Surgery for cervical spondylotic myelopathy: anterior versus posterior approaches

Surgical treatment of cervical spondylotic myelopathy [CSM] remains controversial. Several approaches have been advocated to treat cervical spondylotic myelopathy including anterior, posterior and combined approaches. The aim of this study was to review the clinical and imaging varieties of cervical spondylotic myelopathy and their influence on choosing the appropriate surgical approach. Fifty five cases with cervical spondylotic myelopathy operated upon at the neurosurgery department, Alexandria University were reviewed. The different clinical and imaging features were analyzed, and parameters for choice of surgical approach were addressed. Among all patients with CSM, neck pain was present in 49%, brachialgia in 67%, mild myelopathy in 44% and moderate myelopathy in 56%. Following cervical laminectomy, neck pain improved in 50% and remained stationary in 50%; brachialgia recovered in 33%, improved in 50% and remained stationary in 17%; mild myelopathy showed good outcome in 80% and fair outcome in 20%; whereas moderate myelopathy showed good outcome in 20%, fair outcome in 60% and poor outcome in 20%. Following anterior discectomy with fusion, neck pain recovered in 28.5%, improved in 38% and remained stationary in 28.5%; brachialgia recovered in 58.5%, improved in 31% and remained stationary in 10.5%; mild myelopathy showed excellent outcome in 17%, good outcome in 58% and fair outcome in 25%; whereas moderate myelopathy showed good outcome in 35%, fair outcome in 30% and poor outcome in 35%. Following cervical laminoplasty, neck pain improved in 100%; brachialgia remained stationary in 100%; mild myelopathy showed good outcome in 100%; whereas moderate myelopathy showed fair outcome in 50% and poor outcome in 50%. Early surgical intervention for CSM is associated with higher recovery rate. Selection of surgical approach depends on age, cord morphology, and spine geometry mostly spinal curve and canal diameter. The presense of cervical spine instability necessitates complementation of spine decompression with spine fixation

Anterior cervical interbody fusion using carbon fiber cages

Anterior decompression and inter body fusion is a widely accepted surgical treatment for patients with cervical disc herniations and cervical spondylosis. Tricorticaf iliac crest autograft has been considered the classic method but problems such as graft collapse, and extrusion still persist. Cages were introduced because of their theoretical ability to prevent graft collapse. Carbon fiber cages for anterior cervical fusion will be evaluated in this study. Thirty two patients with symptomatic cervical disc disease were treated by anterior cervical discectomy and fusion using carbon fiber cages packed with autogenous bone graft. The average duration of symptoms was 9.3 months [range, 2-15 months]. The average follow-up was 28 months [range, 12-36 months]. All patients had neck pain. Twenty one patients [65.6%] had a single level affection, and eleven patients [34.4%] had double level affection with a total of 43 disc lesions. Fifteen patients [46.9%] had radiculopathy without myelopathy, ten patients [31.2%] had myelopathy without radiculopathy and seven patients [21.9%] had myeloradiculopathy. Four patients [12.5%] had sphinctric disturbances. Twenty seven patients [84.4%] had complete relief of neck pain. All patients improved neurologically postoperatively, except 2 patients [6.2%] with myelopathy although their symptoms stopped to progress. Maintenance of cervical lordosis or correction of kyphosis occurred in 29 patients [90.6%]. Fusion occurred in 40 disc lesions [93%]. Subsidence [< 5mm] occurred in 6 disc spaces [14%]. There were no implantrelated complications. Carbon fiber cages represent a good option to restore the intervertebral disc space and promote fusion in cervical disc surgery. Furthermore, the bone fusion can be easily assessed because of radiolucency of these cages

Laminoplasty: an evaluation of 24 cases.

Cervical expansive laminoplasty has been advocated as an alternative procedure to laminectomy for the decompression of the cervical spine. It provides favourable cord decompression and stabilisation of the cervical spine and is a simpler and safer alternative to anterior fusion and laminectomy for myelopathy and myeloradiculopathy, due to multisegmental cervical spondylosis and ossified posterior longitudinal ligament. We report our experience in 24 patients with this procedure, 12 of whom had myelopathy and another 12 had myeloradiculopathy. The earliest symptom to improve was radicular pain or paraesthesia (75%). A reduction in spasticity was seen in 21 of the 24 patients (87.5%). Eleven patients had improvement in their motor power during a follow up period ranging from 1 month to 14 months. One patient deteriorated following the procedure and developed Brown Sequard features due to under riding of the lamina on the hinged side, another had severe post operative paraesthesias, while one patient had a CT scan evidence of 'closing of the door', without being symptomatic for it. The technique of the procedure is discussed and the pertinent literature reviewed.

