Lesson learned in endoscopic endonasal dens resection for C1-C2 spinal cord decompression.

PURPOSE: Endoscopic endonasal approach (EEA) is the safest and most effective technique for odontoidectomy. Nevertheless, this kind of approach is yet not largely widespread. The aim of this study is to share with the scientific community some tips and tricks with our ten-year-old learned experience in endoscopic endonasal odontoidectomy (EEO), which remains a challenging surgical approach. MATERIAL AND METHODS: Our case series consists of twenty-one (10 males, 11 females; age range of 34-84 years) retrospectively analyzed patients with ventral spinal cord compression for non-reducible CVJ malformation, treated with EEA from July 2011 to March 2019. RESULTS: The results have recently been reported in a previous paper. The only intraoperative complication observed was intraoperative cerebrospinal fluid (CSF) leak (9.5%), without any sign of post-operative CSF leak. CONCLUSIONS: Considering our experience, EEO represents a valid and safe technique to decompress neural cervical structures. Despite its technical complexity, mainly due to the use of endoscope and the challenging surgical area, with this study we encourage the use of EEO displaying our experience-based surgical tips and tricks.

Manejo del dolor óseo en pacientes cancerosos / Bony pain management in cancerous patients

Las metástasis óseas se desarrollan en aproximadamente 30 a 70% de todos los pacientes con cáncer. El dolor es una experiencia de la condición humana universal, y es común que las personas busquen atención médica a raíz de ello. El presente estudio tuvo como objetivo describir la eficacia y el papel de diferentes estrategias en el control del dolor óseo en pacientes cancerosos metastásicos. Se trata de un estudio observacional realizado entre el 1 de diciembre de 2018 y el 30 de diciembre de 2019. Se inscribieron exactamente 100 pacientes cancerosos. Los pacientes fueron evaluados antes de recibir las modalidades de control del dolor, al principio y al final del tratamiento. La puntuación del dolor óseo se utilizó de 0 (sin dolor) a 10 (el peor dolor). Nuestros hallazgos con respecto al sexo, hubo 51 (51%) hombres y 49 (49%) mujeres. La edad media fue de 57,3 ± 11,2 años y el grupo de edad más frecuente fue de 41-50 años, 37 (37%). Entre los tipos de cáncer, el cáncer de mama ocupa el primer lugar entre los casos estudiados en nuestra investigación 37 (37%), seguido del cáncer de próstata 24 (24%). Las vértebras de la columna fueron el sitio más representado en un 52%, seguido de los huesos pélvicos en un 36%. La mayoría de los pacientes no requirieron cirugía. Mientras que el 15% de los pacientes se sometieron a descompresión del cordón, el 13% requirió fijación interna y solo cuatro pa- LA PRENSA MÉDICA ARGENTINA Bony pain management in cancerous patients 117 V.107/Nº 2 cientes se sometieron a vertebroplastia. El dolor agudo se describió comúnmente en un 40%, seguido de naturaleza punzante en un 15%. El dolor frecuente fue más prevalente en el 60% de los pacientes, mientras que el dolor constante se presentó en el 40%. La noche fue el momento más común de sentir dolor en el 55%. Después de recibir el tratamiento, varias modalidades provocan un desplazamiento de la puntuación del dolor hacia abajo. Combinación de más de estrategias más eficientes que utilizar una opción para el manejo del dolor óseo con un mejor resultado y pronóstico.

Bone metastases develop in approximately 30­70% of all cancer patients. Pain is a universal human experience condition, and it is a common question for people to seek health care. The study aimed to describe the efficacy and roles of different strategies in the control of bony pain in metastatic cancerous patients. This is an observational study carried out, from the 1st of December 2018 to the 30th of December 2019. Exactly 100 cancerous patients were enrolled. Patients were assessed before received of pain control modalities, in the beginning, and at the end of treatment. Bone pain scoring was used from 0 (no pain) to 10 (the worst pain). Our findings regarding sex, there were 51(51%) male and 49(49%) female. The mean age was 57.3±11.2 years, and the most frequent age group was 41-50 years as 37(37%). Among cancer types, breast cancer comes in 1st rank cases studied in our research 37(37%), followed by prostate cancer 24(24%). Spine vertebrae were the most site figured 52%, followed by pelvic bones in 36%. Most patients did not require surgery. Whereas 15% of patients underwent cord decompression, 13% required internal fixation and only four patients performed for vertebroplasty. The sharp pain was commonly described by 40%, followed by stabbing nature in 15%. Frequent pain was more prevalent in 60% of patients, whereas constant pain presented in 40%. The night was the commonest timing of feeling pain in 55%. After receiving treatment, several modalities cause shifting of the pain scoring downward. Combination of more than strategies more efficient than of use one option for manage of bone pain with a better outcome, and prognosis.

