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Anterior decompression for cervical spondylotic myelopathy

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Abstract

Cervical spondylotic myelopathy is a clinical entity that manifests itself due to compression and ischemia of the spinal cord. The goal of treatment is to decompress the spinal cord and stabilize the spine in neutral, anatomical position. Since the obstruction and compression of the cord are localized in front of the cord, it is obvious that an anterior surgical approach is the preferred one. The different surgical procedures, complications, and outcome are discussed here.

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References

  1. Abraham DJ, Herkowitz HN (1998) Indications and trends in use in cervical spinal fusions. Orthop Clin North Am 29:731–744

    CAS  PubMed  Google Scholar 

  2. An HS, Simpson JM (1994) Surgery of the cervical spine. In: An H, Simpson J (eds) Spinal instrumentation. Dunitz, London

  3. An HS, Simpson JM, Glover JM, Stephany J (1995) Comparison between allograft plus demineralised bone matrix versus autograft in anterior cervical fusion: a prospective multicenter study. Spine 20:2211–221

    CAS  PubMed  Google Scholar 

  4. Anderson PA, Budorick TE, Easton KB, Henley MB, Salciccioli GG (1991) Failure of halo vest to prevent in vivo motion in patients with injured cervical spines. Spine 16 [Suppl 10]:S501–S505

  5. Askins V, Eismont FJ (1997) Efficacy of five cervical orthoses in restricting cervical motion: a comparison study. Spine 22:1193–1198

    Article  CAS  PubMed  Google Scholar 

  6. Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine 20:1055–1060

    CAS  PubMed  Google Scholar 

  7. Bernard TN Jr, Whitecloud TS III (1987) Cervical spondylotic myelopathy and myeloradiculopathy. Anterior decompression and stabilization with autogenous fibula strut graft. Clin Orthop 221:149–160

    PubMed  Google Scholar 

  8. Bernhardt M, Hynes R, Blume H, White A (1993) Current concepts review: cervical spondylotic myelopathy. J Bone Joint Surg Am 5:119–127

    Google Scholar 

  9. Bernhardt M, Hynes RA, Blume HW, White AA (1993) Cervical spondylotic myelopathy: current concepts review. J Bone Joint Surg Am 75:119–128

    CAS  PubMed  Google Scholar 

  10. Bohlman HH (1995) Cervical spondylosis and myelopathy. Instr Course Lect 44:81–98

    CAS  PubMed  Google Scholar 

  11. Bohlman HH, Emery SE, Goodfellow DB, Jones PK (1993) Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. J Bone Joint Surg Am 75:1298–1307

    CAS  PubMed  Google Scholar 

  12. Bolesta MJ, Rechtine Gr, Chrin AM (2000) Three and four-level anterior cervical discectomy and fusion with plate fixation: a prospective study. Spine 25:2040–2044

    Article  CAS  PubMed  Google Scholar 

  13. Boni M, Cherubino P, Denaro V, et al (1984) Multiple subtotal somatectomy. Technique and evaluation of a series of 39 cases. Spine 9:358–362

    CAS  PubMed  Google Scholar 

  14. Brain WR, Nortfield D, Wilkinson M (1952) The neurological manifestations of cervical spondylosis. Brain 75:187–225

    Google Scholar 

  15. Brown AJ, Havel P, Ebraheim N, Greenblatt SH, Jackson WT (1988) Cervical stabilization by plate and bone fusion. Spine 13:236–240

    CAS  PubMed  Google Scholar 

  16. Caspar W (1987) Anterior stabilization with trapezoid osteosynthetic technique in cervical spine injuries. In: Kehr P, Weidnner A (eds) Cervical spine. Springer, Berlin Heidelberg New York, pp 198–204

  17. Clements DH, O'Leary PF (1990) Anterior cervical discectomy and fusion. Spine 15:1023–1025

    CAS  PubMed  Google Scholar 

  18. Connolly PJ, Esses SI, Kostuik JP (1996) Anterior cervical fusion: outcome analysis of patients fused with or without anterior cervical plates. J Spinal Disord 9:202–206

    CAS  PubMed  Google Scholar 

  19. DiAngelo DJ, Foley KT, Vossel KA, Rampersaud YR, Jansen TH (2000) Anterior cervical plating reverses load transfer through multilevel strut-grafts. Spine 25:783–795

    Article  CAS  PubMed  Google Scholar 

  20. Doh ES, Heller JG (1998) Multi-level anterior cervical reconstruction: comparison of surgical techniques and results. Program and abstracts of Cervical Spine Research Society 26th Annual Meeting, 3–5 December 1998, Atlanta

  21. Ebraheim NA, DeTroye RJ, Rupp RE, at al (1995) Osteosynthesis of the cervical spine with an anterior plate. Orthopedics 18:141–147

    CAS  PubMed  Google Scholar 

  22. Edwards CC II, Heller JG, Murakami, H (2002) Corpectomy versus laminoplasty for multilevel cervical myelopathy. Spine 27:1168–1175

    Article  PubMed  Google Scholar 

  23. Emery Se, Bohlman HH, Bolesta MJ, et al (1998) Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy: two-to seventeen-year follow-up. J Bone Joint Surg Am 80:941–951

    Article  CAS  PubMed  Google Scholar 

  24. Fernyhough JC, White JI, LaRocca H (1991) Fusion rates in multi-level cervical spondylosis comparing allograft fibula with autograft fibula in 126 patients. Spine 16:561–S564

