Anterior osteophytectomy for cervical spondylotic myelopathy in developmentally narrow canal

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✓ The authors present 19 cases of cervical spondylotic myelopathy in patients with developmentally narrow canal treated by microsurgical anterior osteophytectomy with interbody fusion, with follow-up periods of 1 to 8 years (mean 38 months). Postoperatively, the lower limb function, evaluated by Nurick's six-grade classification, improved two or three grades in 16 cases, one grade in two cases, and remained unchanged in one case. The upper limb function, evaluated by the authors' own four-grade classification, improved two or three grades in 11 cases, one grade in seven cases, and remained unchanged in one case. No deterioration caused by the osteophytectomy was seen. During the follow-up period, spondylolisthesis appeared 31 months postoperatively in one patient and soft disc hernia occurred 66 months postoperatively in another; these two patients were treated by a second operation and cervical traction, respectively. The authors conclude that anterior osteophytectomy with interbody fusion is applicable as a surgical treatment of cervical spondylotic myelopathy even where developmental canal stenosis is present.

Article Information

Address reprint requests to: Satoru Kadoya, M.D., Department of Neurosurgery, Kanazawa Medical University, Uchinada-machi, Kahoku-gun, Ishikawa-ken 920-02, Japan.

© AANS, except where prohibited by US copyright law.

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Figures

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    Comparison of number of operated discs with number of discs showing myelographic block in 19 cases.

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    Radiographs in a 42-year-old man with cervical spondylotic myelopathy and a developmentally narrow canal. A: Cross-table view of the cervical spine showing C5-6 osteophytic formation and intervertebral space narrowing. Poorly developed laminae are also seen. The sagittal diameter of the spinal canal at the C-5 vertebra was 11.9 mm. B: Metrizamide myelography obtained by C1-2 lateral injection. Anterior defects due to osteophytes at the C5-6 disc space and retrolisthesis at the C3-4 level are apparent. C: Laminagram showing prominent osteophytes at the C5-6 disc space. D: Postoperative laminagram (1 month later). Anterior osteophytectomy and interbody fusion were performed at three levels (C3-4, C4-5, and C5-6), with complete removal of spondylotic osteophytes together with a part of the posterior edge of the vertebral body.

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    Metrizamide myelogram with computerized tomography at C5-6 in the patient illustrated in Fig. 2. Left: Preoperative view. Bilateral posteromedial osteophytes and the resulting cervical cord deformity are apparent. Dotted line indicates the extent of anterior osteophytectomy. Right: Postoperative view 1 month after complete osteophytectomy (arrows) and interbody fusion. The cord deformity was still seen, but there is ample space around the cord.

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    Comparison of the pre- and postoperative severity of neurological symptoms in 19 cases. Grading was based on Nurick's classification.14 Grade 0: no myelopathy; Grade I: signs of myelopathy but no difficulty in walking; Grade II: slight difficulty in walking; Grade III: difficulty in walking, preventing full-time employment or the ability to do all housework; Grade IV: able to walk only with some kind of support; and Grade V: chair-bound or bedridden.

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    Comparison of the pre- and postoperative symptoms of the upper limbs in 19 cases. Grading was based on our own classification. Grade 0: no symptoms; Grade I: paresthesia and/or finger clumsiness; Grade II: slight sensory and/or motor deficits; Grade III: sensory and/or motor deficits preventing full-time employment or the ability to do all housework.

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