Laminectomy versus open-door laminoplasty for cervical spondylotic myelopathy: A clinical outcome analysis.

BACKGROUND: Cervical spondylotic myelopathy (CSM) is one of the most common diseases in the geriatric population. Decompressive laminectomy or laminoplasty is the predominant surgical procedure of choice, but there remains debate as to which procedure is optimal for managing CSM. METHODS: Here, we retrospectively analyzed 64 patients with CSM undergoing laminectomy (39 patients) versus laminoplasty (25 patients). The data were collected included respective Japanese orthopedic association (JOA) scores, Nurick grades, and Visual analog scale (VAS) values preoperatively versus 12 months postoperatively. RESULTS: The JOA score after 1 month improved in both groups utilizing laminectomy or laminoplasty. However, at 12 postoperative months, the JOA scores and Nurick grades showed greater improvement following laminoplasty, despite no differences in postoperative pain and complication rates. CONCLUSION: Patients with cervical spondylotic myelopathy undergoing laminoplasty (25 patients) showed better 12-month postoperative outcomes (JOA scores and Nurick grades) versus those having laminectomies (39 patients).

Primary Spinal Epidural Abscesses Not Associated With Pyogenic Infectious Spondylodiscitis: A New Pathogenetic Hypothesis.

Introduction: Spinal epidural abscess (SEA) incidence is rising. However, most series do not differentiate between SEAs associated with pyogenic infectious spondylodiscitis (PS) and SEAs limited to the epidural space. Methods: We retrospectively reviewed the records and radiological images of all patients admitted to our institutions with a diagnosis of SEA not associated with PS between January 2013 and December 2018. Results: We found three males and four females; five of the seven were intravenous drug users. All patients presented with pain: in six, it was associated with acute motor and sensory deficits, while one had only pain and paresthesias. Staphylococcus aureus was cultured from abscesses and/or from multiple blood cultures in four patients. Abscesses were localized to the cervical spine in one patient, thoracic in three, lumbar in one, and in two, the SEAs involved multiple segments. All patients but one underwent urgent open surgery. This patient had a multisegmental abscess and was successfully treated by percutaneous aspiration when pain became intractable. After abscess evacuation, the neurological deficits improved in all patients except one. The patients that were treated without spine instrumentation did not develop delayed kyphosis or instability at follow-up. Conclusion: Patients with SEAs not associated with PS are likely to present with pain and motor deficits, appear to benefit from urgent abscess evacuation, and seem to be less dependent on spine instrumentation to avoid delayed spinal deformities compared to SEA associated with PS. Finally, the lack of initial involvement of bone and intervertebral disks may suggest that at least some of the SEAs without PS originate from infection of epidural lymphatic vessels that are not present inside those structures.

Surgical decompression for recurrent cord compression in cancer: a case series and review of the literature.

Spine metastases affect a significant number of cancer patients each year, with the spine being the third most common location for cancer spread. As patients live longer with improved treatments, the opportunity for recurrence at previously treated sites increases. Here, we describe seven patients with recurrent, compressive, metastatic spine tumors at previously surgically treated sites that required additional surgical intervention with manipulation of at least one rod. Five of the patients had recurrence including adjacent levels while two had recurrence solely at the previously decompressed level. The patients remained ambulatory for an average of 31.2 months after the initial surgery. We also discuss the role of adjuvant treatment in these patients and review the literature.

Circumferential resection decompression combined with bone cement fill-separation for treatment of spine meta-static tumor / 局解手术学杂志

Objective To explore the effect of spinal 360°circumferential resection decompression combined with bone cement fill-separation and pedicle screw fixation instrumentationb for patients suffering from spinal metastases.Methods Retrospectively analyzed the clinical data of 42 patients suffering from spinal metastases and underwent spinal 360°circumferential resection decompression combine with bone cement fill-separation and pedicle screw fixation instrumentation in our hospital from April 2012 to October 2016.The pain level were assessed by visual analogue scale(VAS),the functional impairment was classified by Karnofsky score(KPS) and the neurologic deficit was evaluated by Frankel grade before preoperation,1 week after operation and 3 months after operation.Results Through the following-up of 3 months,there was no neural symptoms relapse in primary segment.The VAS score was (0.57 ±0.79) points,and the KPS was (72.61 ± 19.12) points 3 months after operation,which were significantly improved compared with the data before operation (P ＜ 0.05).The VAS score improvement rate was (91.09％ ±13.73％),and the Frankel grade improvement rate was 80％.Conclusion Circumferential resection decompression combined with bone cement fill-separation and pedicle screw fixation instrumentationb for patients suffering from spinal metastases can effectively improve the neural symptoms and life-quality of patients and prevent neural symptoms relapsing in primary segment after operation.