Evaluation of anterior cervical diskectomy and interbody using titanium cage. report of early results

This study included 160 patients who had been operated upon due to different cervical neurological problems as a result of either cervical spondylosis, cervical disc alone or both. Some of them had more than one level to be operated upon, so 210 disc levels were operated on. These patients had an anterior interbody fusion through an extrapharyngeal anterolateral approach. The fusion was augmented by titanium cage and milled bone autograft. The period of the follow up ranged from 12 months to 4 years with a mean of 28 +/- 4.5 months. The patients were assessed using Odom's criteria. It was concluded that anterior decompression and interbody fusion is a promising option for cervical disc diseases whether herniated disc or degenerative spondylosis. The chances for a sound fusion were better with the use of titanium cage and the postoperative morbidity is remarkably less with the use of autograft

Rediculopatía cervical: acceso posterolateral / Cervical radiculopathy: posterolateral approach

Objetivos: evaluar los resultados obtenidos en pacientes con radiculopatía cervical espondilótica o discal operados mediante abordaje cervical posterolateral. Métodos: desde octubre de 1994 a enero de 1998, 30 pacientes consecutivos fueron intervenidos quirúrgicamente mediante foraminotomía posterior por cuadros de radiculopatía cervical. Hubo 23 hombres y 7 mujeres, con un promedio de 41 años. El seguimiento promedio fue de 64 semanas. Los resultados fueron analizados mediante los criterios de Odom y la escala semi-análoga. Resultados: al seguimiento el 90 por ciento de los pacientes tuvieron recuperación completa o habían mejorado considerablemente su condición prequirúrgica. Conclusión: usando estrictos criterios de selección, el abordaje posterolateral permite obtener excelentes resultados en la radiculopatía cervical espondilótica o discal, con escasa morbilidad

Tricortical cervical inter-body screw fixation.

A new tricortical method of screw implantation for anterior cervical interbody plate fixation is described. The screws are placed obliquely such that they engage the anterior cortex of the body and traverse through the cortices adjoining the disc space. By this method the screws not only hold the plate firmly with a tricortical purchase, but by virtue of their course stabilize the two adjoining vertebral bodies by themselves. Sixteen patients were treated by this method. In three of these cases only tricortical screws without the metal plate were used for fixation. The advantages of the technique are discussed.

Fixaçäo com metilmetacrilato no tratamento microcirúrgico da hérnia de disco cervical / Fixation with methylmethacrylate in microsurgery treatment of cervical disc hernia

Os autores apresentam 49 pacientes com compressäo radiculomedular cervical, tratados por via anterior com discectomia e o uso de metilmetacrilato no espaço intervertebral

Surgical treatment of spondylosis, allesthesias in adult-short term follow-up

During the period extending from 1982-1986, in King Fahad Hospital. Jeddah. We performed 10 operations of posterior fusion for ten patients of different ages group 30-45 years old with mean age 34 years. four were females and six males. Spondylosis in two patients and olisthesis in seven cases, a combined lesions of spondylolysis of L4 and L5 spondylolisthesis.One case dysplastic type of Olisthesis in Two, patients with sloping angles of 20

Osteófitos cervicais e disfagia / Cervical spur and dysphagia

Säo relatados dois casos de osteófitos cervicais causando disfagia intensa em pacientes acima de 50 anos de idade. A revisäo da literatura mostra que osteófito de coluna é uma causa incomum de disfagia e que o esôfago cervical, por estar provavelmente mais fixo a essa regiäo, é o mais freqüentemente envolvido. Os autores enfatizam a necessidade de esofagoscopia, näo só para confirmaçäo diagnóstica, mas também para excluir doença maligna. Preconizam a ressecçäo cirúrgica como o melhor tratamento, com ausência total da sintomatologia