Anterior Cervical Decompression and Arthrodesis for the Treatment of Cervical Spondylotic Myelopathy. Two to Seventeen-Year Follow-up

We reviewed the cases of 108 patients with cervical spondylotic myelopathy who had been managed with anterior decompression and arthrodesis at our institution. Operative treatment consisted of anterior discectomy, partial corpectomy, or subtotal corpectomy at one level or more, followed by placement...

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Vydáno v:	Journal of bone and joint surgery. American volume Ročník 80; číslo 7; s. 941 - 51
Hlavní autoři:	EMERY, SANFORD E., BOHLMAN, HENRY H., BOLESTA, MICHAEL J., JONES, PAUL K.
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Boston, MA Copyright by The Journal of Bone and Joint Surgery, Incorporated 01.07.1998 Journal of Bone and Joint Surgery Incorporated Journal of Bone and Joint Surgery AMERICAN VOLUME
Vydání:	American volume
Témata:	Adult Aged Aged, 80 and over Biological and medical sciences Bone Transplantation Cervical Vertebrae - diagnostic imaging Cervical Vertebrae - surgery Decompression, Surgical - methods Diskectomy Female Follow-Up Studies Humans Male Medical sciences Middle Aged Orthopedic surgery Pain Postoperative Complications Radiography Spinal Cord Compression - diagnostic imaging Spinal Cord Compression - etiology Spinal Cord Compression - surgery Spinal Fusion Spinal Osteophytosis - complications Spinal Osteophytosis - diagnostic imaging Spinal Osteophytosis - surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Treatment Outcome Compression Spinal cord Associated technique Prognosis Diseases of the osteoarticular system Anterior Spine disease Autograft Association Graft Arthrodesis Complication Degenerative disease Human Nervous system diseases Long term Orthopedic surgery Treatment Surgical decompression Spondylolysis Central nervous system disease Bone Osteoarthritis Spinal cord disease Cervical spine
ISSN:	0021-9355, 1535-1386
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Abstract	We reviewed the cases of 108 patients with cervical spondylotic myelopathy who had been managed with anterior decompression and arthrodesis at our institution. Operative treatment consisted of anterior discectomy, partial corpectomy, or subtotal corpectomy at one level or more, followed by placement of autogenous bone graft from the iliac crest or the fibula. At the latest follow-up examination, thirty-eight of the eighty-two patients who had had a preoperative gait abnormality had a normal gait, thirty-three had an improvement in gait, six had no change, four had improvement and later deterioration, and one had a worse gait abnormality. Of the eighty-seven patients who had had a preoperative motor deficit, fifty-four had complete recovery; twenty-six, partial recovery; six, no change; and one had a worse deficit. The average grade according to the system of Nurick improved from 2.4 preoperatively to 1.2 (range, 0.0 to 5.0) postoperatively. A pseudarthrosis developed in sixteen patients, thirteen of whom had had a multilevel discectomy. Only one of thirty-eight arthrodeses that had been performed with use of a fibular strut graft was followed by a non-union. An unsatisfactory outcome with respect to pain was significantly associated with pseudarthrosis (p < 0.001). The development of complications other than non-union was associated with a history of one previous operative procedure or more (p = 0.005). Recurrent myelopathy was rare, but when it occurred it was associated with a pseudarthrosis or stenosis at a new level. The strongest predictive factor for recovery from myelopathy was the severity of the myelopathy before the operative intervention—that is, better preoperative neurological function was associated with a better neurological outcome. Anterior decompression and arthrodesis with autogenous bone-grafting can be performed safely, and is associated with a high rate of neurological recovery, functional improvement, and pain relief, in patients who have cervical spondylotic myelopathy.
AbstractList	We reviewed the cases of 108 patients with cervical spondylotic myelopathy who had been managed with anterior decompression and arthrodesis at our institution. Operative treatment consisted of anterior discectomy, partial corpectomy, or subtotal corpectomy at one level or more, followed by placement of autogenous bone graft from the iliac crest or the fibula. At the latest follow-up examination, thirty-eight of the eighty-two patients who had had a preoperative gait abnormality had a normal gait, thirty-three had an improvement in gait, six had no change, four had improvement and later deterioration, and one had a worse gait abnormality. Of the eighty-seven patients who had had a preoperative motor deficit, fifty-four had complete recovery; twenty-six, partial recovery; six, no change; and one had a worse deficit. The average grade according to the system of Nurick improved from 2.4 preoperatively to 1.2 (range, 0.0 to 5.0) postoperatively. A pseudarthrosis developed in sixteen patients, thirteen of whom had had a multilevel discectomy. Only one of thirty-eight arthrodeses that had been performed with use of a fibular strut graft was followed by a non-union. An unsatisfactory outcome with respect to pain was significantly associated with pseudarthrosis (p < 0.001). The development of complications other than non-union was associated with a history of one previous operative procedure or more (p = 0.005). Recurrent myelopathy was rare, but when it occurred it was associated with a pseudarthrosis or stenosis at a new level. The strongest predictive factor for recovery from myelopathy was the severity of the myelopathy before the operative intervention—that is, better preoperative neurological function was associated with a better neurological outcome. Anterior decompression and arthrodesis with autogenous bone-grafting can be performed safely, and is associated with a high rate of neurological recovery, functional improvement, and pain relief, in patients who have cervical spondylotic myelopathy. We reviewed the cases of 108 patients with cervical spondylotic myelopathy who had been managed with anterior decompression and arthrodesis at our institution. Operative treatment consisted of anterior discectomy, partial corpectomy, or subtotal corpectomy at one level or more, followed by placement of autogenous bone graft from the iliac crest or the fibula. At the latest follow-up examination, thirty-eight of the eighty-two patients who had had a preoperative gait abnormality had a normal gait, thirty-three had an