Early Versus Delayed Surgical Decompression of Spinal Cord after Traumatic Cervical Spinal Cord Injury: A Cost-Utility Analysis.

OBJECTIVE: This cost-utility analysis was undertaken to compare early (≤24 hours since trauma) versus delayed surgical decompression of spinal cord to determine which approach is more cost effective in the management of patients with acute traumatic cervical spinal cord injury (SCI). METHODS: This study includes the patients enrolled into the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) and admitted at Toronto Western Hospital. Cases were grouped into patients with motor complete SCI and individuals with motor incomplete SCI. A cost-utility analysis was performed for each group of patients by the use of data for the first 6 months after SCI. The perspective of a public health care insurer was adopted. Costs were estimated in 2014 U.S. dollars. Utilities were estimated from the STASCIS. RESULTS: The baseline analysis indicates early spinal decompression is more cost-effective approach compared with the delayed spinal decompression. When we considered the delayed spinal decompression as the baseline strategy, the incremental cost-effectiveness ratio analysis revealed a saving of US$ 58,368,024.12 per quality-adjusted life years gained for patients with complete SCI and a saving of US$ 536,217.33 per quality-adjusted life years gained in patients with incomplete SCI for the early spinal decompression. The probabilistic analysis confirmed the early-decompression strategy as more cost effective than the delayed-decompression approach, even though there is no clearly dominant strategy. CONCLUSIONS: The results of this economic analysis suggests that early decompression of spinal cord was more cost effective than delayed surgical decompression in the management of patients with motor complete and incomplete SCI, even though no strategy was clearly dominant.

[MINIMALLY INVASIVE PASSAGE IN POSTERIOR LAMINOTOMY DECOMPRESSION AND INTERVERTEBRAL BONE GRAFTING COMBINED WITH PERCUTANEOUS PEDICLE SCREW FIXATION FOR TREATMENT OF Denis TYPE B THORACOLUMBAR BURST FRACTURES].

OBJECTIVE: To evaluate the feasibility and the effectiveness of minimally invasive passage in posterior laminotomy decompression and intervertebral bone grafting combined with percutaneous pedicle screw fixation for the treatment of Denis type B thoracolumbar burst fractures. METHODS: Between January 2013 and March 2015, 53 patients with Denis type B thoracolumbar burst fractures were treated by minimally invasive passage in posterior laminotomy decompression and intervertebral bone grafting combined with percutaneous pedicle screw fixation. There were 37 males and 16 females with a mean age of 43 years (range, 16-57 years). The causes included falling injury from height in 23 cases, traffic accident injury in 15 cases, heavy pound injury in 7 cases, and falling injury in 8 cases. The time between injury and operation was 7 hours to 12 days (mean, 6.7 days). The involved segments included T11 in 2 cases, T12 in 7 cases, L1 in 20 cases, L2 in 18 cases, and L3 in 6 cases; based on the neurological classification of spinal cord injury by American Spinal Injury Association (ASIA), 3 cases were rated as grade A, 5 cases as grade B, 12 cases as grade C, 24 cases as grade D, and 9 cases as grade E. The operation time, bleeding volume, and postoperative drainage were recorded; postoperative visual analogue scale (VAS) was used for pain evaluation, and ASIA for neurological function assessment; CT and X-ray films were taken to observe fracture healing, bone fusion, and grafted bone absorption; The vertebral canal patency rate was calculated; the relative height of fractured vertebrae and Cobb angle were measured. RESULTS: The operation was successfully completed in all patients; the average operation time was 150 minutes (range, 90-240 minutes); the average bleeding volume was 350 mL (range, 50-500 mL); the average postoperative drainage was 80 mL (range, 20-150 mL); and the average VAS score was 2.3 (range, 1.5-4.7) at 3 days after operation. The incisions healed primarily. All the patients were followed up 12-19 months (mean, 15 months). All fractures healed at 3-9 months (mean, 6 months). No complications of broken nails, broken rod, and screw loosening occurred. At last follow-up, the vertebral canal patency rate was significantly improved when compared with preoperative value (t=27.395, P=0.000). The Cobb angle, and the anterior and posterior heights of of traumatic vertebra were significantly improved at 1 week, 1 year, and last follow-up when compared with preoperative ones (P<0.05), but there was no significant difference between different time points after operation (P>0.05). The neurological function was improved in different degrees; 1 case was rated as grade A, 4 cases as grade B, 7 cases as grade C, 15 cases as grade D, and 26 cases as grade E, showing significant difference when compared with preoperative one (Z=-5.477, P=0.000). CONCLUSIONS: Minimally invasive passage in posterior laminotomy decompression, bone graft in the injured vertebrae combined with percutaneous pedicle screw fixation is an effective method to treat Denis type B thoracolumbar burst fractures, which not only can fully decompression, but also can effectively maintain the postoperative injured vertebral height, reduce the postoperative failure risk of internal fixation and decrease operation trauma.

