Skip to main content
Log in

Identifiable causes for poor outcome in surgery for cervical spondylosis

Post-operative computed myelography and MR imaging

  • Originals
  • Published:
Neuroradiology Aims and scope Submit manuscript

Summary

Outcome from surgery for cervical spondylosis is often disappointing. To identify possible causes of poor outcome 56 such patients referred for post-operative computed myelography or MRI were evaluated, 22 of which eventually had further surgery. Alternative diagnoses to cervical spondylosis were eventually established in 14.3 %; 26.8% had spinal cord atrophy 15.6% of which also had myelomalacia; 28.6% had diffuse spinal canal stenosis; and in 57.1% surgery had failed to decompress the spinal canal. These findings can be partly explained by patient selection criteria; nevertheless they do serve to emphasises the point often ignored in discussions of the efficacy of surgery in cervical spondylosis, that operations significantly often fail to achieve adequate decompression. Furthermore there was no evidence in this material that osteophytes regress after spinal fusion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Mair WPG, Druckman R (1953) The pathology of spinal cord lesions and their relation to the clinical features in protrusion of cervical intervertebral discs (a report of four cases). Brain 76: 70–79

    PubMed  CAS  Google Scholar 

  2. Adams CBT, Logue V (1971) Studies in cervical spondylotic myelopathy II. The movement and contour of the spine in relation to the neural complications of cervical spondylosis. Brain 94: 569–586

    Google Scholar 

  3. Schmidek HH, Smith AS (1988) Anterior cervical disc excision in cervical spondylosis. In: Operative neurosurgical techniques. Grune and Stratton, New York, pp 1327–1324

    Google Scholar 

  4. Nurick S (1972) The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95: 87–100

    PubMed  CAS  Google Scholar 

  5. Campbell AMG, Phillips DG (1960) Cervical disc lesions with neurological disorders. Differential diagnosis, treatment and prognosis. Br Med J 2: 481–485

    PubMed  CAS  Google Scholar 

  6. Clarke, Robinson PK (1956) Cervical myelopathy; complication of cervical spondylosis. Brain 79: 483

    PubMed  CAS  Google Scholar 

  7. Lees F, Turner JWA (1963) Natural history and prognosis of cervical spondylosis. Br Med J 2: 1607

    Article  PubMed  CAS  Google Scholar 

  8. Ono K, Ota H, Tada K, Yamamoto T (1977) Cervical myelopathy secondary to multiple spondylotic protrusions: a clinicopathologic study. Spine 2: 109–125

    Article  Google Scholar 

  9. Hughes JT (1984) Disorders of the spine and spinal cord. In: Greenfield's neuropathology. Arnold, London, pp 799–806

    Google Scholar 

  10. Scotti G, Scialfa G, Pieralli S (1983) Myelography and radiculopathy due to cervical spondylosis: myelographic-CT correlations. AJNR 4: 601–603

    PubMed  CAS  Google Scholar 

  11. Yu YL, du Boulay GH, Stevens JM, Kendall BE (1986) Computed tomography in cervical spondylotic myelopathy and radiculopathy: visualisation of structures, myelographic comparison, cord measurements and clinical utility. Neuroradiology 28: 221–236

    Article  PubMed  CAS  Google Scholar 

  12. Lee SH, Coleman PE, Hahn FJ (1988) Magnetic resonance imaging of degenerative disk disease of the spine. Radiol Clin North Am 26: 949–964

    PubMed  CAS  Google Scholar 

  13. Fujiwara F, Yonenobu K, Ebara S, Yamashita K, Ono K (1989) The prognosis of surgery for cervical compression myelopathy. (An analysis of the factors involved). J Bone Joint Surg [Br] 71B: 393–398

    Google Scholar 

  14. Miller DH, McDonald WI, Blumhardt LD, DuBoulay GH, Halliday AM, Johnson G, Kendall BE, Kingsley DP, MacManus DG, Moseley IF (1987) Magnetic resonance imaging in isolated non compressive spinal cord syndromes. Ann Neurol 22: 714–723

    Article  PubMed  CAS  Google Scholar 

  15. Stevens JM, O'Driscoll DM, Yu YL, Kendall BE, Anathapavan S (1987) Some dynamic factors in compressive deformity of the cervical spinal cord. Neuroradiology 29: 136–142

    Article  PubMed  CAS  Google Scholar 

  16. Collias JC, Roberts MP (1988) Posterior operations for cervical disc herniation and spondylotic myelopathy. In: Operative neurosurgical techniques. Grune and Stratton, New York, pp 1347–1357

    Google Scholar 

  17. Cloward RB (1958) The anterior approach for removal of ruptured cervical discs. J Neurosurg 15: 602–607

    PubMed  CAS  Google Scholar 

  18. Smith GW, Robinson RA (1958) The treatment of certain cervical spine disorders by anterior removal of intervertebral disc and interbody fusion. J Bone Joint Surg [Am] 40: A607-A624

    Google Scholar 

  19. Aronsen N, Filtzler Dl, Bagan M (1958) Anterior cervical fusion by Smith-Robinson approach. J Neurosurg 29: 369–404

    Google Scholar 

  20. Lunsford LD, Bisonette D, Jannetta PJ, Sheptak PE, Zorub DS (1980) Anterior surgery for cervical disc disease. Part 1: treatment of lateral disc herniation in 32 cases. J Neurosurg 53: 1–11

    PubMed  CAS  Google Scholar 

  21. Lunsford LD, Bisonette D, Zorub DS (1980) Anterior surgery for cervical disc disease. Part 2: treatment of cervical spondylotic myelopathy in 32 cases. J Neurosurg 53: 12–19

    Article  PubMed  CAS  Google Scholar 

  22. Hukuda S, Mochizuki T, Ogata M, Shichikawa K, Shimomura Y (1985) Operations for cervical spondylotic myelopathy (A comparison of the results of anterior and posterior procedures). J Bone Joint Surg [Br] 67B: 609–615

    Google Scholar 

  23. Walker J, Gillespie R, Davis J, Dawson (1988) Water-soluble contrast medium for intraoperative evaluation of anterior cervical discectomy. J Neurosurg 68: 491–492

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Clifton, A.G., Stevens, J.M., Whitear, P. et al. Identifiable causes for poor outcome in surgery for cervical spondylosis. Neuroradiology 32, 450–455 (1990). https://doi.org/10.1007/BF02426453

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02426453

Key words

Navigation