European Spine Journal

, Volume 24, Supplement 7, pp 832–841 | Cite as

Cervical spondylotic myelopathy: the relevance of the spinal cord back shift after posterior multilevel decompression. A systematic review

  • Vincenzo Denaro
  • Umile Giuseppe Longo
  • Alessandra Berton
  • Giuseppe Salvatore
  • Luca Denaro
Review Article

Abstract

Purpose

Spinal cord back shift has been considered the desired end point of posterior decompression procedures for cervical spondylotic myelopathy (CSM). However, the association with postoperative outcomes has not been definitively demonstrated. The aim of this review is to obtain an overview of the current knowledge on the spinal back shift after posterior decompression to clarify the main controversial aspects and provide recommendations for further studies on the subject.

Methods

A comprehensive quantitative review of the literature was performed. Bibliographic databases were searched using the following keywords: spinal cord drift, spinal cord shift, CSM, ossification of posterior longitudinal ligament, posterior decompression, laminoplasty, laminectomy and fusion.

Results

Twelve eligible studies were included. The authors measured the spinal cord back shift in different ways, using the posterior edge, the center or the anterior margin of the spinal cord as reference points. Six studies analyzed the correlation between the spinal cord back shift and the recovery rate, but their results were discordant. The correlation between the posterior cord migration and cervical alignment was not confirmed in all studies.

Conclusions

There is a need for a consensus on the best way to measure the spinal cord back shift. The action of multiple factors on spinal cord back shift can explain the difference in the results collected from the studies. We recommend further studies to clarify the behavior of the spinal cord after posterior decompression and its clinical meaning.

