SEVERE CERVICAL MYELOPATHY: APPROACHES AND POSTOPERATIVE EVALUATION

ABSTRACT Objectives: To evaluate and compare the clinical evolution of surgical approaches used in patients with severe cervical myelopathy. Methods: Retrospective observational study in which 19 patients with myelopathy who underwent surgery were evaluated. Neurological assessments using the Frankel scale were conducted both preoperatively and one year following surgery, and the modified Japanese Orthopedic Association (JOA), Nurick, and Visual Analog Scale for pain (VAS) questionnaires were applied 1 year after the surgical procedure. Results: 89% of the participants were male and the average age was 63.9 years. No patient had postoperative neurological worsening, 12 patients (63.16%) had mild pain, and seven (36.84%) had moderate pain. The group with degenerative disease showed neurological improvement after surgery and the exclusively anterior approach was used in 84% of the cases, the exclusively posterior approach in 10% of the cases, and the dual approach in 6% of the cases. Conclusion: Surgical treatment has good results for inhibiting the unfavorable natural evolution of myelopathy within 1 year following surgery and promotes neurological improvement in degenerative cases, making it possible to use the anterior access route in most cases. Level of evidence III; Retrospective Study.

Analysis of Sagittal Thoracic Inlet Measures in Relation to Anterior Access to the Cervicothoracic Junction

Study Design: Retrospective radiographic study. Objective: The aim of this study was to define the association between thoracic inlet measures in relation to anterior access to the cervicothoracic junction. Methods: Trauma CT scans in patients >16 years were analyzed. The projection angle (PA), defined as the angle subtended by a line along the superior endplate of the vertebral body and the line from the anterosuperior corner of the vertebral body to the manubrium, was measured at C7, T1 and T2; angles were positive if the projection was above the manubrium. Thoracic inlet angle (TIA), thoracic inlet distance (TID) and pelvic incidence (PI) were measured. Results: 65 scans were assessed (33 males; mean age 47.7 years (s.d. 8.7)). The mean TIA 79.9° (s.d. 13.4°; range 52.6° – 112.2°), mean TID 66.1 mm (s.d. 6.6 mm) and mean PI was 50.5° (s.d. 10.2°). Mean values for the projection angles at C7, T1 and T2 were 24.2°, 7.6° and −8.3° respectively. PA were positive in 95% at C7, 73% at T1 and 30% at T2. PA at each level correlated significantly with age (mean r=−0.371; P = .015) and TIA (mean r=−0.916; P < .001) but neither TID nor PI. TIA correlated with age (r = 0.328; P = .008). Conclusions: The projection angles of the CTJ vertebrae are influenced by thoracic inlet angle and a lesser degree age. Understanding sagittal spinal parameters in the CTJ can aid in planning surgical strategy and approach.

Early Complications of Anterior Cervical Fusion Using Zero-profile Implants: Analysis of 193 Consecutive Cases

Background: Anterior access to the cervical spine is considered safe, with the most common complication being dysphagia. The objective of this study is to describe early complications of anterior cervical fusion using Zero-profile implants in a neurosurgery department and compare these with the literature. Methods: In a retrospective study, we analyzed data of patients diagnosed with cervical spondylodiscoarthrosis at a single center between January 2011 and January 2017 who underwent anterior cervical fusion using Zero-profile implants. The analyzed demographic data included age, sex, symptoms, number of operated levels, time of preoperative symptoms, type of symptom and length of hospital stay. Immediate postoperative complications were noted. Results: A total of 193 consecutively operated patients were included. Of the total, 106 patients were female (54.9%). The average age of the patients was 52.7 years. Average hospitalization was 3.20 days and the average number of levels was 1.68. Complications were noted in 57 patients (29.5%). Older patients had more complications (mean 55.5 years versus 51.5). The average length of stay was longer for patients with complications. The average number of operated levels was 1.84 in patients with complications and 1.61 in those who did not complicate. The most common complications were dysphagia (9.32%) and dysphonia (5.69%). We had 1 case of C5 monoparesis and 1 case of epidural hematoma, considered serious complications. Conclusions: Postoperative dysphagia and dysphonia were the most common complications in our series. Risk factors for complications were advanced age and number of operated levels.