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Surgical options in treating cervical stenosis and myelopathy
EANS Academy. Hitchon P. Sep 27, 2019; 276027; EP02069
Abstract
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Cervical stenosis and myelopathy is successfully treated with either anterior or posterior decompression and instrumentation. There is however a subset of patients that may require contemporaneous anterior plus posterior instrumentation (CAPI). The intent in this retrospective review is to identify the indications and outcomes of patients who had undergone CAPI, compared to those treated with anterior cervical fusion and instrumentation (ACDF), and posterior laminectomy and instrumentation (LI).
We reviewed records on 51 patients treated with ACDF, 56 treated with LI, and 32 who had undergone CAPI. Overall there were 59 women, and 80 men, with a mean age (+/- SD) of 62+/-10 years. All patients were myelopathic, and two thirds had myelomalacia or hyperintensity of the cord on MRI. Eighteen percent of patients with LI had undergone previous cervical surgery, compared to nearly one third of patients with CAPI. Preoperative C2-7 lordosis was measured between C2 and C7, and C2-SVA measured by distance from C7 to the C2 plumb line. Improvement in lordosis of 12° was encountered after ACDF, of 24° after CAPI, but no improvement with LI. C2-SVA increased by 6mm, 19mm and by 1mm after ACDF, after LI, and after CAPI respectively. There were 9 (16%), and 10 (31%) complications in the LI, and CAPI respectively, and none with ACDF.
In summary, CAPI was the recommended procedure in cervical stenosis and myelopathy in 3 situations. 1) In cases of severe stenosis where a single anterior or posterior approach was deemed insufficient. 2) CAPI was the choice operation after failure of previous surgery (nearly 1/3 of patients). 3) CAPI was also undertaken in severe kyphosis (>20°). Kyphosis in patients who had undergone CAPI was much worse than that in patients treated with ACDF or LI, and was dramatically improved.
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