Surgical treatment of severe multilevel circumferential compressive myelopathy of the cervical spine: is circumferential procedure necessary?

• Published in: British journal of neurosurgery Vol. 31; no. 2; pp. 189 - 193
• Main Authors: Liu, Xiao-Kang, Li, Hao, Xu, Jian-Guang, Yang, Er-Zhu, Hou, Tie-Sheng, Zeng, Bing-Fang, Lian, Xiao-Feng
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.04.2017; Taylor & Francis Ltd
• Subjects: Adult; Aged; cervical myelopathy; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - surgery; circumferential cervical surgery; circumferential compression; Decompression, Surgical - adverse effects; Decompression, Surgical - methods; Female; Humans; Lordosis - epidemiology; Magnetic Resonance Imaging; Male; Middle Aged; Multilevel; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - methods; Pain Measurement; Patient Satisfaction; Postoperative Complications - epidemiology; Reoperation - statistics & numerical data; Retrospective Studies; Spinal Cord Compression - diagnostic imaging; Spinal Cord Compression - surgery; Surgery; Treatment Outcome; two-stage; circumferential cervical surgery; circumferential compression; two-stage; Multilevel; cervical myelopathy
• ISSN: 0268-8697; 1360-046X
• DOI: 10.1080/02688697.2016.1238038

Objective: To determine the necessity of circumferential decompression and fusion in patients with severe multilevel cervical spondylotic myelopathy with circumferential cord compression. Methods: This prospective study involved 51 patients with severe multilevel circumferential cervical myelopathy underwent two-stage circumferential procedure between July 2008 and June 2010. VAS scores, satisfaction surveys and JOA scores and imaging studies were obtained. Twenty-three patients (45.1%) underwent two-stage surgery (group A); the other 28 patients (54.9%) were satisfied with the outcomes after first-stage surgery, and the second-stage surgery was avoided (group B). Age, sex and symptom duration did not differ between the groups. Results: Patients were followed up for 3-5 years (mean, 42.5 months). In group A, VAS and JOA scores significantly improved from 63.3 and 7.9 to 38.3 and 10.4, respectively, at 3 months after the first-stage operation and 10.2 and 12.7, respectively, at 3 months after the second-stage operation. In group B, the VAS and JOA scores significantly improved from 62.7 and 7.9 to 31.1 and 11.2 respectively, at 3 months and 18.2 and 12.4, respectively at 6 months. Patient satisfaction rate significantly increased from 43.5% after the first-stage operation to 82.6% after the second-stage operation in group A. In group B, this rate was 89.3%. In group A, cervical spine lordosis increased from 12.8° preoperatively to 18.5° (p < .0001) and 19.1° (p > .05) at 3 months after the first-stage and second-stage operations, respectively. In group B, lordosis significantly increased from 12.5° preoperatively to 18.8° at 3 months. The total complication rate did not significantly differ from the rates after a single surgery (either anterior or posterior). Conclusion: Only 45.1% patients required surgery via both approaches. Therefore, a two-stage procedure is a rational choice and safe procedure. If outcomes are unsatisfactory after the first-stage operation, a second-stage operation can be performed.