Cervical stenosis in adults undergoing thoracolumbar deformity surgery: incidence, treatment, and complications

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The goals of this study were to determine the incidence of occult cervical stenosis in patients over 50 years old with thoracolumbar deformity and to assess the risk of progressive cervical myelopathy after complex thoracolumbar reconstruction in asymptomatic or mildly symptomatic patients with cervical stenosis.


Charts and cervical imaging for patients who were over 50 years old when they had undergone thoracolumbar deformity surgery between 2005 and 2008 were reviewed. Patients with primary neurological disorders were excluded from the study.


Seventy-three patients (56 women and 17 men) met the study inclusion criteria. The minimum follow-up time was 2 years. Fifty-eight percent of patients (42 of 73) had cervical stenosis on advanced imaging. Thirty-three patients had mild or moderate stenosis; only 3 of these patients had clinical myelopathy. Nine patients (12%) had critical cervical stenosis, as determined from imaging; among these patients, 3 had moderate or severe myelopathy. Patients with noncritical stenosis and no or mild myelopathy underwent thoracolumbar reconstruction without any postoperative progression of myelopathy. Patients with critical stenosis and/or moderate or severe myelopathy were offered cervical decompression prior to thoracolumbar reconstruction; those who accepted this offer did not have progression of myelopathy. One patient underwent thoracolumbar reconstruction first despite critical cervical stenosis. At 20 months, her cervical myelopathy had progressed, and she ultimately required cervical decompression.


Cervical stenosis, even critical stenosis in some cases, was seen in more than one-half of the patients. Most presented without obvious cervical complaints. In those with mild to moderate stenosis and no or mild myelopathy, lengthy thoracolumbar reconstruction procedures were not associated with progression of the myelopathy. The authors recommend that all adults with thoracolumbar deformity undergo a detailed upper- and lower-extremity neurological examination prior to major thoracolumbar reconstruction.

Article Information

Address correspondence to: Eeric Truumees, M.D., Seton Spine & Scoliosis Center, 1600 W. 38th St., Ste. 200, Austin, TX 78731. email: ETruumees@Seton.org.

Please include this information when citing this paper: published online July 26, 2013; DOI: 10.3171/2013.6.SPINE121152.

© AANS, except where prohibited by US copyright law.



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    Clinical findings of cervical myelopathy in patients with thoracolumbar deformity.

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    Images obtained in a patient with thoracolumbar deformity and mild myelopathic symptoms. A: A radiograph demonstrating lumbar flat-back and positive sagittal imbalance. B: A sagittal lumbar MR image demonstrating multilevel, severe lumbar spinal stenosis. C: A preoperative cervical spine MR image showing critical cervical stenosis. D: A postoperative cervical spine radiograph demonstrating a healed anterior-posterior spine reconstruction.



Antonacci MDEismont FJ: Neurologic complications after lumbar spine surgery. J Am Acad Orthop Surg 9:1371452001


Boden SDMcCowin PRDavis DODina TSMark ASWiesel S: Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 72:117811841990


Lee MJCassinelli EHRiew KD: Prevalence of cervical spine stenosis. Anatomic study in cadavers. J Bone Joint Surg Am 89:3763802007


Lee SHKim KTSuk KSLee JHShin JHSo DH: Asymptomatic cervical cord compression in lumbar spinal stenosis patients: a whole spine magnetic resonance imaging study. Spine (Phila Pa 1976) 35:205720632010


Matsunaga SKukita MHayashi KShinkura RKoriyama CSakou T: Pathogenesis of myelopathy in patients with ossification of the posterior longitudinal ligament. J Neurosurg 96:2 Suppl1681722002


Ono KEbara SFuji TYonenobu KFujiwara KYamashita K: Myelopathy hand. New clinical signs of cervical cord damage. J Bone Joint Surg Br 69:2152191987


Rhee JMHeflin JAHamasaki TFreedman B: Prevalence of physical signs in cervical myelopathy: a prospective, controlled study. Spine (Phila Pa 1976) 34:8908952009


Suri AChabbra RPMehta VSGaikwad SPandey RM: Effect of intramedullary signal changes on the surgical outcome of patients with cervical spondylotic myelopathy. Spine J 3:33452003


Yagi MNinomiya KKihara MHoriuchi Y: Long-term surgical outcome and risk factors in patients with cervical myelopathy and a change in signal intensity of intramedullary spinal cord on Magnetic Resonance imaging. Clinical article. J Neurosurg Spine 12:59652010




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