palumbo, P. K. Jones, and H. H. Bohlman, “Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis,” Journal of Bone and Joint Surgery—Series A, vol. 81, no. 4, pp. 519–528, 1999.
[20]  R. B. Cloward, “Lesions of the intervertebral disks and their treatment by interbody fusion methods. The painful disk,” Clinical orthopaedics and related research, vol. 27, pp. 51–77, 1963.
[21]  G. W. Smith and R. A. Robinson, “The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion,” Journal of Bone and Joint Surgery—Series A, vol. 40, pp. 607–624, 1958.
[22]  E. H. Simmons and S. K. Bhalla, “Anterior cervical discectomy and fusion. A clinical and biomechanical study with eight-year follow-up,” Journal of Bone and Joint Surgery—Series B, vol. 51, no. 2, pp. 225–237, 1969.
[23]  A. S. Hilibrand, G. D. Carlson, M. A. Palumbo, P. K. Jones, and H. H. Bohlman, “Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis,” Journal of Bone and Joint Surgery—Series A, vol. 81, no. 4, pp. 519–528, 1999.
[24]  R. L. Saunders, “On the pathogenesis of the radiculopathy complicating multilevel corpectomy,” Neurosurgery, vol. 37, no. 3, pp. 408–413, 1995.
[25]  J. F. Cusick, “Pathophysiology and treatment of cervical spondylotic myelopathy,” Clinical Neurosurgery, vol. 37, pp. 661–681, 1991.
[26]  D. J. Maiman, F. A. Pintar, N. Yoganandan et al., “Pull-out strength of Caspar cervical screws,” Neurosurgery, vol. 31, no. 6, pp. 1097–1101, 1992.
[27]  V. Seifert, “Anterior decompressive microsurgery and osteosynthesis for the treatment of multi-segmental cervical spondylosis,” Acta Neurochirurgica, vol. 135, no. 3-4, pp. 105–121, 1995.
[28]  J. C. Wang, P. W. McDonough, K. K. Endow, and R. B. Delamarter, “A comparison of fusion rates between single-level cervical corpectomy and two-level discectomy and fusion,” Journal of Spinal Disorders, vol. 14, no. 3, pp. 222–225, 2001.
[29]  T. A. Zdeblick and T. B. Ducker, “The use of freeze-dried allograft bone for anterior cervical fusions,” Spine, vol. 16, no. 7, pp. 726–729, 1991.
[30]  J. Lu, N. A. Ebraheim, Y. Nadim, and M. Huntoon, “Anterior approach to the cervical spine: surgical anatomy,” Orthopedics, vol. 23, no. 8, pp. 841–845, 2000.
[31]  D. Samartzis, F. H. Shen, D. K. Matthews, S. T. Yoon, E. J. Goldberg, and H. S. An, “Comparison of allograft to autograft in multilevel anterior cervical discectomy and fusion with rigid plate fixation,” Spine Journal, vol. 3, no. 6, pp. 451–459, 2003.


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