Effectiveness of 3 surgical decompression strategies for treatment of multilevel cervical myelopathy in 3 spinal centers in China: a retrospective study.
ABSTRACT Retrospective multicenter study.
To compare clinical outcomes and surgical-related adverse events in patients with multilevel cervical myelopathy (MCM) undergoing simple anterior, simple posterior, or 1-stage posterior-anterior surgical decompression strategies.
Simple anterior, simple posterior, and 1-stage posterior-anterior surgical decompression strategies have been advocated for MCM treatment in both Western and Chinese populations. However, there is limited evidence on whether 1-stage posterior-anterior strategy may offer equal or more advantages than the other 2 strategies for patients with MCM.
A retrospective review of medical records was conducted for 255 patients with MCM who had undergone surgical decompression in 3 Chinese spinal centers from 1999 to 2010. Neurological status, perioperative variables, and surgical complications were assessed. Multiple linear regression was used to evaluate factors associated with the outcomes of each strategy.
Analyses were conducted on a total of 229 patients with MCM undergoing surgical decompression via 1-stage posterior-anterior (68 patients), simple anterior (102 patients), and simple posterior approaches (59 patients). One-stage posterior-anterior approach had the highest Japanese Orthopaedic Association recovery rate after adjusted for age and sex (adjusted mean ± SD: 50.0 ± 3.2, P < 0.001) and additionally adjusted for smoking, duration from onset of symptoms to surgery, comorbidities, preoperative Japanese Orthopaedic Association score, Ishihara's curvature index and Pavlov ratio, operative blood loss, operating time, anterior operated disc levels, and posterior operated levels (adjusted mean ± SD: 51.6 ± 11.6, P < 0.01). Anterior approach had the largest difference between the pre- and postoperative Ishihara's curvature indexes after adjusted for age and sex (adjusted mean ± SD: 5.3 ± 1.0, P < 0.01) and after multivariable adjustment (adjusted mean ± SD: 6.5 ± 2.8, P = 0.003).
One-stage posterior-anterior strategy can be a reliable and effective treatment strategy for MCM in a subgroup of patients with anterior and posterior compression on spinal cord simultaneously.
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ABSTRACT: Corpectomy is widely used to treat cervical spondylotic myelopathy (CSM). However, when this technique alone is performed at 1 or 2 levels for a multisegmental involvement (3 or more vertebrae), the incidence of post-operative complications is high. The optimal treatment for multisegmental CSM is still debatable. The aim of this study was to assess clinical and radiological outcomes for patients with multisegmental CSM who underwent combined anterior and posterior (AP) surgical approaches. Forty adults (17 women and 23 men; age range, 41-76 y) treated at our center between 2004 and 2007 were reviewed retrospectively. Their neurological function was assessed at different times using the Nurick classification (Grades 0 [root symptoms only] to 5 [wheelchair- or bed-bound]). Patients' satisfaction with the surgery was evaluated using Odom's criteria (poor, fair, good, or excellent). Pre-operatively, 20% of patients were assessed as Nurick Grade 0, 60% as Grade 1, and 20% as Grade 2. At the 1-year follow-up, only 10% of patients were assessed as Grade 1. At 1 year after surgery, 85% of patients rated their satisfaction with the operation as "excellent" and 15% rated it as "good". These outcomes suggest that, when surgery is indicated and patients with multisegmental CSM are carefully selected, the combined AP approach yields symptom relief comparable to that of corpectomy alone and a lower incidence of post-operative complications.Journal of Clinical Neuroscience 02/2009; 16(3):404-9. · 1.25 Impact Factor
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ABSTRACT: Cervical myelopathy is a varied clinical syndromes resulting from spinal cord dysfunction. Underlying causes are numerous, but spondylosis at one or more levels is the most common etiology. Natural history studies have demonstrated a variable clinical course with gradual neurologic deterioration in a majority of patients. While prospective clinical comparisons are limited, existing literature suggests that operative management reliably arrests the progression of myelopathy and may lead to functional improvement in a majority of patients. The selection of surgical procedures must be carefully individualized based on specific clinical and radiographic factors. Whereas anterior decompression and fusion procedures at one or two motion segments have predictable results, procedures involving three or more levels are associated with increased morbidity. Newer techniques for the treatment of multilevel cervical myelopathy include anterior decompression with 360-degree fusion, hybrid corpectomy/anterior cervical discectomy and fusion techniques and the use of dynamic anterior cervical plates. An alternative technique for patients with a lordotic sagittal alignment is laminoplasty, which has a proven track record of long-term good to excellent results.The Spine Journal 01/2003; 3(1):68-81. · 3.36 Impact Factor
- European Spine Journal 07/2008; 17(8):1119-20; author reply 1121-2. · 2.13 Impact Factor