MINIMALLY INVASIVE PASSAGE IN POSTERIOR LAMINOTOMY DECOMPRESSION AND INTERVERTEBRAL BONE GRAFTING COMBINED WITH PERCUTANEOUS PEDICLE SCREW FIXATION FOR TREATMENT OF Denis TYPE B THORACOLUMBAR BURST FRACTURES / 中国修复重建外科杂志

RESULTS: The operation was successfully completed in all patients; the average operation time was 150 minutes (range, 90-240 minutes); the average bleeding volume was 350 mL (range, 50-500 mL); the average postoperative drainage was 80 mL (range, 20-150 mL); and the average VAS score was 2.3 (range, 1.5-4.7) at 3 days after operation. The incisions healed primarily. All the patients were followed up 12-19 months (mean, 15 months). All fractures healed at 3-9 months (mean, 6 months). No complications of broken nails, broken rod, and screw loosening occurred. At last follow-up, the vertebral canal patency rate was significantly improved when compared with preoperative value (t=27.395, P=0.000). The Cobb angle, and the anterior and posterior heights of of traumatic vertebra were significantly improved at 1 week, 1 year, and last follow-up when compared with preoperative ones (P0.05). The neurological function was improved in different degrees; 1 case was rated as grade A, 4 cases as grade B, 7 cases as grade C, 15 cases as grade D, and 26 cases as grade E, showing significant difference when compared with preoperative one (Z=-5.477, P=0.000).

Gradual spinal cord decompression through migration of floated plaques after anterior decompression via a posterolateral approach for OPLL in the thoracic spine.

OBJECT: Several surgical procedures have been developed to treat thoracic OPLL (ossification of the posterior longitudinal ligament). However, favorable surgical results are not always achieved, and consistent protocols and procedures for surgical treatment of OPLL in this region have not been established. Beak-type OPLL in the thoracic spine is known to be the most complicated form of OPLL to treat surgically. In this study, the authors examine the clinical outcomes after anterior decompression via a posterolateral approach for beak-type OPLL in the thoracic spine and address the gradual spinal cord decompression caused by migration of the floated plaques after surgery. METHODS: Between 2011 and 2013, a total of 12 patients with thoracic myelopathy due to OPLL were surgically treated at the authors' institute. The study group for this paper comprises 6 of those 12 patients. These 6 patients, who had beak-type OPLL, underwent with anterior decompression and instrumented fusion via the authors' posterolateral approach-based surgical technique. The other 6 patients, who exhibited other types of OPLL, underwent posterior decompression and instrumented fusion. In the study group (the 6 patients with beak-type OPLL), half of the patients (the 3 patients who were treated first) were treated with removal of the ossified ligament. These patients are referred to as the removal group. The other 3 patients were treated by means of "floating" the OPLL plaques and are referred to as the floating group. Clinical and radiographic outcomes were evaluated in these 6 cases. RESULTS: The recovery rates were 52.4% in the removal group and 60.0% in the floating group. Two patients in the removal group had operative complications, including a dural tear and temporary neurological deterioration. No operative complications were encountered in the floating group. In all 3 cases in the floating group, floating of the ossified ligament was completely achieved, and the floated plaque gradually migrated into the ventral bone resection areas. The mean migration distances of the floated plaque were 2.4 mm, 4.3 mm, 4.7 mm, and 4.8 mm at 1, 3, 6, and 12 months after surgery. CONCLUSIONS: Treatment of beak-type OPLL in the thoracic spine via the posterolateral approach-based floating plaque technique was safe and effective in this small case series. Gradual migration of the floated plaques provided additional spinal cord decompression during the postoperative course.

