Surgical outcome and prognostic factors of anterior decompression and fusion for cervical compressive myelopathy due to ossification of the posterior longitudinal ligament

✓ Anterior decompression and fusion for treating ossification of the posterior longitudinal ligament of the cervical spine was performed in 12 patients. The central part of the vertebral body and the ossified area of the posterior longitudinal ligament were removed by means of a microrongeur and an air drill. The defect was filled with a long bone graft taken from the ilium. The operative results were excellent. Marked improvement of radicular and spinal cord signs was seen in all 12 cases. Three vertebral bodies were fused in one case, four in nine cases, and five in two cases. The highest level of fusion was C-2 and the lowest was T-1. It is considered that any ossification of the ligament below the C-2 level can be removed via an anterior approach as long as no more than five vertebral bodies are involved. Spinal computerized tomography was valuable in providing more detailed information about the stenotic spinal canal and the shape of the ossified ligament.

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Evaluation of clinical profile, radiological and functional outcome following anterior cervical discectomy and fusion for cervical compressive myelopathy

International Surgery Journal ◽

10.18203/2349-2902.isj20203069 ◽

2020 ◽

Vol 7 (8) ◽

pp. 2679

Author(s):

Ranjit Kumar ◽

Brijesh Kumar Tiwari ◽

Sanjeev Kumar Pandey

Keyword(s):

Cervical Spine ◽

Blood Loss ◽

Surgical Outcome ◽

Postoperative Outcome ◽

Anterior Cervical Discectomy ◽

Cervical Disc ◽

Cervical Cord ◽

Cervical Discectomy ◽

Cervical Compressive Myelopathy ◽

Compressive Myelopathy

Background: Symptomatic cervical disc prolapse is best managed with anterior cervical discectomy with or without fusion. We studied the clinical, radiological and surgical profile with postoperative outcome of the patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical compressive myelopathy at one level.Methods: In this retrospective study, data was collected from patients who underwent ACDF for cervical compressive myelopathy in our hospital between 2016 and 2019. Clinical, radiological profile with surgical outcome were studied.Results: A total of 283 patients were recruited. They could be followed up for a period of at least 6 months and so were recruited for the study. Out of these 283 patients (201 males; 82 females; mean age, 48.4 years, range, 22 years to 83 years), magnetic resonance imaging (MRI) cervical spine without contrast and x-ray cervical spine was available for all the patients. Nape of neck pain was the most common presenting symptom followed by tingling sensation in all four limbs and trunk. Average time taken for surgery was 2 hours 10 minutes with an average blood loss of 50 ml. Mean follow up duration was 2.7 years (range 6 months to 4 years).Conclusions: ACDF is the treatment of choice for the patients with clinical and radiological evidence of cervical cord compression. The techniques is associated with minimal blood loss and exceptionally good surgical outcome. Following discectomy, putting an autologous graft or titanium cage improves the spine stability and maintains the cervical lordosis.

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Role of Decompressive Laminectomy without Instrumentation in the Management of Nurick Grade 4 and 5 Cervical Compressive Myelopathy

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_254_18 ◽

2019 ◽

Vol 10 (01) ◽

pp. 21-27 ◽

Cited By ~ 1

Author(s):

Sunil Malagi ◽

Subhas Konar ◽

Dhaval P. Shukla ◽

Dhananjaya I. Bhat ◽

Nishanth Sadashiva ◽

...

Keyword(s):

Posterior Longitudinal Ligament ◽

Female Ratio ◽

Decompressive Laminectomy ◽

Japanese Orthopedic Association ◽

Poor Grade ◽

Cervical Compressive Myelopathy ◽

The Mean ◽

Ossified Posterior Longitudinal Ligament ◽

Compressive Myelopathy

ABSTRACT Introduction: Cervical laminectomy is a very well-known posterior decompressive procedure for cervical compressive myelopathy (CCM). Our objective is to evaluate the functional effect of posterior decompressive laminectomy for poor grade CCM. Methods: This study was an observational retrospective study carried out on patients with poor-grade CCM who underwent decompressive laminectomy from January 2010 to December 2015. Patients with Nurick Grades 4 and 5 (walking with support or bedbound) were included in the study. Clinical data and radiological information were collected from medical records, and objective scales were applied to compare the surgical outcome between preoperative score and postoperative score. Results: A total of 69 patients who underwent decompressive laminectomy for poor grade CCM were included. The mean age was 54.9 years, and the male-to-female ratio was 5.3:1. Ossified posterior longitudinal ligament comprised 52.6% cases. The follow-up data of at least 6 months' duration after surgery was available for 57 (82.6%) cases. On comparing with preoperative Nurick grade at follow-up, 40 of the 57 patients (70.2%) were found to have improvement following surgery by at least one grade. The remaining 17 (29.8%) had either remained the same or had deteriorated further. The mean preoperative modified Japanese Orthopedic Association score was 8.4 ± 2.8, and the mean follow-up score was 11.8±0.3 (P = 0.0001). On multivariate analysis, the number of levels of laminectomy, postoperative deterioration, and anesthesia grade were predictors of outcome. Conclusion: Decompressive laminectomy for poor grade myelopathy is effective in improving functional outcome.

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