ISSN: 1859 - 2872
Enlarged laminectomy and lateral mass screw fixation for multilevel cervical degenerative myelopathy associated with kyphosis
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Abstract
Objective: To investigate the surgical efficacy of enlarged laminectomy (removing the medial of facet joints and decompressing the nerve foramina) and lateral mass screw fixation for the treatment of multilevel cervical degenerative myelopathy (CDM) associated with kyphosis. Subject and method: Retrospective study. All neurological parameters and radiological data were recorded from preoperative and postoperative X-ray, magnetic resonance imaging (MRI) were accessed in each patient. Analysis consisted of: Japanese Orthopedic Association (JOA) score, recovery rate, curvature index (CI), the expansion degree and drift-back distance of the spinal cord, axial symptom severity, and C5 root palsy. The recovery rate based on the JOA score was calculated for each patient. Cervical CI as well as the expansion degree and drift-back distance of the spinal cord was measured on MRI. Axial symptom severity was quantified by a visual analog scale (VAS). Statistical analysis was performed using paired t test with significance set at p<0.05. Result: A total of 32 patients (24 men and 8 women; average age, 64.6 ± 6.7 years) with multilevel CDM correlated to kyphosis were obtained in the study. Enlarged laminectomy was performed with a mean of 3.9 levels (range, 3 - 5 levels). Follow-up information was obtained at a mean of 11.2 months (range, 6 - 24 months) after surgery. Analysis of the final follow-up data showed significant differences before and after surgery in the JOA score (t = 25.12, p<0.001), CI improvement (t = 22.68, p<0.001), the anteroposterior diameter at the level of maximum compression of the spinal cord (t = 9.67, p<0.001), and VAS score (t = 12.7, p<0.001). The mean of spinal cord posterior shift was 4.42 ± 1.12mm. X-rays confirmed that bone grafts were completely fused at a mean of 6 months after surgery. During the follow-up period, four patients (12.5%) experienced axial symptoms; there were no C5 root palsy and instrument failures noted in this series. Conclusion: Enlarged laminectomy with fixation for the management of multilevel CDM is demonstrated to be an effective surgery for improving neurological function, restoring the normal cervical lordosis, and decreasing the incidence of axial symptoms and C5 root palsy.
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References
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