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Functional outcome of corpectomy in cervical spondylotic myelopathy  [cached]
Williams Kanishka,Paul Rajesh,Dewan Yashbir
Indian Journal of Orthopaedics , 2009,
Abstract: Background : Cervical spondylotic myelopathy (CSM) is serious consequence of cervical intervertebral disk degeneration. Morbidity ranges from chronic neck pain, radicular pain, headache, myelopathy leading to weakness, and impaired fine motor coordination to quadriparesis and/or sphincter dysfunction. Surgical treatment remains the mainstay of treatment once myelopathy develops. Compared to more conventional surgical techniques for spinal cord decompression, such as anterior cervical discectomy and fusion, laminectomy, and laminoplasty, patients treated with corpectomy have better neurological recovery, less axial neck pain, and lower incidences of postoperative loss of sagittal plane alignment. The objective of this study was to analyze the outcome of corpectomy in cervical spondylotic myelopathy, to assess their improvement of symptoms, and to highlight complications of the procedure. Materials and Methods: Twenty-four patients underwent cervical corpectomy for cervical spondylotic myelopathy during June 1999 to July 2005.The anterior approach was used. Each patient was graded according to the Nuricks Grade (1972) and the modified Japanese Orthopaedic Association (mJOA) Scale (1991), and the recovery rate was calculated. Results: Preoperative patients had a mean Nurick′s grade of 3.83, which was 1.67 postoperatively. Preoperative patients had a mean mJOA score of 9.67, whereas postoperatively it was 14.50. The mean recovery rate of patients postoperatively was 62.35% at a mean follow-up of 1 year (range, 8 months to 5 years).The complications included one case (4.17%) of radiculopathy, two cases (8.33%) of graft displacement, and two cases (8.33%) of screw back out/failure. Conclusions: Cervical corpectomy is a reliable and rewarding procedure for CSM, with functional improvement in most patients.
Cervical Spondylotic Myelopathy: Factors in Choosing the Surgical Approach  [PDF]
Praveen K. Yalamanchili,Michael J. Vives,Saad B. Chaudhary
Advances in Orthopedics , 2012, DOI: 10.1155/2012/783762
Abstract: Cervical spondylotic myelopathy is a progressive disease and a common cause of acquired disability in the elderly. A variety of surgical interventions are available to halt or improve progression of the disease. Surgical options include anterior or posterior approaches with and without fusion. These include anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, cervical disc replacement, laminoplasty, laminectomy with and without fusion, and combined approaches. Recent investigation into the ideal approach has not found a clearly superior choice, but individual patient characteristics can guide treatment.
Cervical Spondylotic Myelopathy: Factors in Choosing the Surgical Approach  [PDF]
Praveen K. Yalamanchili,Michael J. Vives,Saad B. Chaudhary
Advances in Orthopedics , 2012, DOI: 10.1155/2012/783762
Abstract: Cervical spondylotic myelopathy is a progressive disease and a common cause of acquired disability in the elderly. A variety of surgical interventions are available to halt or improve progression of the disease. Surgical options include anterior or posterior approaches with and without fusion. These include anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, cervical disc replacement, laminoplasty, laminectomy with and without fusion, and combined approaches. Recent investigation into the ideal approach has not found a clearly superior choice, but individual patient characteristics can guide treatment. 1. Introduction Cervical degenerative disease, or cervical spondylosis, is an age-related change affecting the cervical spinal column. Radiographic evidence of cervical spondylosis can be found in 85% of individuals over sixty years of age [1]. Certain occupations and activities that place increased loads on the head may have a predisposition for cervical degenerative disease. Cervical myelopathy is a clinical syndrome that may result from cervical spondylosis. When cervical myelopathy is a result of spondylosis, it is referred to as cervical spondylotic myelopathy (CSM). Cervical spondylotic myelopathy manifests as long-tract clinical findings in the upper and lower extremities caused by spinal cord compression [2]. Patients present with a variety of findings, including clumsiness, loss of manual dexterity, difficulty with gait or balance, urinary complaints, motor weakness, sensory changes, and abnormal or pathologic reflexes. Appropriate initial imaging of CSM consists of plain static radiographs and flexion extension views to evaluate for instability. The advancing imaging of choice is magnetic resonance imaging (MRI) of the cervical spine to evaluate the soft tissues about the spine and the spinal cord. Clinical correlation is important when evaluating MRI changes as MRI can be overly sensitive and reveal abnormalities in asymptomatic adults [3]. Electrodiagnostic studies may be helpful to exclude other causes of upper extremity symptoms, such as suspected peripheral nerve entrapment syndromes. The natural history of CSM is a progression of symptoms in a stepwise fashion over time [4]. Patients with mild myelopathy (that does not interfere with function) may be offered a trial of nonoperative management, whereas progressive, long-standing, or severe myelopathy is candidates for surgical decompression of the spinal cord in the affected areas [5, 6]. Operative intervention may be via anterior, posterior, or combined
Laminoplasty and Laminectomy Hybrid Decompression for the Treatment of Cervical Spondylotic Myelopathy with Hypertrophic Ligamentum Flavum: A Retrospective Study  [PDF]
