The Surgical Approaches of Cervical Spondylotic Myelopathy and the Predictive Factors for the Surgical Outcomes
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Abstract
Objective To explore the efficacy and safety of different surgical approaches of cervical spondylotic myelopathy, and the predictive factors for the outcome of surgery. Methods Clinical data of 68 consecutive patients who underwent surgical treatment from 2003-08-01 to 2006-12-01 were collected. The quantization of the efficacy of operation was made by applying Japanese Orthopedic Association (JOA) scoring system, based on which the recovery rate and satisfaction rate were calculated. In the patients who underwent anterior approach, we compared the recovery rate among the subgroups of different duration of symptoms, age at surgery and the severity of diseases. Any surgery-related complications were also noted. Results 73.5% (50/68) patients underwent anterior approach, with an average recovery rate of (68.21 ± 10.06)% and the satisfaction rate of 88.00%; 20.6% patients (14/68) underwent posterior approach, with an average recovery rate of (64.03 ± 7.07)% and the satisfaction rate of 100%. The recovery rate had no significant difference in the two approaches. Only 4 patients (5.9%) underwent anterior and posterior combined approach, and the recovery rate and the satisfaction rate were 65.10% and 100%, respectively. In the group of patients who accepted anterior approach, no significant differences were found in the recovery rates of different age subgroups and different duration of symptom subgroups; the significant differences recovery rates between the moderate and severe subgroups were identified. Minor complications, such as asymptomatic screw misplacement, transient dysphagia/odynophagia, pain related to the donor site and axial syndrome, were observed in a few patients. Conclusion The JOA score can be improved by applying the appropriate approaches and the high recovery and satisfaction rates can be achieved at the same time. The efficacies of anterior and posterior approaches were similar. The complications of surgery were minor. In the patients who underwent anterior approach, the severity of diseases was a predictive factor for the outcome of surgery.
- [1] P. G. Matz, P. A. Anderson, L. T. Holly, M. W. Groff, R. F. Heary, M. G. Kaiser, P. V. Mummaneni, T. C. Ryken, T. F. Choudhri, E. J. Vresilovic, D. K. Resnick and Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons, “The Natural History of Cervical Spondylotic Myelopathy,” Journal of Neurosurgery Spine, Vol. 11, No. 2, August 2009, pp. 104-111. doi:10.3171/2009.1.SPINE08716
- [2] Z. Kadanka, M. Mares, J. Bednarík, V. Smrcka, M. Krbec, R. Chaloupka and L. Dusek “Predictive Factors for Spondylotic Cervical Myelopathy Treated Conservatively or Surgically,” European Journal of Neurology, Vol. 12, No. 1, January 2005, pp. 55-63. doi:10.1111/j.1468-1331.2004.00896.x
- [3] P. G. Matz, P. R. Pritchard and M. N. Hadley, “Anterior Cervical Approach for the Treatment of Cervical Myelopathy,” Neurosurgery, Vol. 60, No. 1, Supp11, January 2007, pp. S64-S70.
- [4] L. S. Jia, “The Status of the Anterior Approach of Cervical Spondylotic Myelopathy,” The Journal of Practical Medicine, Vol. 14, No. 4, 2005, pp. 337-338.
- [5] K. W. Lu, D. D. Jin, J. Wang, J. T. Chen, J. X. Wang, J. M. Jiang and D. B. Qu, “Analysis of the Long-Term Outcome of Anterior Approach Surgery on Cervical Spondylotic Myelopathy,” Chinese Journal of Surgery, Vol. 44, No. 16, Aug 2006, pp.1091-1093.
- [6] H. Koller, A. Hempfing, L. Ferraris, O. Maier, W. Hitzl and P. Metz-Stavenhagen, “4- and 5-Level Anterior Fusions of the Cervical Spine: Review of Literature and Clinical Results,” European Spine Journal, Vol. 16, No. 12, December 2007, pp. 2055-2071. doi:10.1007/s00586-007-0398-7
- [7] Z. Ying, W. Xinwei, Z. Jing, X. Shengming, L. Bitao, Z. Tao and Y. Wen, “Cervical Corpectomy with Preserved Posterior Vertebral Wall for Cervical Spondylotic Mye- lopathy: A Randomized Control Clinical Study,” Spine (Phila Pa 1976), Vol. 32, No. 14, June 2007, pp. 1482-1487.
- [8] Y. Yukawa, F. Kato, K. Ito, Y. Horie, T. Hida, Z. Ito and Y. Matsuyama, “Laminoplasty and Skip Laminectomy for Cervical Compressive Myelopathy: Range of Motion, Postoperative Neck Pain, and Surgical Outcomes in a Randomized Prospective Study,” Spine (Phila Pa 1976), Vol. 32, No. 18, August 2007, pp. 1980-1985.
- [9] W. B. Xu, G. Lv, L. S. Jia, D. Y. Chen, D. W. Zhao, Y. Zhu, G. J. Tu, T. Huang and J. W. Xu, “The Approach of Two Anterior Surgical Methods for Multi-Segment Cervical Spondylotic Myelopathy,” Journal of Spinal Surgery, Vol. 13, No. 3, 2005, pp. 170-176.