Multilevel cervical laminectomy and fusion with posterior cervical cages
Context: Cervical spondylotic myelopathy (CSM) is a progressive disease that can result in significant disability. Single-level stenosis can be effectively decompressed through either anterior or posterior techniques. However, multilevel pathology can be challenging, especially in the presence of si...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2017-01-01
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| Series: | Journal of Craniovertebral Junction and Spine |
| Subjects: | |
| Online Access: | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2017;volume=8;issue=4;spage=316;epage=321;aulast=Bou |
| _version_ | 1818539400054702080 |
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| author | Jad N Bou Monsef Krzysztof B Siemionow |
| author_facet | Jad N Bou Monsef Krzysztof B Siemionow |
| author_sort | Jad N Bou Monsef |
| collection | DOAJ |
| description | Context: Cervical spondylotic myelopathy (CSM) is a progressive disease that can result in significant disability. Single-level stenosis can be effectively decompressed through either anterior or posterior techniques. However, multilevel pathology can be challenging, especially in the presence of significant spinal stenosis. Three-level anterior decompression and fusion are associated with higher nonunion rates and prolonged dysphagia. Posterior multilevel laminectomies with foraminotomies jeopardize the bone stock required for stable fixation with lateral mass screws (LMSs).
Aims: This is the first case series of multilevel laminectomy and fusion for CSM instrumented with posterior cervical cages.
Settings and Design: Three patients presented with a history of worsening neck pain, numbness in bilateral upper extremities and gait disturbance, and examination findings consistent with myeloradiculopathy. Cervical magnetic resonance imaging demonstrated multilevel spondylosis resulting in moderate to severe bilateral foraminal stenosis at three cervical levels.
Materials and Methods: The patients underwent a multilevel posterior cervical laminectomy and instrumented fusion with intervertebral cages placed between bilateral facet joints over three levels. Oswestry disability index and visual analog scores were collected preoperatively and at each follow-up. Pre- and post-operative images were analyzed for changes in cervical alignment and presence of arthrodesis.
Results: Postoperatively, all patients showed marked improvement in neurological symptoms and neck pain. They had full resolution of radicular symptoms by 6 weeks postoperatively. At 12-month follow-up, they demonstrated solid arthrodesis on X-rays and computed tomography scan.
Conclusions: Posterior cervical cages may be an alternative option to LMSs in multilevel cervical laminectomy and fusion for cervical spondylotic myeloradiculopathy. |
| first_indexed | 2024-12-11T21:41:32Z |
| format | Article |
| id | doaj.art-f912f56dfe9749b39bf7558e61bd4832 |
| institution | Directory Open Access Journal |
| issn | 0974-8237 |
| language | English |
| last_indexed | 2024-12-11T21:41:32Z |
| publishDate | 2017-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Craniovertebral Junction and Spine |
| spelling | doaj.art-f912f56dfe9749b39bf7558e61bd48322022-12-22T00:49:50ZengWolters Kluwer Medknow PublicationsJournal of Craniovertebral Junction and Spine0974-82372017-01-018431632110.4103/jcvjs.JCVJS_69_17Multilevel cervical laminectomy and fusion with posterior cervical cagesJad N Bou MonsefKrzysztof B SiemionowContext: Cervical spondylotic myelopathy (CSM) is a progressive disease that can result in significant disability. Single-level stenosis can be effectively decompressed through either anterior or posterior techniques. However, multilevel pathology can be challenging, especially in the presence of significant spinal stenosis. Three-level anterior decompression and fusion are associated with higher nonunion rates and prolonged dysphagia. Posterior multilevel laminectomies with foraminotomies jeopardize the bone stock required for stable fixation with lateral mass screws (LMSs). Aims: This is the first case series of multilevel laminectomy and fusion for CSM instrumented with posterior cervical cages. Settings and Design: Three patients presented with a history of worsening neck pain, numbness in bilateral upper extremities and gait disturbance, and examination findings consistent with myeloradiculopathy. Cervical magnetic resonance imaging demonstrated multilevel spondylosis resulting in moderate to severe bilateral foraminal stenosis at three cervical levels. Materials and Methods: The patients underwent a multilevel posterior cervical laminectomy and instrumented fusion with intervertebral cages placed between bilateral facet joints over three levels. Oswestry disability index and visual analog scores were collected preoperatively and at each follow-up. Pre- and post-operative images were analyzed for changes in cervical alignment and presence of arthrodesis. Results: Postoperatively, all patients showed marked improvement in neurological symptoms and neck pain. They had full resolution of radicular symptoms by 6 weeks postoperatively. At 12-month follow-up, they demonstrated solid arthrodesis on X-rays and computed tomography scan. Conclusions: Posterior cervical cages may be an alternative option to LMSs in multilevel cervical laminectomy and fusion for cervical spondylotic myeloradiculopathy.http://www.jcvjs.com/article.asp?issn=0974-8237;year=2017;volume=8;issue=4;spage=316;epage=321;aulast=BouCervicalintervertebral cagelaminectomymyelopathyspondylosis |
| spellingShingle | Jad N Bou Monsef Krzysztof B Siemionow Multilevel cervical laminectomy and fusion with posterior cervical cages Journal of Craniovertebral Junction and Spine Cervical intervertebral cage laminectomy myelopathy spondylosis |
| title | Multilevel cervical laminectomy and fusion with posterior cervical cages |
| title_full | Multilevel cervical laminectomy and fusion with posterior cervical cages |
| title_fullStr | Multilevel cervical laminectomy and fusion with posterior cervical cages |
| title_full_unstemmed | Multilevel cervical laminectomy and fusion with posterior cervical cages |
| title_short | Multilevel cervical laminectomy and fusion with posterior cervical cages |
| title_sort | multilevel cervical laminectomy and fusion with posterior cervical cages |
| topic | Cervical intervertebral cage laminectomy myelopathy spondylosis |
| url | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2017;volume=8;issue=4;spage=316;epage=321;aulast=Bou |
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