| Popis: |
Fifty-five patients with progressive, worsening cervical spondylotic myelopathy were surgically treated and followed from 2 to 20.5 years (mean 7 years). The biomechanical factors impinging on the spinal cord were clarified mainly by air myelography. Twenty-six patients underwent anterior interbody fusion by the Cloward technique which was used for removal of large midline masses, kyphosis angulation, single-level and double-level osteophytes or rarely for unstable subluxations. Twenty-nine patients underwent cervical laminectomy at C3 through C7; the majority were also treated with a dural graft to enlarge the dural tube in instances of vertebral retrolisthesis, osteophytes at three or more levels, pathological lordosis, or advanced vertebral body ankylosis. Ultimate success or failure of the surgical procedure could not be predicted by the preoperative presence or absence of most numerous complaints or findings. However, presence of sphincter disturbance and excessive lower extremity weakness was associated with a postoperative worsened result. A trend of improvement in disability after anterior interbody fusion and a tendency to late worsening in disability following cervical laminectomy were significant. In some instances, late worsening occurred as long as 8 to 12 years after improvement and plateau. |
