Posterior cervical decompression and fusion for circumferential spondylotic cervical stenosis: review of 50 consecutive cases.

PURPOSE OF STUDY: This study presents a clinical and radiological evaluation of 50 consecutive patients with symptomatic spondylotic cervical myelopathy and circumferential spinal cord compression who were managed with a single stage wide posterior laminectomy and lateral mass instrumented fusion.

METHODS USED: 50 consecutive patients (33 male, 17 female) over a 4 year period presenting with symptomatic cervical myelopathy due to circumferential cervical spondylotic spinal stenosis were evaluated and operated upon by a single surgeon and followed in a prospective fashion. All patients underwent pre- and postoperative clinical, radiological and MRI evaluation.

SUMMARY OF FINDINGS: No deaths occurred and no instrumentation-related neural or vascular injuries were noted. No patient required reoperation for ventral compression and in all cases CSF was visible anterior to the cord on postoperative MRI scanning, with relief of the circumferential compression. Most patients improved by at least 1 Nurick grade. Three patients (6%) had single level screw pullouts which did not affect clinical outcome, and required no intervention. Slight worsening of kyphosis occurred in 4% of cases but as group there was no measured difference in sagittal balance (P=0.10). Oswestry Neck Disability Scores improved from 25.7+/-3.6 to 16.6+/-7.1 (P<0.05). One patient required a foraminotomy/posterior discectomy 12 months postoperatively at an adjacent level.

CONCLUSIONS

This study demonstrates that multisegmental spondylotic circumferential cervical stenosis causing symptomatic myelopathy can be managed by single stage decompression and fusion via a posterior approach with very low morbidity and excellent clinical and radiological outcome. The incidence of adjacent segment disease is lower than for anterior interbody fusions with a 1%/year incidence at follow up to date.