Huairong Ding, Yuan Xue, Yanming Tang, Dong He, Zhiyang Li, Ying Zhao, Yaqi Zong, Yi Wang, Pei Wang
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0095482
Abstract: Objective To report the outcomes of a posterior hybrid decompression protocol for the treatment of cervical spondylotic myelopathy (CSM) associated with hypertrophic ligamentum flavum (HLF). Background Laminoplasty is widely used in patients with CSM; however, for CSM patients with HLF, traditional laminoplasty does not include resection of a pathological ligamentum flavum. Methods This study retrospectively reviewed 116 CSM patients with HLF who underwent hybrid decompression with a minimum of 12 months of follow-up. The procedure consisted of reconstruction of the C4 and C6 laminae using CENTERPIECE plates with spinous process autografts, and resection of the C3, C5, and C7 laminae. Surgical outcomes were assessed using Japanese Orthopedic Association (JOA) score, recovery rate, cervical lordotic angle, cervical range of motion, spinal canal sagittal diameter, bone healing rates on both the hinge and open sides, dural sac expansion at the level of maximum compression, drift-back distance of the spinal cord, and postoperative neck pain assessed by visual analog scale. Results No hardware failure or restenosis was noted. Postoperative JOA score improved significantly, with a mean recovery rate of 65.3±15.5%. Mean cervical lordotic angle had decreased 4.9 degrees by 1 year after surgery (P<0.05). Preservation of cervical range of motion was satisfactory postoperatively. Bone healing rates 6 months after surgery were 100% on the hinge side and 92.2% on the open side. Satisfactory decompression was demonstrated by a significantly increased sagittal canal diameter and cross-sectional area of the dural sac together with a significant drift-back distance of the spinal cord. The dural sac was also adequately expanded at the time of the final follow-up visit. Conclusion Hybrid laminectomy and autograft laminoplasty decompression using Centerpiece plates may facilitate bone healing and produce a comparatively satisfactory prognosis for CSM patients with HLF.
Laminoplasty Techniques for the Treatment of Multilevel Cervical Stenosis  [PDF]
Lance K. Mitsunaga,Eric O. Klineberg,Munish C. Gupta
Advances in Orthopedics , 2012, DOI: 10.1155/2012/307916
Abstract: Laminoplasty is one surgical option for cervical spondylotic myelopathy. It was developed to avoid the significant risk of complications associated with alternative surgical options such as anterior decompression and fusion and laminectomy with or without posterior fusion. Various laminoplasty techniques have been described. All of these variations are designed to reposition the laminae and expand the spinal canal while retaining the dorsal elements to protect the dura from scar formation and to preserve postoperative cervical stability and alignment. With the right surgical indications, reliable results can be expected with laminoplasty in treating patients with multilevel cervical myelopathy.
Cervical Laminoplasty for Multilevel Cervical Myelopathy  [PDF]
Murali Krishna Sayana,Hassan Jamil,Ashley Poynton
Advances in Orthopedics , 2011, DOI: 10.4061/2011/241729
Abstract: Cervical spondylotic myelopathy can result from degenerative cervical spondylosis, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multi-level myelopathy aims to decompress the spinal cord and maintain stability of the cervical spine. Laminoplasty was major surgical advancement as laminectomy resulted in kyphosis and unsatisfactory outcomes. Hirabayashi popularised the expansive open door laminoplasty which was later modified several surgeons. Laminoplasty has changed the way surgeons approach multilevel cervical spondylotic myelopathy. 1. Introduction Chronic compression of the cervical spinal cord leads to a clinical syndrome of cervical spondylotic myelopathy (CSM). In degenerative cervical spondylosis, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the PLL (OPLL) can all cause spinal cord compression. The effect on spinal cord compression is much more pronounced if a patient has a congentially small spinal canal. The aetiopathogenesis, clinical manifestations, investigations, and nonoperative management are discussed in other articles of this special edition. The primary aims of surgical intervention for multilevel myelopathy are to decompress the spinal cord and maintain stability of the cervical spine. Secondary aims are to minimize complications which include long-term pain and motion loss. This can be achieved by anterior approach and/or posterior approach to cervical spine. Anterior approach would involve multilevel discectomy at times with corpectomy and fusion. Posterior approach would involve laminectomy with or without fusion or laminoplasty. This article will focus on cervical laminoplasty for multilevel myelopathy. 2. Evolution of Laminoplasty Kirita, in 1968, devised a sophisticated operative technique, in which the laminae were thinned and divided at the midline using a high-speed drill followed by their en bloc resection to achieve total decompression of the compressed spinal cord [1]. Although this technique improved the results and bettered the technique of conventional laminectomy, complications like postoperative kyphosis and membrane formation resulted. Oyama et al. reported a Z-plasty (Hattori technique) of the cervical spine laminae in 1973 [2]. This procedure was technically demanding and had not been adopted widely other surgeons. In the year 1977, Hirabayashi et al. described an expansive open door laminoplasty (ELAP), which is a relatively easier and safer procedure than laminectomy [3].