A radical procedure of circumferential spinal cord decompression through a modified posterior approach for thoracic myelopathy caused by severely impinging anterior ossification.

BACKGROUND CONTEXT: Thoracic myelopathy caused by an anterior, massive ossified plaque is often progressive and responds poorly to conservative treatment. Direct removal of the compressing ossification is the optimal procedure for a spinal cord that is severely impinged anteriorly. However, both anterior and posterior decompressive manipulations have caused catastrophic iatrogenic spinal cord injuries. A comprehensive treatment method for severe thoracic myelopathy that enables a sufficient and safe decompression of the spinal cord is needed. PURPOSE: The purpose of this study is to demonstrate the efficacy, safety, and results of a one-stage circumferential decompressive procedure using a modified posterior approach in patients with severe thoracic myelopathy resulting from anterior spinal compression. STUDY DESIGN: A modified procedure of circumferential spinal cord decompression for thoracic myelopathy is described. A retrospective study was conducted to investigate the clinical outcomes of 23 sequentially treated patients. PATIENT SAMPLE: Twenty-three patients were treated sequentially with a modified procedure for circumferential spinal cord decompression for thoracic myelopathy. OUTCOME MEASURES: Outcomes were assessed using the Japanese Orthopedic Association (JOA) score, modified Frankel classification, Hirabayashi recovery rate, and a general assessment of complications. METHODS: Twenty-three patients with thoracic myelopathy caused by a massive, anterior ossified structure were treated with an extensive posterior laminectomy, anterior removal of the ossification, and interbody fusion with kyphosis-reversing stabilization through a modified posterolateral approach. The neurologic outcomes are evaluated according to the JOA and the modified Frankel classification before surgery, 2 weeks after surgery, 1 year after surgery, and at the final follow-up visit. The surgical outcomes are also described using the Hirabayashi recovery rate. Radiographs, computed tomography (CT), and magnetic resonance imaging were performed before and after surgery. A postoperative CT scan was obtained to determine the efficacy of the decompression. Operative time, intraoperative blood loss, and complications were reviewed from the medical records. In addition, a 48-year-old man who presented with severe thoracic myelopathy resulting from anterior impingement with multiple osteophytes is described as an illustrative patient. RESULTS: The sites of ossification in this series were distributed widely, from T4-T12. The anterior ossified plaques of all patients were resected completely. Five patients who had intraoperative evidence of dural ossification required resection of the ossified dura matter. The average operating time was 276 minutes. Mean intraoperative blood loss was 1,350 mL. The postoperative follow-up ranged from 2.5 to 6 years, with an average of 4.6 years. The average preoperative JOA score was 4.3±1.5 points, and it improved to 6.1±1.9 points 2 weeks postoperatively, to 8.1±1.8 points 1 year postoperatively, and to 8.5±1.9 points at the most recent follow-up. The overall Hirabayashi recovery rate at the final examination averaged 63.6±22.4%. Eight patients were graded as excellent, 10 as good, 4 as fair, and 1 as unchanged. No patient was graded as deteriorated. The paralysis improved by at least 1 grade in 22 patients (95.7%). Transient deterioration of thoracic myelopathy occurred immediately after surgery in three patients (13%). Cerebrospinal fluid leakage occurred in six patients (26.1%). One patient sustained severe bilateral groin pain, three had unilateral intercostal neuralgia, and pleura tear occurred in one patient. CONCLUSION: One-stage posterior decompression, anterior extirpation of the ossification, and interbody fusion with instrumentation via a modified posterior approach is a safe and effective treatment for severe thoracic myelopathy resulting from prominent anterior impingement. This procedure is technically demanding, and the indications are limited to thoracic myelopathy caused by severe anterior impingement of various etiologies from T4-T12.

