Functional Outcome after Central Corpectomy in Poor-grade Patients with Cervical Spondylotic Myelopathy or Ossified Posterior Longitudinal Ligament

Neurosurgery ◽  
2005 ◽  
Vol 56 (6) ◽  
pp. 1279-1285 ◽  
Author(s):  
Vedantam Rajshekhar ◽  
G Samson Sujith Kumar
Keyword(s):  
Functional Outcome ◽  
Cervical Spondylotic Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Outcome Data ◽  
Functional Improvement ◽  
Prognostic Indicators ◽  
Poor Grade ◽  
Grade 5 ◽  
Ossified Posterior Longitudinal Ligament

Abstract OBJECTIVE: We studied the long-term functional outcome in poor-grade patients (Nurick Grades 4 and 5) with cervical spondylotic myelopathy (CSM) or ossified posterior longitudinal ligament after central corpectomy (CC). We sought to determine whether there were any prognostic factors that could predict functional outcome in these patients. METHODS: Functional outcome data were collected for 72 patients (68 men and 4 women; mean age, 49.7 yr; range, 30–67 yr) with CSM (60 patients) or OPLL (12 patients) of Nurick Grades 4 (55 patients) and 5 (17 patients). Uninstrumented CC was performed at 1 level in 12 patients, at 1 level combined with a discoidectomy at another level in 4 patients, at 2 levels in 50 patients, and at 2 levels plus a discoidectomy in 5 patients. The age at presentation (≤50 yr or >50 yr), grade before surgery (4 or 5), the number of levels operated (1 or >1), diagnosis (CSM or ossified posterior longitudinal ligament), and duration of myelopathic symptoms (≤12 mo or >12 mo) were studied for their effect on the functional outcome noted at the last follow-up. Functional outcome was graded as poor (no change in Nurick grade), fair (improvement of one Nurick grade), good (improvement of two Nurick grades), and cure (follow-up Nurick grade of 0 or 1). RESULTS: The follow-up ranged from 9 to 104 months (mean, 36.3 mo). One patient died 3 weeks after CC after surgery for a perforated duodenal ulcer. There was transient operative morbidity in 12 patients (16.9%). The mean Nurick score improved from 4.24 to 2.47 (P < 0.001). Of the 54 patients (76%) who improved in their Nurick grade, the functional outcome was graded as fair in 13 patients (18.3%), good in 24 patients (33.8%), and cure in 17 patients (23.9%). The functional outcome was poor in 17 patients (23.9%). Functional improvement after CC was uniformly correlated with myelopathic symptoms of 12 months' duration or shorter. The other favorable prognostic indicators for improvement after CC were a diagnosis of CSM and preoperative Nurick Grade 5; however, patients with a preoperative Nurick grade of 4 were more likely to experience a cure. CONCLUSION: More than three-fourths of patients with poor-grade CSM improve in their functional status after CC, with nearly 24% of patients obtaining a cure. Because patients with a duration of myelopathic symptoms of 12 months or less had the best functional outcome, early decompressive surgery should be offered to patients with poor-grade CSM.

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

2019 ◽  
Vol 10 (01) ◽  
pp. 21-27 ◽  
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.

“Skip” corpectomy in the treatment of multilevel cervical spondylotic myelopathy and ossified posterior longitudinal ligament

2010 ◽  
Vol 12 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Sedat Dalbayrak ◽  
Mesut Yilmaz ◽  
Sait Naderi
Keyword(s):  
Vertebral Body ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Japanese Orthopaedic Association Score ◽  
Cervical Lordosis ◽  
The Mean ◽  
Ossified Posterior Longitudinal Ligament ◽  
Multilevel Cervical Spondylotic Myelopathy

Object The authors reviewed the results of “skip” corpectomy in 29 patients with multilevel cervical spondylotic myelopathy (CSM) and ossified posterior longitudinal ligament (OPLL). Methods The skip corpectomy technique, which is characterized by C-4 and C-6 corpectomy, C-5 osteophytectomy, and C-5 vertebral body preservation, was used for decompression in patients with multilevel CSM and OPLL. All patients underwent spinal fixation using C4–5 and C5–6 grafts, and anterior cervical plates were fixated at C-3, C-5, and C-7. Results The mean preoperative Japanese Orthopaedic Association score increased from 13.44 ± 2.81 to 16.16 ± 2.19 after surgery (p < 0.05). The cervical lordosis improved from 1.16 ± 11.74° to 14.36 ± 7.85° after surgery (p < 0.05). The complications included temporary hoarseness in 3 cases, dysphagia in 1 case, C-5 nerve palsy in 1 case, and C-7 screw pullout in 1 case. The mean follow-up was 23.2 months. The final plain radiographs showed improved cervical lordosis and fusion in all cases. Conclusions The authors conclude that the preservation of the C-5 vertebral body provided an additional screw purchase and strengthened the construct. The results of the current study demonstrated effectiveness and safety of the skip corpectomy in patients with multilevel CSM and OPLL.

