Cervical osteotomies for neurological deformities

Abstract

Purpose

To report our experience and technique for performing cervical osteotomies under the setting of cervical deformity and myelopathy.

Methods

Patients who underwent cervical osteotomies for CD with myelopathy were identified in a 10 year period from 2000 to 2010. Demographics, surgery type, osteotomy type, operative details, and radiographs were collected for pre-operative and ultimate post-operative time points. Cervical lordosis (CL) and basion plumb line were collected to assess angular and translational corrections.

Results

In the study period, a total of 35 patients underwent a cervical osteotomy for fixed cervical deformity with a diagnosis of cervical myelopathy or myeloradiculopathy with an average follow-up of 3.4 years (range 1.0–6.3). The cohort was separated into two groups based on the type of surgical approach taken to correct their deformity. Anterior osteotomy with or without posterior instrumentation were performed in 31 patients (Group 1). Pedicle subtraction osteotomies were performed in 4 patients (Group 2). For Group 1, the mean angular correction achieved in this was 27.7° (range 9.0–66.0°) and the mean translational correction was 1.8 cm (range 0.1–2.4 cm). In group 2, the mean angular correction was 48.8° (range 38.4–68.3°) and the mean translational correction was 2.8 cm per PSO (range 0.1–5.6 cm). Similar improvements in pre- and post-operative Neck Disability Index scores were achieved with either osteotomy technique.

Conclusions

We present our series of patients with cervical myelopathy and/or radiculopathy and concurrent cervical deformity who were treated with cervical osteotomies. The re-alignment of the spine was a key step in preventing the progression of myelopathy and protecting the spinal cord from the continued injury.