Facetal distraction as treatment for single- and multilevel cervical spondylotic radiculopathy and myelopathy: a preliminary report

Technical note

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The authors discuss their successful preliminary experience with 36 cases of cervical spondylotic disease by performing facetal distraction using specially designed Goel cervical facet spacers. The clinical and radiological results of treatment are analyzed. The mechanism of action of the proposed spacers and the rationale for their use are evaluated.

Between 2006 and February 2010, 36 patients were treated using the proposed technique. Of these patients, 18 had multilevel and 18 had single-level cervical spondylotic radiculopathy and/or myelopathy. The average follow-up period was 17 months with a minimum of 6 months. The Japanese Orthopaedic Association classification system, visual analog scale (neck pain and radiculopathy), and Odom criteria were used to monitor the clinical status of the patient. The patients were prospectively analyzed. The technique of surgery involved wide opening of the facet joints, denuding of articular cartilage, distraction of facets, and forced impaction of Goel cervical facet spacers into the articular cavity. Additionally, the interspinous process ligaments were resected, and corticocancellous bone graft from the iliac crest was placed and was stabilized over the adjoining laminae and facets after adequately preparing the host bone. Eighteen patients underwent single-level, 6 patients underwent 2-level, and 12 patients underwent 3-level treatment. The alterations in the physical architecture of spine and canal dimensions were evaluated before and after the placement of intrafacet joint spacers and after at least 6 months of follow-up.

All patients had varying degrees of relief from symptoms of pain, radiculopathy, and myelopathy. Analysis of radiological features suggested that the distraction of facets with the spacers resulted in an increase in the intervertebral foraminal dimension (mean 2.2 mm), an increase in the height of the intervertebral disc space (range 0.4–1.2 mm), and an increase in the interspinous distance (mean 2.2 mm). The circumferential distraction resulted in reduction in the buckling of the posterior longitudinal ligament and ligamentum flavum. The procedure ultimately resulted in segmental bone fusion. No patient worsened after treatment. There was no noticeable implant malfunction. During the follow-up period, all patients had evidence of segmental bone fusion. No patient underwent reexploration or further surgery of the neck.

Distraction of the facets of the cervical vertebra can lead to remarkable and immediate stabilization-fixation of the spinal segment and increase in space for the spinal cord and roots. The procedure results in reversal of several pathological events related to spondylotic disease. The safe, firm, and secure stabilization at the fulcrum of cervical spinal movements provided a ground for segmental spinal arthrodesis. The immediate postoperative improvement and lasting recovery from symptoms suggest the validity of the procedure.

Abbreviations used in this paper: JOA = Japanese Orthopaedic Association; PLL = posterior longitudinal ligament; VAS = visual analog scale.

Article Information

Address correspondence to: Atul Goel, M.Ch., Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai 400012, India. email: atulgoel62@hotmail.com.

Please include this information when citing this paper: published online March 18, 2011; DOI: 10.3171/2011.2.SPINE10601.

© AANS, except where prohibited by US copyright law.

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Figures

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    Photographs of the implant. Left: The various-sized spacers. The flat surface has serrations to make the surface rough. The hole with serrations is seen on the side of the implant, which is meant for the spacer holder. The hole in the center of the flat surface is meant to assist in arthrodesis. Right: The implant holder with the spacer.

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    Images obtained in a 39-year-old man. A and B: Preoperative images. Sagittal T2-weighted MR image showing cord compression opposite the C3–4 disc space (A). Sagittal CT scan showing the reduced disc spaces (B). C–H: Postoperative images. Sagittal CT scan showing the spacer within the C3–4 facet joint (C). Axial CT scan showing the spacer in the joint (D). Sagittal CT scan showing an increase in intervertebral space between C-3 and C-4 (E). Sagittal MR image showing the increase in spinal canal size and reduction in the extent of cord compression (F). Lateral radiograph showing the spacers in the joint (G). Anteroposterior radiograph showing the spacers (H).

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    Images obtained in a 68-year-old woman. The patient presented with complaints of neck and radicular pain and quadriparesis. A–C: Preoperative images. Sagittal T2-weighted MR images showing evidence of cord compression opposite the C5–6 and C6–7 disc levels (A). Buckling of both PLLs and ligamentum flavum can be seen. Sagittal CT scans showing degenerative changes, more predominantly at the C5–6 level (B). Sagittal CT scan showing the facets (C). Degenerative changes can be appreciated at the C5–6 level. D–G: Postoperative images. Sagittal MR images showing increase in the canal size, reduction in the extent of cord compression, reduction in the posterior buckling of the PLL, and anterior buckling of the ligamentum flavum (D). Sagittal CT scans showing an increase in the intervertebral and interspinous process spaces at the C5–6 and C6–7 levels (E). Evidence of bone fusion can be seen between spinous processes. Sagittal CT scan showing spacers within the facets of C5–6 and C6–7 (F). Coronal view showing the spacers (G).

  • View in gallery

    Images obtained in a 60-year-old woman. A–D: Preoperative images. Sagittal T2-weighted MR image showing evidence of significant spondylotic disease (A). Further MR imaging sections showed cord compression opposite C3–4, C4–5, and C5–6 disc spaces. Sagittal CT scan showing degenerative changes in the spine (B). Coronal section showing the facets of the cervical spine (C). Sagittal section showing the facets (D). E–J: Postoperative images. Sagittal section through the facets showing the spacers with the C3–4, C4–5, and C5–6 facet joint (E). Coronal view showing the spacers within the joints (F). Note the extent of distraction achieved by the procedure. Sagittal CT scan showing distraction and increase in the intervertebral and interspinous process spaces (G). Sagittal MR image showing reduction in the extent of cord compression (H). Reduction in the buckling of PLL and ligamentum flavum at the levels treated can be seen. Lateral radiograph showing the spacers (I). Anteroposterior radiograph showing the spacers (J).

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