scholarly journals Outcome of intra-articular hyaluronic acid in treatment of osteoarthritis of knee at a tertiary care hospital in Kathmandu, Nepal

2019 ◽  
Vol 7 (1) ◽  
pp. 36-40
Author(s):  
Deepak Kumar Dutta
Keyword(s):  
Hyaluronic Acid ◽  
Knee Osteoarthritis ◽  
Functional Outcome ◽  
Tertiary Care ◽  
Oxford Knee Score ◽  
Functional Improvement ◽  
Care Hospital ◽  
Post Intervention ◽  
Viscous Solution

Background and Objectives: Intra-articular hyaluronic acid is widely used in the treatment of knee osteoarthritis. This study aimed to assess the efficacy of hyaluronic acid in moderate severity knee osteoarthritis. Material and Methods: Patients of knee osteoarthritis were administered single intra-articular injection of Hyaluronic Acid 25 mg (2.5 ml viscous solution) and were followed up at 4, 12, and 24 weeks. Functional improvement was assessed using Oxford Knee Score (OKS). Comparisons of pre- and post-intervention mean OKS scores were done by paired t test. Results: Total 50 patients (mean age 58.62±12.62 years) were studied. In the six months follow up, patients showed marked improvement in functional outcome from a mean OKS of 27 before injection to 39 at 4 weeks and remained constant up to 6months of follow up. Conclusion: Intra-articular hyaluronic acid injectionas a treatment modality for moderate grade knee osteoarthritis provides good functional outcome and pain control for up to six months.

scholarly journals Differences in Postoperative Changes of Cervical Sagittal Alignment and Balance After Laminoplasty Between Cervical Spondylotic Myelopathy and Cervical Ossification of the Posterior Longitudinal Ligament

2018 ◽  
Vol 9 (3) ◽  
pp. 266-271 ◽  
Author(s):  
Hironobu Sakaura ◽  
Atsunori Ohnishi ◽  
Akira Yamagishi ◽  
Tetsuo Ohwada
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Sagittal Alignment ◽  
Posterior Longitudinal Ligament ◽  
Kyphotic Deformity ◽  
Sagittal Imbalance ◽  
Patient Age ◽  
Neurologic Recovery ◽  
Postoperative Changes ◽  
Cervical Sagittal Alignment

Study Design: Retrospective cohort study. Objectives: To compare postoperative changes of cervical sagittal alignment (CSA) and cervical sagittal balance (CSB) after laminoplasty between cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) and to examine impacts of these radiologic changes on neurologic outcomes. Methods: A total of 168 consecutive patients with CSM (CSM group) and 51 consecutive patients with OPLL (OPLL group) were included. As indicators of CSA and CSB, the C2-7 angle and C1-C7 sagittal vertical axis (SVA) were, respectively, measured before surgery and at 2-year follow-up. Neurologic status was assessed using the Japanese Orthopaedic Association score before surgery and at 2-year follow-up. Results: Whereas both postoperative loss of C2-7 angle and increase of C1-C7 SVA were significantly greater in the elderly subgroup of the CSM group, patient age did not significantly affect these changes in the OPLL group. Preservation of C7 maintained C1-C7 SVA at postoperative 2 years only in the CSM group. Postoperative cervical kyphosis and sagittal imbalance significantly decreased neurologic improvement in the CSM group but not in the OPLL group. Conclusions: Elderly patients with CSM have significantly greater postoperative loss of lordosis and increase in C1-C7 SVA than nonelderly patients, and both postoperative kyphotic deformity and sagittal imbalance significantly deteriorate neurologic recovery. On the other hand, although patients with OPLL, irrespective of patient age and preservation of C7, have significantly more loss of lordosis and increase in C1-C7 SVA than CSM patients, neither postoperative kyphotic deformity nor sagittal imbalance significantly deteriorates neurologic recovery in OPLL patients.

scholarly journals Clinical adjacent-segment pathology after central corpectomy for cervical spondylotic myelopathy: incidence and risk factors

2016 ◽  
Vol 40 (6) ◽  
pp. E12 ◽  
Author(s):  
Aditya Vedantam ◽  
Vedantam Rajshekhar
Keyword(s):  
Risk Factors ◽  
Cervical Spondylotic Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Adjacent Segment ◽  
Initial Surgery ◽  
The Mean

