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PubMed2001

Anterior approaches to cervical spondylosis and ossification of the posterior longitudinal ligament: review of operative technique and assessment of 65 multilevel circumferential procedures.

BACKGROUND: Multilevel anterior cervical corpectomy with fusion (ACF) offers direct resection of spondylostenosis and ossification of the posterior longitudinal ligament (OPLL) with immediate stabilization. Ideal candidates for multilevel ACF include younger patients (<65 years of age), or older individuals (>65 years of age) with loss or reversal of the cervical lordosis (kyphosis). METHODS: Sixty-five patients, averaging 56 years of age and including 40 males and 25 females, with multilevel MR- and CT-documented spondylostenosis and OPLL were studied. Preoperatively, patients exhibited moderate to severe myelopathy (average Nurick grade 3.8), and were managed with 2- to 4-level ACF with posterior wiring and fusion (PWF) procedures with halo application. The first 22 patients had no plate instrumentation, the next 22 had constrained (Orion) plates applied followed sequentially by the application of 13 semi-constrained (Atlantis) plates, and finally, 8 dynamic (ABC Aesculap) plates. RESULTS: Patients improved an average of three postoperative Nurick grades. None exhibited new cord injuries, whereas three had transient C5 root paresis. Graft/plate or vertebral fracture with extrusion were observed in 3/22 nonplated patients, 2/22 constrained-plated patients, 3/13 semi-constrained-plated patients, and 0/8 dynamic-plated patients. Fusion was documented on dynamic radiographs and 2D-CT or 3D-CT studies obtained 3 and 6 months postoperatively, or later where indicated. CONCLUSIONS: Multilevel ACF/PWF offers direct resection of spondylostenosis and OPLL with immediate maximal stabilization. Thus far, no graft/plate or vertebral body fracture or extrusions have been seen with dynamic plates, whereas the absence of plating and constrained and semi-constrained plating systems have failed.

Adult↗
PubMedDate not supplied

Posterior approaches in the management of cervical spondylosis and ossification of the posterior longitudinal ligament.

BACKGROUND: If the cervical lordotic curvature has been well preserved, spondylostenosis or ossification of the posterior longitudinal ligament, with or without instability, may be approached posteriorly in selected older patients (over 65 years of age). Posterior surgical alternatives include the laminectomy with or without fusion, or laminoplasty. However, in younger patients or in geriatric patients with predominantly anterior disease with kyphosis, direct anterior surgical procedures yield better results. METHODS: Laminectomy with medial facetectomy and foraminotomy is classically performed in cases in which stability is preserved. However, posterior stabilization using either facet wiring or lateral mass fusion may be warranted. Although some consider the "open door" laminoplasty a reasonable alternative for dorsal decompression, limitations include restricted access to the hinged side, a potential for "closing of the door," and it does not offer a "real" fusion. RESULTS: Postoperative neurologic improvement may approximate an 85% incidence of good to excellent results. However, where a posterior decompression has been chosen, particularly in younger individuals with or without a lordotic curvature, or in older patients with kyphosis, they will fail to significantly improve, and will be susceptible to early neurologic deterioration. CONCLUSIONS: Posterior approaches to cervical disease may be successful in geriatric individuals in whom the cervical lordotic curvature has been well preserved. However, it is inappropriate for either older or younger patients with predominantly anterior disease, for whom direct anterior decompression with or without posterior stabilization is indicated. In those patients with significant ventral ossification of the posterior longitudinal ligament (OPLL), direct anterior resection will result in improved neurologic outcomes, whereas posterior decompression will fail to achieve a similar degree of neurologic recovery. Furthermore, dorsal decompression of OPLL may promote a more rapid progression of OPLL growth and concomitant neurologic deterioration.

Adult↗
PubMed1988

Anterior cervical arthrodesis with heterologous bone graft and human fibrin glue in the surgical treatment of myelopathy due to spondylosis. Preliminary note.

The use of fibrin glue to fix heterologous bone dowels in the recipient site in Cloward's procedure for cervical spondylotic myelopathy is described. The procedure ensures immediate and satisfactory spinal stability without need for any postoperative contention device. It has been successful in 18 patients with 26 intervertebral spaces operated upon, as demonstrated by early and late dynamic X-rays study.

Aprotinin↗
PubMed1985

Dysphagia due to cervical spondylosis.

Dysphagia from mechanical obstruction by osteophytes is rare. It is most important to investigate cases fully to rule out an alternative pathology. We describe a case of dysphagia resulting from cervical osteophytes interfering with epiglottic retrovertion. As far as we are aware, this has not been previously described.

Aged↗
PubMed1995

Surgical treatment guided by spinal cord evoked potentials for tetraparesis due to cervical spondylosis.

Sixteen consecutive patients who were unable to ambulate independently due to cervical spondylotic myelopathy were treated surgically with the guidance of spinal cord evoked potentials (SCEPs). The SCEPs were recorded intraoperatively with needle electrodes inserted into serial cervical intervertebral discs after caudal epidural stimulation. Despite the presence of multiple extradural defects and/or cord compression seen on MRI, anterior decompression followed by fusion was able to be focused on a single level where the distinct change in waveform of the SCEP suggestive of spinal conduction block was revealed. Excellent neurological improvement resulted from the operation and all patients followed up for a period of more than 6 months were found to be ambulatory without walking aids.

Aged↗