Surgical Management of 4-level Cervical Spondylotic Myelopathy

May 2013
Orthopedics;May2013, Vol. 36 Issue 5, pe613
Academic Journal
The optimal surgical approach for 4-level cervical spondylotic myelopathy is controversial. The authors compared the clinical outcomes, radiographic changes, and complications of 53 patients who underwent either discontinuous corpectomy and fusion (DCF) with reservation of the middle vertebra (n=29) or laminectomy and fusion (n=24). Neurological function was measured using Nurick's grade and modified Japanese Orthopedic Association scores. The Neck Disability Index was recorded for neck-shoulder pain level evaluation. Patients' satisfaction with the surgery was evaluated using the Short Form 36. Segmental lordosis was measured. Both groups demonstrated significantly improved Nurick's grades and Japanese Orthopedic Association scores (P<.001), and the recovery rate was similar between the groups (59.86%±17.63% and 60.18%±12.01%, respectively). In terms of Neck Disability Index scores, Short Form 36 scores, and cervical lordosis measurements, no significant intergroup differences were found preoperatively. Mean postoperative Neck Disability Index scores were significantly lower in the DCF group (12.31 ±1.91) than in the laminectomy group (15.04±3.09; P=.000). Mean postoperative segmental lordosis was significantly higher in the DCF group (14.24±2.29) than in the laminectomy group (9.96±2.14; P=.001). The Short Form 36 scores significantly improved in both groups postoperatively (P<.01). Relative to the DCF group, the laminectomy group had a significantly longer operative time (192.25±33.47 vs 192.25±33.47 minutes, respectively; P<.01) and significantly more operative blood loss (455.41 ±140.46 vs 253.79±77.94 mL, respectively; P<.01). Discontinuous corpectomy and fusion with reservation of the middle vertebra is a safe and effective surgical treatment for 4-level cervical spondylotic myelopathy that results in significant functional improvement in most patients.


Related Articles

  • WHAT'S NEW IN SPINE SURGERY. Zigler, Jack E.; Boden, Scott; Anderson, Paul A.; Bridwell, Keith; Vaccaro, Alexander // Journal of Bone & Joint Surgery, American Volume;Jul2002, Vol. 84-A Issue 7, p1282 

    Discusses developments in spine surgery. Cervical disc replacement; Surgical management of cervical spondylotic myelopathy; Spinal deformity surgery; Treatment of the lumbar spine; Spinal cord injury.

  • Cervical Laminoplasty for Multilevel Cervical Myelopathy. Sayana, Murali Krishna; Jamil, Hassan; Poynton, Ashley // Advances in Orthopedics;2011, p1 

    Cervical spondylotic myelopathy can result from degenerative cervical spondylosis, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multi-level myelopathy aims to decompress the spinal cord and...

  • Abstracts of 25th annual meeting of the Cervical Spine Research Society: European Section held in Uppsala, Sweden on June 10th–13th, 2009.  // European Spine Journal;Mar2010, Vol. 19 Issue 3, p517 

    The article presents abstracts on medical topics discussed at the 25th annual meeting of the Cervical Spine Research Society held in Sweden which include the use of natural history of cervical myelopathy, surgical treatment for cervical spondylotic myelopathy in athetoid cerebral palsy, and...

  • Surgical management of cervical spondylotic myelopathy. Muthukumar, N. // Neurology India;Mar2012, Vol. 60 Issue 2, p201 

    Cervical spondylotic myelopathy (CSM) is emerging as the most common cause of spinal cord dysfunction in the elderly worldwide. In the past decade, our understanding of the biomechanics of the spine has improved along with advances in spinal instrumentation and this has led to significant...

  • Erratum to: Degenerative spondylolisthesis does not influence surgical results of laminoplasty in elderly cervical spondylotic myelopathy patients. Shigematsu, Hideki; Ueda, Yurito; Takeshima, Toshichika; Koizumi, Munehisa; Satoh, Nobuhisa; Matsumori, Hiroaki; Oshima, Takuya; Tanaka, Masato; Kugai, Atsuo; Takakura, Yoshinori; Tanaka, Yasuhito // European Spine Journal;Aug2010, Vol. 19 Issue 8, p1393 

    A correction to the article "Degenerative spondylolisthesis does not influence surgical results of laminoplasty in elderly cervical spondylotic myelopathy patients" that was published in the May 8, 2010 issue is presented.

  • Cervical Spondylotic Myelopathy.  // ACA News (American Chiropractic Association);Dec2015, Vol. 11 Issue 10, p26 

    The article discusses cervical spondylotic myelopathy (CSM) disorder and topics including radiographic examination of the cervical spine, magnetic resonance imaging (MRI) for high-resolution imaging of the spinal cord in CSM, and possible treatment including non-surgical management for mild CSM.

  • How beneficial is surgery for cervical radiculopathy and myelopathy? Fouyas, Ioannis P.; Sandercock, Peter A. G.; Statham, Patrick F. X.; Nikolaidis, Ioannis // BMJ: British Medical Journal (Overseas & Retired Doctors Edition;7/24/2010, Vol. 341 Issue 7765, p200 

    The article presents a study concerning the clinical benefits of surgical management for cervical radiculopathy and myelopathy. It states that radiculopathy and myelopathy result from spondylotic degeneration of the cervical spine which is associated to ageing. It highlights the evidence of...

  • Laminoplasty versus laminectomy for multi-level cervical spondylotic myelopathy: a systematic review of the literature. Lifeng Lao; Guibin Zhong; Xinfeng Li; Lie Qian; Zude Liu // Journal of Orthopaedic Surgery & Research;2013, Vol. 8 Issue 1, p45 

    Background: There is considerable controversy as to which posterior technique is best for the treatment of multi-level cervical spondylotic myelopathy. The aim of this study was to compare the clinical and radiographic results and complications of laminoplasty (LAMP) and laminectomy (LAMT) in...

  • Human neuropathological and animal model evidence supporting a role for Fas-mediated apoptosis and inflammation in cervical spondylotic myelopathy. Yu, Wen Ru; Liu, Tianyi; Kiehl, Tim-Rasmus; Fehlings, Michael G. // Brain: A Journal of Neurology;May2011, Vol. 134 Issue 5, p1277 

    Although cervical spondylotic myelopathy is a common cause of chronic spinal cord dysfunction in humans, little is known about the molecular mechanisms underlying the progressive neural degeneration characterized by this condition. Based on animal models of cervical spondylotic myelopathy and...

  • Similar results seen with anterior, posterior approaches for cervical spondylotic myelopathy. Buddle, Renee Blisard // Orthopedics Today;Feb2013, Vol. 33 Issue 2, p34 

    The article reports on the claim by Doctor Michael G. Fehlings of Toronto Western Hospital in Ontario that the use of posterior and anterior surgical approaches in patients with cervical spondylotic myelopathy yielded similar results.


Read the Article


Sign out of this library

Other Topics