Michael Y Wang1, Barth A Green. 1. Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. myw@usc.edu
Abstract
OBJECT: Cervical stenotic myelopathy can be treated via anterior or posterior approaches. In anterior cervical decompression and fusion (ACDF), because the risks and likelihood of pseudarthrosis increase with the number of treated segments, attempts are typically made to limit the number of treated levels. Thus, postoperative recurrence of myelopathy following ACDF may occur because stenotic levels were not treated or because adjacent segments have degenerated. Revision decompressive surgery via an anterior approach is one solution; however, if the stenosis involves multiple levels a posterior decompressive laminoplasty can be performed as an alternative. METHODS: Twenty-four cases treated over an 8-year period were identified and data were retrospectively reviewed. In 15 cases posterior decompressive surgery was necessary because of progressive spinal degeneration and stenosis (five cases following initial treatment for radiculopathy, seven after initial treatment for spondylotic myelopathy, and three due to spreading of an ossified posterior longitudinal ligament). In nine cases revision surgery was undertaken because the initial decompression was inadequate. The mean follow-up period after the second surgery was 16 months. Improvements in myelopathy were seen in 83% of patients (mean improvement of 1.25 points on the Nurick Scale). Preoperative severe gait disorders were associated with poor recovery. Complications included two cases of transient C-5 nerve root palsy and two cases of new persistent axial neck pain. CONCLUSIONS: Laminoplasty is a straightforward and effective treatment for failed ACDF due to inadequate decompression or progressive degeneration of the spinal column, avoiding reentry through scar tissue. In terms of myelopathic pain, the recovery rate is comparable with that related to revision ACDF.
OBJECT: Cervical stenotic myelopathy can be treated via anterior or posterior approaches. In anterior cervical decompression and fusion (ACDF), because the risks and likelihood of pseudarthrosis increase with the number of treated segments, attempts are typically made to limit the number of treated levels. Thus, postoperative recurrence of myelopathy following ACDF may occur because stenotic levels were not treated or because adjacent segments have degenerated. Revision decompressive surgery via an anterior approach is one solution; however, if the stenosis involves multiple levels a posterior decompressive laminoplasty can be performed as an alternative. METHODS: Twenty-four cases treated over an 8-year period were identified and data were retrospectively reviewed. In 15 cases posterior decompressive surgery was necessary because of progressive spinal degeneration and stenosis (five cases following initial treatment for radiculopathy, seven after initial treatment for spondylotic myelopathy, and three due to spreading of an ossified posterior longitudinal ligament). In nine cases revision surgery was undertaken because the initial decompression was inadequate. The mean follow-up period after the second surgery was 16 months. Improvements in myelopathy were seen in 83% of patients (mean improvement of 1.25 points on the Nurick Scale). Preoperative severe gait disorders were associated with poor recovery. Complications included two cases of transient C-5 nerve root palsy and two cases of new persistent axial neck pain. CONCLUSIONS: Laminoplasty is a straightforward and effective treatment for failed ACDF due to inadequate decompression or progressive degeneration of the spinal column, avoiding reentry through scar tissue. In terms of myelopathic pain, the recovery rate is comparable with that related to revision ACDF.