Unilateral ossified ligamentum flavum in the high cervical spine causing myelopathy  [cached]
Singhal Udit,Jain Manoj,Jaiswal Awadhesh,Behari Sanjay
Indian Journal of Orthopaedics , 2009,
Abstract: High cervical ossified ligamentum flavum (OLF) is rare and may cause progressive quadriparesis and respiratory failure . Our two patients had unilateral OLF between C1 and C4 levels. MR showed a unilateral, triangular bony excrescence with low signal and a central, intermediate or high signal on all pulse sequences due to bone marrow within. There was Type I thecal compression (partial deficit of contrast media ring). The first patient had a linear and nodular OLF with calcification within tectorial membrane, C2-3 fusion and unilateral C2-facetal hypertrophy; and the second patient, a lateral, linear OLF with loss of lordosis and C3-6 spondylotic changes. A decompressive laminectomy using "posterior floating and enbloc resection" brought significant relief in myelopathy. Histopathology showed mature bony trabeculae, bone marrow and ligament tissue. The coexisting mobile cervical vertebral segment above and congenitally fused or spondylotic rigid segment below the level of LF may have led to abnormal strain patterns within resulting in its unilateral ossification. In dealing with cervical OLF, carefully preserving facets during laminectomy or laminoplasty helps in maintaining normal cervical spinal curvature.
Cervical Spondylotic Myelopathy Mimicking ALS  [PDF]
Subramaniam PC,Kumar R,Biswas A
Indian Journal of Physical Medicine and Rehabilitation , 2008,
Abstract: Cervical spondylotic myelopathy presenting with muscle wasting in upper extremities and insignificantsensory loss has been termed as cervical spondylotic amyotrophy. This condition has to be differentiatedfrom Amyotrophic lateral sclerosis which also has similar presentation. Here we present a case study ofcervical spondylotic myelopathy resembling Amyotrophic lateral sclerosis clinically.
Operative Treatment of Cervical Myelopathy: Cervical Laminoplasty  [PDF]
Brett A. Braly,David Lunardini,Chris Cornett,William F. Donaldson
Advances in Orthopedics , 2012, DOI: 10.1155/2012/508534
Abstract: Cervical spondylotic myelopathy (CSM) is a degenerative process which may result in clinical signs and symptoms which require surgical intervention. Many treatment options have been proposed with various degrees of technical difficulty and technique sensitive benefits. We review laminoplasty as a motion-sparing posterior decompressive method. Current literature supports the use of laminoplasty for indicated decompression. We also decribe our surgical technique for an open-door, or “hinged”, laminoplasty. 1. Introduction Cervical spondylotic myelopathy (CSM) is the natural result of degenerative compression on the cervical spinal cord. The result may be a progressive and stepwise deterioration of neurological function in patients. The chronic debilitating nature of this process justifies surgical decompression. Posterior decompression has been described as a treatment for CSM since the 1940s. Laminectomy was the initial surgical option used. The decompression was performed by rongeurs. However, the insertion of the rongeur in an already limited space available for the cord led often to a decrease in neurological function postoperatively [1–3]. Even with modern approaches to laminectomy using high speed burs, development of postoperative instability has led surgeons to explore more efficacious ways of decompression. In 1977, Hirabayashi and Satomi published their results on multisegment decompression by means of an open-door laminoplasty [4]. This technique allows for adequate posterior decompression of the spinal cord while retaining the posterior elements. This avoids the postoperative instability seen with laminectomy as well as the stiffness and risks of posterior cervical fusion. Additionally, motion is spared due to the absence of a fusion. There have since been multiple techniques for performing a cervical laminoplasty described with supporting literature [4–8]. These techniques include the expansive “open door,” a midline “French Door,” En Bloc resection, spinous process splitting, and Z-Plasty [4, 9]. Outcome studies have supported laminoplasty as a valid treatment for CSM however, no definitive literature shows its superiority to laminectomy in conjunction with a posterior cervical fusion. All surgical strategies appear to be equal in yielding neurologic outcomes, though differences are found in complication reports. Patient selection is crucial prior to proceeding with cervical laminoplasty. Special attention must be paid to sagittal alignment for optimal outcomes. Laminoplasty is ideal for multilevel stenosis (AP canal diameter < 13?mm) due to
Operative Techniques for Cervical Radiculopathy and Myelopathy  [PDF]
C. Moran,C. Bolger
Advances in Orthopedics , 2012, DOI: 10.1155/2012/916149
Abstract: 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
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