Surgical treatment of cervical spondylotic myelopathy with anterior compression: a review of 67 cases

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Object

In patients with cervical spondylotic myelopathy (CSM), ventral disease and loss of cervical lordosis are considered to be relative indications for anterior surgery. However, anterior decompression and fusion operations may be associated with an increased risk of swallowing difficulty and an increased risk of nonunion when extensive decompression is performed. The authors reviewed cases involving patients with CSM treated via an anterior approach, paying special attention to neurological outcome, fusion rates, and complications.

Methods

Retrospectively, 67 cases involving consecutive patients with CSM requiring an anterior decompression were reviewed: 46 patients underwent anterior surgery only (1-to3-level anterior cervical discectomy and fusion [ACDF] or 1-level corpectomy), and 21 patients who required > 3-level ACDF or ≥ 2-level corpectomy underwent anterior surgery supplemented by a posterior instrumented fusion procedure.

Results

Postoperative improvement in Nurick grade was seen in 43 (93%) of 46 patients undergoing anterior decompression and fusion alone (p < 0.001) and in 17 (81%) of 21 patients undergoing anterior decompression and fusion with supplemental posterior fusion (p = 0.0015). The overall complication rate for this series was 25.4%. Interestingly, the overall complication rate was similar for both the lone anterior surgery and combined anterior-posterior groups, but the incidence of adjacent-segment disease was greater in the lone anterior surgery group.

Conclusions

Significant improvement in Nurick grade can be achieved in patients who undergo anterior surgery for cervical myelopathy for primarily ventral disease or loss of cervical lordosis. In selected high-risk patients who undergo multilevel ventral decompression, supplemental posterior fixation and arthrodesis allows for low rates of construct failure with acceptable added morbidity.

Abbreviations used in this paper: ACDF = anterior cervical discectomy and fusion; CSM = cervical spondylotic myelopathy.

Article Information

Address correspondence to: Timothy Witham, M.D., Department of Neurourgery, Johns Hopkins University, Meyer 7–109, 600 North Wolfe Street, Baltimore, Maryland 21287. email: twitham2@jhmi.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    A: A T2-weighted sagittal MR image revealing severe cervical stenosis at C3–4 and C4–5 with retropulsion of C-4 relative to C-5. B: Postoperative lateral radiograph (same case as in A) decompression via C-4 corpectomy and titanium cage reconstruction with plate placement. C: A T2-weighted sagittal MR image revealing severe 3-level cervical stenosis. D: Postoperative lateral radiograph (same case as in C) showing decompression via 3-level anterior cervical discectomy and fusion.

  • View in gallery

    A: A T2-weighted sagittal MR image showing multilevel cervical stenosis and congenital canal stenosis. B: Postoperative lateral radiograph demonstrating 2-level corpectomy with titanium cage reconstruction with plate placement, supplemented by posterior instrumentation.

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