Effects of Microscopic Anterior Cervical Approach in Cervical Spondylotic Diseases / 天津医药

Objective To assess the curative effect of microscopic anterior cervical approach in cervical spondylotic diseases. Methods A total of 75 patients were selected, who underwent microscopic subtotal anterior cervical decompres-sion and titanium mesh to fusion fixation or microscopic decompression of resection of the cervical intervertebral disc and cage implant fixation in Tianjin People's Hospital since October 2011 to October 2012. The Cervical vertebra gap involved 1 level in 41 cases, 2 levels in 30 cases and 3 levels in 4 cases. Pateints followed up regularly after operation. The nerve func-tion was assessed using Japanese orthopaedic association scoring system (JOA) function was calculated to examine the im-provement rate and to assess the curative effect of microscopic anterior cervical approach. Results All patients were fol-lowed up. The nerve function recovery was excellent in 44 cases, was well in 25 cases, was general in 6 cases, and the ex-cellent and well recovery rate was 92%. There was no significant difference between excellent recovery rate and well recov-ery rate. There were significant differences in values of each cervical levels between before and after surgery in the last fol-low-up of patients (P<0.05). Conclusion Microscopic operative treatment for cervical spondylotic is safe and effective, with less trauma and bleeding. After surgical decompression, the recovery is rapid in patients with early ambulation.

Acondroplasia -estenosis del canal medular- una complicación neurológica / Achondroplasia -spinal canal stenosis-a neurological complication

Introducción. La acondroplasia es un trastorno genético del crecimiento óseo de herencia autosómica dominante. Su incidencia es de 1:26,000 nacimientos por año. Este trastorno es causado por una mutación en el gen que codifica al receptor tipo 3 del factor de crecimiento del fibroblasto (FGFR3) en el cromosoma 4, el cual se expresa en los condrocitos de la placa de crecimiento de los huesos; de esta manera afecta la osificación endocondral. Se manifiesta clínicamente por talla baja con desproporción anatómica, macrocefalia, acortamiento de extremidades y deformidades esqueléticas. Las complicaciones neurológicas de la acondroplasia son la causa más frecuente de morbilidad y mortalidad. Caso clínico. Se trata de un paciente femenino de 5 años de edad con acondroplasia que ingresó con diagnóstico de enfermedad tipo influenza. A la exploración física presentaba clonus, hiperreflexia, limitación funcional de extremidades y retraso del desarrollo psicomotor. Durante su estancia intrahospitalaria presentó paro respiratorio que ameritó fase III de ventilación; por la debilidad de los músculos torácicos no fue posible la extubación. Se realizó una tomografía de cráneo y una imagen de resonancia magnética cráneo-cervical, encontrando la compresión del canal cérvico-medular. Conclusiones. La identificación temprana de la compresión medular y su descompresión inmediata pueden ayudar a prevenir complicaciones serias, como la insuficiencia respiratoria y la muerte súbita.

Background. Achondroplasia (AC) is an autosomal dominant genetic disorder of bone growth with an annual incidence of 1:26,000 births. It is caused by a mutation in the gene encoding the receptor type 3 growth of fibroblast factor (FGFR3) on chromosome 4, which is present in chondrocytes of the growth plate of bones, thus affecting endochondral ossification. It is manifested clinically by short stature with anatomic disproportion, macrocephaly, shortened limbs and skeletal deformities. Neurological complications of AC are the most common cause of morbidity and mortality. Case report. We report the case of a 5-year-old female patient with achondroplasia who was admitted with a diagnosis of influenza-like illness. Physical examination revealed clonus, hyperreflexia, limb functional limitation, and delayed psychomotor development. During her hospital stay the patient experienced respiratory arrest, necessitating the use of phase III mechanical ventilation, making extubation impossible due to weakness of chest muscles. Cranial computed tomography (CT) and cervical magnetic resonance imaging (MRI) were performed, demonstrating compression of the cervicospinal canal. Conclusions. Early identification of spinal cord compression and its immediate decompression can help to prevent serious complications, including respiratory failure and sudden death.

Operative Treatment of Cervical Spondylotic Myelopathy by Bilateral Backward Displacement of Lamina and Expansion of Nerve Root Canal / 中华骨科杂志

Objective:To evaluate the results of 25 cases of cervical spondylotic myelopathy treated by the bilateral backward displacement of lamina and expansion of the nerve root canalsince 1994. Method: Thepostopera tire and preoperative CT and MR imaging were used to compare the efficacy of backward displacement and decompression of the spinal cord. Result: According to the criteria for assessment set up by Dr Yin Huafu, the result was excellent in 13 cases, good in 8 and acceptable in 3; one case failed to get any improvement. Conclusion: This operation is a safe and an effective procedure for the treatment of the majority cases of cervical spondylotic myelopathy. In some cases this procedure should be done in combination with anterolateral decompression.