Unilateral Approaches for Posterior Spinal Canal Decompression in Cervical Spondylotic Myelopathy—An Evaluation of Conceptual Feasibility
| Autor: | Sebastian, Siller, Laura, Pannenbaecker, Joerg-Christian, Tonn, Stefan, Zausinger |
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| Rok vydání: | 2022 |
| Předmět: | |
| Zdroj: | Operative Neurosurgery. 23:431-438 |
| ISSN: | 2332-4260 2332-4252 |
| DOI: | 10.1227/ons.0000000000000364 |
| Popis: | Patients with cervical spondylotic myelopathy (CSM) can be treated with posterior approaches for spinal canal decompression.We compared the patients' outcome after 2 different unilateral and a bilateral posterior approach for decompression to elucidate feasibility and potential procedure-related differences.Medical records of 98 patients with CSM undergoing posterior decompression between 2012 and 2018 were assessed. Patients were divided into 3 groups: (1) unilateral interlaminar fenestration with over-the-top "undercutting" (laminotomy) for compression limited to a ligamentum flavum hypertrophy, (2) unilateral hemilaminectomy for lateralized compression with a combination of ligamentous hypertrophy and osseus stenosis, and (3) laminectomy/laminoplasty for circular osseous-ligamentous spinal canal narrowing.The mean age was 73 years (m:f = 1.4:1), and most frequent symptoms (mean duration: 15 months) were ataxia (69%) and sensory changes (57%). Main location of stenoses (median Naganawa Score = 3; mean anteroposterior spinal canal diameter = 7.7 ± 2.2 mm) was C3 to C6. Thirty-one percent of the patients were assigned for a laminotomy procedure, 20% for a hemilaminectomy, and 49% for a laminectomy/laminoplasty. There were no significant differences of patients' characteristics, blood loss, and operation time between the 3 groups. Independent from the mode of surgery, the spinal canal was significantly widened (median Naganawa Score = 0; mean anteroposterior diameter = 11.4 ± 3.6 mm) and myelopathy (mJOA Score) improved ( Plt; .001); a higher body mass index was significantly correlated with a worse mJOA improvement (r = 0.293/ P = .003). Quality of life (Short-Form 36v2 Health Survey/Neck Disability Index) and reduction of the neck pain level were similar in the 3 groups at last follow-up (mean: 28 months).To minimize patients' periprocedural burden in CSM with dorsal compression, individual tailoring of the posterior approach according to the underlying compressive pathology achieves sufficient decompression and comparable long-term results. |
| Databáze: | OpenAIRE |
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