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Connor Berlin, Alexandria C. Marino, Praveen V. Mummaneni, Juan Uribe, Luis M. Tumialán, Jay Turner, Michael Y. Wang, Paul Park, Erica F. Bisson, Mark Shaffrey, Oren Gottfried, Khoi D. Than, Kai-Ming Fu, Kevin Foley, Andrew K. Chan, Mohamad Bydon, Mohammed Ali Alvi, Cheerag Upadhyaya, Domagoj Coric, Anthony Asher, Eric A. Potts, John Knightly, Scott Meyer, and Avery Buchholz

C ervical spondylotic myelopathy (CSM) is the most common form of spinal cord disability in North America, with prevalence expected to continue increasing over the next decade. 1 As a blanket term, CSM describes degeneration of the cervical spinal bony anatomy that results in canal narrowing, which leads to spinal cord compression and neurological impairment. 1 , 2 Canal narrowing can be due to cervical spondylosis, ossification of the posterior longitudinal ligament, ossification of the ligamentum flavum, degenerative disc disease, or a combination of

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Neurosurgical Forum: Letters to the Editor To The Editor Paul R. Cooper , M.D. New York University School of Medicine New York, New York 253 254 Abstract Object. Investigators reporting decompressive surgery to treat patients with cervical spondylotic myelopathy (CSM) have described inconsistent benefits. In the present study the authors used three types of outcomes instruments to assess the results of CSM surgery. Methods. The authors collected prospective baseline and 6-month follow-up data in a cohort of

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Nader S. Dahdaleh, Albert P. Wong, Zachary A. Smith, Ricky H. Wong, Sandi K. Lam, and Richard G. Fessler

hospitalization time. 3 We have used a minimally invasive technique to treat certain cases of cervical spondylotic myelopathy. The patients are primarily those who have acceptable preoperative effective cervical lordosis, 6 whose preoperative flexion-extension radiographs do not indicate abnormal motion, and whose radiographs do not show segmental listhesis. The technique involves a unilateral paramedian approach through small incisions, with minimal muscle dissection, through which decompressive single or multilevel bilateral hemilaminotomies are achieved with total

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Paul G. Matz, Paul A. Anderson, Langston T. Holly, Michael W. Groff, Robert F. Heary, Michael G. Kaiser, Praveen V. Mummaneni, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. Vresilovic, and Daniel K. Resnick

) w/ MRI spondylotic compression. mJOA scores = 18; FU was 2-yr min (4-yr avg). Studied were EMG (anterior horn cell), SEPs, Pavlov ratio, & clinical exam. 19.7% developed CSM (5%/yr). Radiculopathy present premorbid in 92% w/ CSM & 24% w/o (p <0.0001), SEPs were abnormal in 38.5% w/ CSM & 9.4% w/o (p <0.02); Anterior horn cell EMG abnormal in 61% CSM & 11.3% w/o (p <0.01). No imaging correlates. I Development of CSM in a pathological cervical spine occurs in those w/ radiculopathy, abnormal SEP, or anterior horn cell disease on EMG. The rate is 5%/yr

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Kunihiko Sasai, Masayuki Umeda, Takanori Saito, Hiroyuki Ohnari, Ei Wakabayashi, and Hirokazu Iida

radiculomyelopathy is caused by short segmental stenosis, both the spinal cord and the nerve root are decompressed using anterior cervical decompression and interbody fusion. 24 In patients with radiculomyelopathy caused by multiple segmental stenosis and a developmentally narrowed spinal canal, however, the spinal cord but not the nerve root can be decompressed by laminoplasty alone. In these cases, anterior cervical decompression and fusion can be performed to alleviate both the spinal cord and nerve root compression, but long segmental fusion is needed. Cervical spondylotic

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Saman Shabani, Mayank Kaushal, Matthew D. Budde, Marjorie C. Wang, and Shekar N. Kurpad

C ervical spondylotic myelopathy (CSM) is a degenerative condition of the cervical spine and is the most common cause of spinal dysfunction in adults. 2 , 23 , 46 The progressive spinal cord injury in CSM stems from age-dependent structural changes to components of the cervical spinal axis such as the vertebral body, intervertebral disc, ligaments, and facet joints. 35 , 44 The diagnosis of CSM is based on a combination of clinical signs and symptoms and conventional MRI. 34 , 35 Despite being the imaging modality of choice for evaluating cervical cord

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Satoru Kadoya, Tsutomu Nakamura, Ryungchan Kwak, and Genjiro Hirose

a developmentally narrow canal. 9, 19 Since 1976, we have been using the anterior approach (namely, microsurgical osteophytectomy with interbody fusion) in cases of cervical spondylotic myelopathy, and have obtained good results. 12 Based upon this experience, we surmised that favorable results in myelopathy might be obtained even in patients with a developmentally narrow canal, if the primary causes of the cervical myelopathy were osteophytes and instability resulting from spondylosis. We have operated on 19 cases using this anterior approach and report the

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Hae-Dong Jho

C ervical spondylotic myelopathy has been surgically treated either by a posterior decompressive laminectomy or by an anterior discectomy or vertebrectomy approach. 1, 2, 5–9 Decompressive laminectomy is actually an indirect decompressive procedure because compressive lesions are most often located anteriorly. 2, 6, 9 An anterior vertebrectomy approach requires bone graft fusion and immobilization for a few months. After the author had accumulated experience with microsurgical anterior foraminotomy for cervical radiculopathy, 4 a new anterior technique was

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Ossama Al-Mefty, Louis H. Harkey, Troy H. Middleton, Robert R. Smith, and John L. Fox

I n 1981, Lucci, et al. , 20 reported on two cases in which computerized tomography (CT) demonstrated hypodense intramedullary cavitation of the spinal cord at, and extending beyond, levels of cord compression from cervical spondylosis. In 1983, Mossman and Jestico 24 illustrated a large syrinx in a postlaminectomy case of cervical spondylotic myelopathy (CSM); this was demonstrated by enhancement on CT 6 hours after intrathecal injection of metrizamide. Recently, investigators from Japan 14 and Saudi Arabia, 18 using delayed CT scanning after

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Kirpal S. Mann, Virender K. Khosla, and Des R. Gulati

C ervical spondylotic myelopathy is the most serious consequence of cervical spondylosis, especially when it is associated with a narrow spinal canal due to protruded intervertebral discs, bone bars, osteophytes, and laminar, dural, ligamentous, or apophyseal joint hypertrophy. 1, 22, 23, 31–34, 38, 42 Surgical procedures in various combinations have been advocated for the treatment of cervical spondylotic myelopathy; 1, 7, 11, 14, 26, 40, 41, 43 however, there is no general consensus or statistical evidence to prove the superiority of one surgical procedure