Favourable outcome of posterior decompression and stabilization in lordosis for cervical spondylotic myelopathy: the spinal cord "back shift" concept.

Abstract

PURPOSE:

Surgical management of patients with multilevel CSM aims to decompress the spinal cord and restore the normal sagittal alignment. The literature lacks of high level evidences about the best surgical approach. Posterior decompression and stabilization in lordosis allows spinal cord back shift, leading to indirect decompression of the anterior spinal cord. The purpose of this study was to investigate the efficacy of posterior decompression and stabilization in lordosis for multilevel CSM.

METHODS:

36 out of 40 patients were clinically assessed at a mean follow-up of 5, 7 years. Outcome measures included EMS, mJOA Score, NDI and SF-12. Patients were asked whether surgery met their expectations and if they would undergo the same surgery again. Bone graft fusion, instrumental failure and cervical curvature were evaluated. Spinal cord back shift was measured and correlation with EMS and mJOA score recovery rate was analyzed.

RESULTS:

All scores showed a significative improvement (p < 0.001), except the SF12-MCS (p > 0.05). Ninety percent of patients would undergo the same surgery again. There was no deterioration of the cervical alignment, posterior grafted bones had completely fused and there were no instrument failures. The mean spinal cord back shift was 3.9 mm (range 2.5-4.5 mm). EMS and mJOA recovery rates were significantly correlated with the postoperative posterior cord migration (P < 0.05).

CONCLUSIONS:

Posterior decompression and stabilization in lordosis is a valuable procedure for patients affected by multilevel CSM, leading to significant clinical improvement thanks to the spinal cord back shift. Postoperative lordotic alignment of the cervical spine is a key factor for successful treatment.

• Authors: Vincenzo Denaro, Umile Giuseppe Longo, Alessandra Berton, Giuseppe Salvatore, Luca Denaro
• Journal: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (Eur Spine J) Vol. 24 Suppl 7 Pg. 826-31 (Nov 2015) ISSN: 1432-0932 [Electronic] Germany
• PMID: 26538154 (Publication Type: Evaluation Study, Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Cervical Vertebrae (surgery)
• Decompression, Surgical (methods)
• Female
• Follow-Up Studies
• Humans
• Lordosis (complications)
• Male
• Middle Aged
• Orthopedic Procedures (methods)
• Patient Satisfaction
• Retrospective Studies
• Spinal Cord Diseases (complications, surgery)
• Spondylosis (complications, surgery)
• Treatment Outcome