Operative outcomes of patients with cervical spondylotic myelopathy at Cipto Mangunkusumo National Central Hospital 2014-2016
Keywords:cervical spondylotic myelopathy, JOA scores, anterior and posterior approach
Cervical spondylotic myelopathy (CSM) is the most common type of myelopathy with cervical spondylosis as the underlying disorder. To this date, there has been ongoing debate regarding operative approach in CSM treatment that there is still no established treatment proven superior one over the other. This study aims to investigate the operative outcomes of CSM.
We retrospectively reviewed patients with CSM who had undergone anterior approach and posterior surgery at Cipto Mangunkusumo Hospital, Jakarta, Indonesia, between January 2014 and December 2016. The average followup time was 13-42 months, with an average of 27 months. The clinical data of patients were observed, including age, sex, operation records, pre- and post-operative Japanese Orthopaedic Association (JOA) scores, cervical spine canal stenosis, cervical curvature, and the presence of ossification of the posterior longitudinal ligament.
Eight patients (6 male, 2 female) with CSM were enrolled in this study with mean age of 55.6 ± 9 years. Two patients experienced minor complication, and one patient had major complication of Frankel grade decrement and phrenic nerve paralysis that led to prolonged intensive care. The preoperative cervical JOAs of the eight patients were 11.2 ± 2.81 and post operative JOAs were 13.1 ± 3.44. (p< 0.05). Seven patients were satisfied with the outcomes of their surgery.
A definite conclusion could not be drawn regarding the most effective surgical approach for CSM. Further studies with larger number of samples and centres are required to investigate the comparison of best treatment choice for CSM.
Galbraith JG, Butler JS, Dolan AM, O’Byrne JM. Operative Outcomes for Cervical Myelopathy and Radiculopathy. Adv Orthop. 2012;2012:1-8. doi:10.1155/2012/919153.
Smith BE, Diver CJ, Taylor AJ. Cervical Spondylotic Myelopathy presenting as mechanical neck pain: A case report. Man Ther. 2014;19(4):360-364. doi:10.1016/j.2014.04.008.
Guan L, Hai Y, Yang J-C, Zhou L-J, Chen X-L. Anterior cervical discectomy and fusion may be more effective than anterior cervical corpectomy and fusion for the treatment of cervical spondylotic myelopathy. BMC Musculoskelet Disord. 2015;16(1):29. :10.1186/s12891-015-0490-9.
Liu J, Chen X, Liu Z, Long X, Huang S, Shu Y. Anterior cervical discectomy and fusion versus corpectomy and fusion in treating two-level adjacent cervical spondylotic myelopathy: a minimum 5-year follow-up study. Arch Orthop Trauma Surg. 2015;135(2):149-153. doi:10.1007/ s00402-014-2123-4.
Mattei TA, Goulart CR, Milano JB, Dutra LPF, Fasset DR. Cervical Spondylotic Myelopathy: Pathophysiology, Diagnosis, and Surgical Techniques. ISRN Neurol. 2011;2011:1-5. doi:10.5402/2011/463729.
Lin Q, Zhou X, Wang X, Cao P, Tsai N, Yuan W. A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy. Eur Spine J. 2012;21(3):474- 481. doi:10.1007/s00586-011-1961-9.
Perez-Cruet MJ, Samartzis D, Fessler RG. Anterior cervical discectomy and corpectomy. Neurosurgery. 2006;58(SUPPL. 2). doi:10.1227/01. NEU.0000205285.20336.C2. 8. Vedantam A, Revanappa KK, Rajshekhar V. Changes in the range of motion of the cervical spine and adjacent segments at ≥24 months after uninstrumented corpectomy for cervical spondylotic myelopathy. Acta Neurochir
(Wien). 2011;153(5):995-1001. doi:10.1007/s00701-011- 0986-5.
Sasso RC, Ruggiero RA, Reilly TM, Hall P V. Early reconstruction failures after multilevel cervical corpectomy. Spine (Phila Pa 1976). 2003;28(2):140-142.doi:10.1097/00007632-200301150-00009.
Bohlman HH, Emery SE, Goodfellow DB, Jones PK. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Jt Surg - Ser A. 1993;75(9):1298-1307. doi:10.2106/00004623-
Chang H, Kim C, Choi BW. Selective laminectomy for cervical spondylotic myelopathy: a comparative analysis with laminoplasty technique. Arch Orthop Trauma Surg. 2017;137(5):611-616. doi:10.1007/s00402-017-2670-6.
Edwards CC, Riew KD, Anderson P a, Hilibrand AS, Vaccaro AF. Cervical myelopathy: current diagnostic and treatment strategies. Spine J. 2003;3(1):68-81.doi:10.1016/S1529-9430(02)00566-1.
Luo J, Cao K, Huang S, et al. Comparison of anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy. Eur Spine J. 2015;24(8):1621-1630. doi:10.1007/s00586-015-3911-4.
Zhu B, Xu Y, Liu X, Liu Z, Dang G. Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis. Eur Spine J. 2013;22(7):1583-1593. doi:10.1007/s00586-013-2817-2.