Keywords

Spinal cord shift Cervical spondylotic myelopathy Posterior decompression Laminectomy and fusion 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med 3:e123–e130PubMedCentralPubMedGoogle Scholar
  2. 2.
    Baba H, Uchida K, Maezawa Y, Furusawa N, Azuchi M, Imura S (1996) Lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy: a magnetic resonance imaging study. J Neurol 243:626–632CrossRefPubMedGoogle Scholar
  3. 3.
    Aita I, Hayashi K, Wadano Y, Yabuki T (1998) Posterior movement and enlargement of the spinal cord after cervical laminoplasty. J Bone Joint Surg Brit 80:33–37CrossRefPubMedGoogle Scholar
  4. 4.
    Fujimura Y, Nishi Y, Nakamura M (1997) Dorsal shift and expansion of the spinal cord after expansive open-door laminoplasty. J Spinal Disord 10:282–287CrossRefPubMedGoogle Scholar
  5. 5.
    Sodeyama T, Goto S, Mochizuki M, Takahashi J, Moriya H (1999) Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord. Spine 24:1527–1531 (discussion 1531–1522) CrossRefPubMedGoogle Scholar
  6. 6.
    Hatta Y, Shiraishi T, Hase H, Yato Y, Ueda S, Mikami Y, Harada T, Ikeda T, Kubo T (2005) Is posterior spinal cord shifting by extensive posterior decompression clinically significant for multisegmental cervical spondylotic myelopathy? Spine 30:2414–2419CrossRefPubMedGoogle Scholar
  7. 7.
    Shiozaki T, Otsuka H, Nakata Y, Yokoyama T, Takeuchi K, Ono A, Numasawa T, Wada K, Toh S (2009) Spinal cord shift on magnetic resonance imaging at 24 hours after cervical laminoplasty. Spine 34:274–279. doi: 10.1097/BRS.0b013e318194e275 CrossRefPubMedGoogle Scholar
  8. 8.
    Xia G, Tian R, Xu T, Li H, Zhang X (2011) Spinal posterior movement after posterior cervical decompression surgery: clinical findings and factors affecting postoperative functional recovery. Orthopedics 34:e911–e918. doi: 10.3928/01477447-20111021-03 PubMedGoogle Scholar
  9. 9.
    Lee JY, Sharan A, Baron EM, Lim MR, Grossman E, Albert TJ, Vaccaro AR, Hilibrand AS (2006) Quantitative prediction of spinal cord drift after cervical laminectomy and arthrodesis. Spine 31:1795–1798. doi: 10.1097/01.brs.0000225992.26154.d0 CrossRefPubMedGoogle Scholar
  10. 10.
    Tashjian VS, Kohan E, McArthur DL, Holly LT (2009) The relationship between preoperative cervical alignment and postoperative spinal cord drift after decompressive laminectomy and arthrodesis for cervical spondylotic myelopathy. Surg Neurol 72:112–117. doi: 10.1016/j.surneu.2009.02.024 CrossRefPubMedGoogle Scholar
  11. 11.
    Radcliff KE, Limthongkul W, Kepler CK, Sidhu GD, Anderson DG, Rihn JA, Hilibrand AS, Vaccaro AR, Albert TJ (2012) Cervical laminectomy width and spinal cord drift are risk factors for postoperative C5 palsy. J Spinal Disord Tech. doi: 10.1097/BSD.0b013e31824e53af Google Scholar
  12. 12.
    Zhao X, Xue Y, Pan F, Zhao H, Li P, Wang P, Ma X (2012) Extensive laminectomy for the treatment of ossification of the posterior longitudinal ligament in the cervical spine. Arch Orthop Trauma Surg 132:203–209. doi: 10.1007/s00402-011-1420-4 CrossRefPubMedGoogle Scholar
  13. 13.
    Du W, Zhang P, Shen Y, Zhang YZ, Ding WY, Ren LX (2013) Enlarged laminectomy and lateral mass screw fixation for multilevel cervical degenerative myelopathy associated with kyphosis. Spine J. doi: 10.1016/j.spinee.2013.06.017 Google Scholar
  14. 14.
    Boni MDGL, Denaro V (1987) CT evaluation of the multiple subtotal somatectomy results. In: Kehr P, Weidner A (eds) Cervical spine. Springer-Verlag, Vienna, pp 124–130CrossRefGoogle Scholar
  15. 15.
    Boni M, Denaro V (1982) Surgical treatment of cervical arthrosis. Follow-up review (2–13 years) of the 1st 100 cases operated on by anterior approach. Rev Chir Orthop Reparatrice Appar Mot 68:269–280PubMedGoogle Scholar
  16. 16.
    Boni M, Cherubino P, Denaro V, Benazzo F (1984) Multiple subtotal somatectomy. Technique and evaluation of a series of 39 cases. Spine 9:358–362CrossRefPubMedGoogle Scholar
  17. 17.
    Yoon ST, Raich A, Hashimoto RE, Riew KD, Shaffrey CI, Rhee JM, Tetreault LA, Skelly AC, Fehlings MG (2013) Predictive factors affecting outcome after cervical laminoplasty. Spine 38:S232–S252. doi: 10.1097/BRS.0b013e3182a7eb55 CrossRefPubMedGoogle Scholar
  18. 18.
    Denaro V (1991) Stenosis of the cervical spine : causes, diagnosis, and treatment. Springer-Verlag, Berlin, New YorkCrossRefGoogle Scholar
  19. 19.
    Ranger MR, Irwin GJ, Bunbury KM, Peutrell JM (2008) Changing body position alters the location of the spinal cord within the vertebral canal: a magnetic resonance imaging study. Br J Anaesth 101:804–809. doi: 10.1093/bja/aen295 CrossRefPubMedGoogle Scholar
  20. 20.
    Takahashi Y, Narusawa K, Shimizu K, Hijioka A, Nakamura T (2006) Enlargement of cervical spinal cord correlates with improvement of motor function in upper extremities after laminoplasty for cervical myelopathy. J Spinal Disord Tech 19:194–198. doi: 10.1097/01.bsd.0000193821.50146.78 CrossRefPubMedGoogle Scholar
  21. 21.
    Matsuyama Y, Kawakami N, Mimatsu K (1995) Spinal cord expansion after decompression in cervical myelopathy. Investigation by computed tomography myelography and ultrasonography. Spine 20:1657–1663CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Vincenzo Denaro
    • 1
  • Umile Giuseppe Longo
    • 1
  • Alessandra Berton
    • 1
  • Giuseppe Salvatore
    • 1
  • Luca Denaro
    • 2
  1. 1.Department of Orthopaedic and Trauma SurgeryCampus Bio-Medico UniversityTrigoriaItaly
  2. 2.Department of NeurosurgeryUniversity-Hospital of PaduaPaduaItaly

Personalised recommendations