improvement in gait, six had no change, four had improvement and later deterioration, and one had a worse gait abnormality. Of the eighty-seven patients who had had a preoperative motor deficit, fifty-four had complete recovery; twenty-six, partial recovery; six, no change; and one had a worse deficit. The average grade according to the system of Nurick improved from 2.4 preoperatively to 1.2 (range, 0.0 to 5.0) postoperatively. A pseudarthrosis developed in sixteen patients, thirteen of whom had had a multilevel discectomy. Only one of thirty-eight arthrodeses that had been performed with use of a fibular strut graft was followed by a non-union. An unsatisfactory outcome with respect to pain was significantly associated with pseudarthrosis (p < 0.001). The development of complications other than non-union was associated with a history of one previous operative procedure or more (p = 0.005). Recurrent myelopathy was rare, but when it occurred it was associated with a pseudarthrosis or stenosis at a new level. The strongest predictive factor for recovery from myelopathy was the severity of the myelopathy before the operative intervention--that is, better preoperative neurological function was associated with a better neurological outcome. Anterior decompression and arthrodesis with autogenous bone-grafting can be performed safely, and is associated with a high rate of neurological recovery, functional improvement, and pain relief, in patients who have cervical spondylotic myelopathy.We reviewed the cases of 108 patients with cervical spondylotic myelopathy who had been managed with anterior decompression and arthrodesis at our institution. Operative treatment consisted of anterior discectomy, partial corpectomy, or subtotal corpectomy at one level or more, followed by placement of autogenous bone graft from the iliac crest or the fibula. At the latest follow-up examination, thirty-eight of the eighty-two patients who had had a preoperative gait abnormality had a normal gait, thirty-three had an improvement in gait, six had no change, four had improvement and later deterioration, and one had a worse gait abnormality. Of the eighty-seven patients who had had a preoperative motor deficit, fifty-four had complete recovery; twenty-six, partial recovery; six, no change; and one had a worse deficit. The average grade according to the system of Nurick improved from 2.4 preoperatively to 1.2 (range, 0.0 to 5.0) postoperatively. A pseudarthrosis developed in sixteen patients, thirteen of whom had had a multilevel discectomy. Only one of thirty-eight arthrodeses that had been performed with use of a fibular strut graft was followed by a non-union. An unsatisfactory outcome with respect to pain was significantly associated with pseudarthrosis (p < 0.001). The development of complications other than non-union was associated with a history of one previous operative procedure or more (p = 0.005). Recurrent myelopathy was rare, but when it occurred it was associated with a pseudarthrosis or stenosis at a new level. The strongest predictive factor for recovery from myelopathy was the severity of the myelopathy before the operative intervention--that is, better preoperative neurological function was associated with a better neurological outcome. Anterior decompression and arthrodesis with autogenous bone-grafting can be performed safely, and is associated with a high rate of neurological recovery, functional improvement, and pain relief, in patients who have cervical spondylotic myelopathy.
Author	BOLESTA, MICHAEL J. EMERY, SANFORD E. JONES, PAUL K. BOHLMAN, HENRY H.
AuthorAffiliation	Department of Orthopaedic Surgery, University Hospitals Spine Institute, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, Ohio 44106. ‡University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75235
AuthorAffiliation_xml	– name: Department of Orthopaedic Surgery, University Hospitals Spine Institute, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, Ohio 44106. ‡University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75235
Author_xml	– sequence: 1 givenname: SANFORD surname: EMERY middlename: E. fullname: EMERY, SANFORD E. organization: †Department of Orthopaedic Surgery, University Hospitals Spine Institute, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, Ohio 44106. ‡University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75235 – sequence: 2 givenname: HENRY surname: BOHLMAN middlename: H. fullname: BOHLMAN, HENRY H. – sequence: 3 givenname: MICHAEL surname: BOLESTA middlename: J. fullname: BOLESTA, MICHAEL J. – sequence: 4 givenname: PAUL surname: JONES middlename: K. fullname: JONES, PAUL K.
BackLink	http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2337230$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/9697998$$D View this record in MEDLINE/PubMed
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ContentType	Journal Article
Copyright	Copyright 1998 by The Journal of Bone and Joint Surgery, Incorporated 1998 INIST-CNRS Copyright Journal of Bone and Joint Surgery, Inc. Jul 1998
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Keywords	Compression Spinal cord Associated technique Prognosis Diseases of the osteoarticular system Anterior Spine disease Autograft Association Graft Arthrodesis Complication Degenerative disease Human Nervous system diseases Long term Orthopedic surgery Treatment Surgical decompression Spondylolysis Central nervous system disease Bone Osteoarthritis Spinal cord disease Cervical spine
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Snippet	We reviewed the cases of 108 patients with cervical spondylotic myelopathy who had been managed with anterior decompression and arthrodesis at our institution....
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SubjectTerms	Adult Aged Aged, 80 and over Biological and medical sciences Bone Transplantation Cervical Vertebrae - diagnostic imaging Cervical Vertebrae - surgery Decompression, Surgical - methods Diskectomy Female Follow-Up Studies Humans Male Medical sciences Middle Aged Orthopedic surgery Pain Postoperative Complications Radiography Spinal Cord Compression - diagnostic imaging Spinal Cord Compression - etiology Spinal Cord Compression - surgery Spinal Fusion Spinal Osteophytosis - complications Spinal Osteophytosis - diagnostic imaging Spinal Osteophytosis - surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Treatment Outcome
Title	Anterior Cervical Decompression and Arthrodesis for the Treatment of Cervical Spondylotic Myelopathy. Two to Seventeen-Year Follow-up
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