OBJECTIVE The goal of this study was to investigate the prevalence and risk factors of clinical adjacent-segment pathology (CASP) following central corpectomy for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL). METHODS The authors reviewed 353 cases involving patients operated on by a single surgeon with a minimum 12-month follow-up after central corpectomy for CSM or OPLL between 1995 and 2007. Patients with symptoms consistent with CASP at follow-up were selected for the study. The authors analyzed the prevalence and risk factors for CASP after central corpectomy for CSM/OPLL. RESULTS Fourteen patients (13 male, 1 female; mean age 46.9 ± 7.7 years) were diagnosed with symptoms of CASP (3.9% of 353 patients) at follow-up. The mean interval between the initial surgery and presentation with symptoms of CASP was 95.6 ± 54.1 months (range 40–213 months). Preoperative Nurick grades ranged from 2 to 5 (mean 3.5 ± 1.2), and the Nurick grades at follow-up ranged from 1 to 5 (mean 3.0 ± 1.3, p = 0.27). Twelve patients had myelopathic symptoms and 2 had radiculopathy at follow-up. Patients with poorer preoperative Nurick grades had a higher risk for development of CASP (HR 2.6 [95% CI 1.2–5.3], p = 0.01). CONCLUSIONS In the present study, CASP was seen in 3.9% of patients following central corpectomy for CSM/OPLL. The risk of CASP after central corpectomy for CSM/OPLL was higher in patients with poorer preoperative Nurick grades.

Bilateral multilevel laminectomy with or without posterolateral fusion for cervical spondylotic myelopathy: relationship to type of onset and time until operation

1996 ◽  
Vol 85 (3) ◽  
pp. 447-451 ◽  
Author(s):  
Chiaki Hamanishi ◽  
Seisuke Tanaka
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Clinical Results ◽  
Posterolateral Fusion ◽  
Content Type ◽  
Insidious Onset ◽  
Relationship Of ◽  
The Relationship ◽  
Preoperative Factors

✓ The authors retrospectively evaluated the relationship of several preoperative factors in 69 patients who had myelopathy due to multilevel cervical spondylosis without ossification of the posterior longitudinal ligament treated with Kirita's bilateral wide laminectomy. In 34 patients with focal instability or malalignments, posterolateral fusion was also combined. The clinical results at an average follow-up period of 3.5 years (range 1–10 years) after operation in the groups that had and had not undergone fusion were equally satisfactory, and preoperative focal instability was believed to be the sole useful indication for adding posterolateral fusion. The patients were classified in three groups according to the acuteness of the onset. The type of onset and time until operation were found to be the factors most strongly related to prognosis, and clinical outcome was correlated with the duration after onset when plotted as days in the acute, months in the subacute, and years in the insidious onset groups. Wide laminectomy with or without posterolateral fusion is a simple operation that is recommended, provided that it is performed early enough according to the type of onset.

Cervical Laminoplasty as a Management Option for Patients With Cervical Spondylotic Myelopathy

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 272-277 ◽  
Author(s):  
Anthony L. Petraglia ◽  
Vasisht Srinivasan ◽  
Michelle Coriddi ◽  
M. Gordon Whitbeck ◽  
James T. Maxwell ◽  
...  
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Medical Center ◽  
Demographic Data ◽  
Adult Population ◽  
Postoperative Outcome ◽  
Outcome Data ◽  
Consecutive Series ◽  
Cervical Laminoplasty ◽  
Presenting Symptoms

Abstract BACKGROUND Cervical spondylotic myelopathy (CSM) is one of the leading causes of spinal cord dysfunction in the adult population. Laminoplasty is an effective decompressive procedure for the treatment of CSM. OBJECTIVE We present our experience with 40 patients who underwent cervical laminoplasty using titanium miniplates for CSM. METHODS We performed a retrospective review of the medical records of a consecutive series of patients with CSM treated with laminoplasty at the University of Rochester Medical Center or Rochester General Hospital. We documented patient demographic data, presenting symptoms, and postoperative outcome. Data are also presented regarding the general cost of constructs for a hypothetical 3-level fusion. RESULTS Forty patients underwent cervical laminoplasty; all were available for follow-up. The mean number of levels was 4. All patients were myelopathic, and 17 (42.5%) had signs of radiculopathy preoperatively. Preoperatively, 62.5% of patients had a Nurick grade of 2 or worse. The average follow-up was 31.3 months. The median length of stay was 48 hours. On clinical evaluation, 36 of 40 patients demonstrated an improvement in their myelopathic symptoms; 4 were unchanged. Postoperative kyphosis did not develop in any patients. CONCLUSION The management of CSM for each of its etiologies remains controversial. As demonstrated in our series, laminoplasty is a cost-effective, decompressive procedure for the treatment of CSM, providing a less destabilizing alternative to laminectomy while preserving mobility. Cervical laminoplasty should be considered in the management of multilevel spondylosis because of its ease of exposure, ability to decompress, effective preservation of motion, maintenance of spinal stability, and overall cost.

Sign in / Sign up

Export Citation Format

Share Document