    Google Scholar 

  25. Fessler RG, Steck JC, Giovanini MA (1998) Anterior cervical corpectomy for cervical spondylotic myelopathy. Neurosurgery 43:257–265

    CAS  PubMed  Google Scholar 

  26. Friedlaender GE, Huo M (1991) Bone grafts and bone graft substitutes. In: Frymoyer JW (ed) The adult spine: principles and practice. Raven, New York, pp 565–574

  27. Friedlander GE, Mankin HJ (1979) Bone banking: current methods and suggested guidelines. Instr Course Lect 30:36–55

    Google Scholar 

  28. Garfin SR, Botte MJ, Waters RL, Nickel VL (1986) Complications in the use of the halo fixation device. J Bone Joint Surg Am 8:320–325

    Google Scholar 

  29. Geer CP, Papadopoulos SM (1999) Instrumentation after anterior cervical fusion: the argument for single-level anterior cervical discectomy and fusion with anterior plate fixation. Clin Neurosurg 45:25–29

    CAS  PubMed  Google Scholar 

  30. Goldberg VM, Stevenson S (1987) Natural history of autografts and allografts. Clin Orthop 225:7–16

    PubMed  Google Scholar 

  31. Gore DR, Sepic SB 1984) Anterior cervical fusion for degenerated or protruded discs. Spine 9:667–671

    CAS  PubMed  Google Scholar 

  32. Grob D (1998) Surgery in the degenerative cervical spine. Spine 23:2674–2683

    Article  CAS  PubMed  Google Scholar 

  33. Groff MW, Sriharan S, Lee SM, Maiman DJ (2003) Partial corpectomy for cervical spondylosis. Spine 28:14–20

    Article  PubMed  Google Scholar 

  34. Guha SC, Poole MD (1983) Stress fracture of the iliac bone with subfascial femoral neuropathy: unusual complications at a bone graft donor site: case report. Br J Plast Surg 36:305–306

    CAS  PubMed  Google Scholar 

  35. Hacker RJ, Cauthen JC, Gilbert TJ, et al (2000) A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine 25:2646–2655

    Article  CAS  PubMed  Google Scholar 

  36. Hall DJ, Webb JK (1991) Anterior plate fixation in spine tumor surgery: indications, technique and results. Spine 16 [Suppl]:80–83

    Google Scholar 

  37. Hanai K, Fujiyoshi F, Kamei K (1986) Subtotal vertebrectomy and spinal fusion for cervical spondylotic myelopathy. Spine 11310–315

  38. Hee HT, Majd ME, Holt RT, Whitecloud TS III, Pienkowski D (2003) Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. J Spin Disorders Techn 16:1:1–9

    Google Scholar 

  39. Herkowitz HN (1989) The surgical management of cervical spondylotic radiculopathy and myelopathy. Clin Orthop 239:94–108

    PubMed  Google Scholar 

  40. Hoogendoorn HA, Renooij W, Akkermans LMA, et al (1984) Long-term study of large ceramic implants (porous hydroxyapatite) in dog femora. Clin Orthop 187:281–288

    CAS  PubMed  Google Scholar 

  41. Hukuda S, Ogata M, Katsura A (1988) Experimental study on acute aggravating factors of cervical spondylotic myelopathy. Spine 13:15–20

    CAS  PubMed  Google Scholar 

  42. Ito T, Oyanagi K, Takahashi H, Takahashi H, Ikuta F (1996) Cervical spondylotic myelopathy: clinocopathologic study of the progression pattern and thin myelinated fibers of the lesions of seven patients examined during complete autopsy. Spine 21:827–833

    Article  CAS  PubMed  Google Scholar 

  43. Jamjoom A, Williams C, Cummins B (1991) The treatment of spondylotic cervical myelopathy by multiple subtotal vertebrectomy and fusion. Br J Neurosurg 5:249–255

    CAS  PubMed  Google Scholar 

  44. Johnston FG, Crockard HA (1995) One-stage internal fixation and anterior fusion in complex cervical spinal disorders. J Neurosurg 82:234–238

    CAS  PubMed  Google Scholar 

  45. Kale AA, DiCesare PE (1995) Osteoinductive agents: basic science and clinical applications. Am J Orthop 24:752–761

    CAS  PubMed  Google Scholar 

  46. Kalfas IH (1996) The anterior cervical spine locking plate: a technique for surgical decompression and stabilization. In: Fessler RG, Haid RW (eds) Techniques in spinal stabilization. McGraw-Hill, New York, pp 25–33

  47. Kang JD, Bohlman HH (1996) Cervical spondylotic myelopathy. Curr Opin Orthop 7I:13–21

    Google Scholar 

  48. Katsuura A, Huduka S, Imanaka T, Miyamoto K, Kanemoto M (1996) Anterior cervical plate used in degenerative disease can maintain cervical lordosis. J Spinal Disord 9:470–476

    CAS  PubMed  Google Scholar 

  49. Kaufmann HH, Jones E (1989) The principles of bony spinal fusion. Neurosurgery 24:264–270

    PubMed  Google Scholar 

  50. Kettler A, Wilke HJ, Claes L (2001) Effects of neck movements on stability and subsidence in cervical interbody fusion: an in vitro study. J Neurosurg 94 [Suppl 1]:97–107

    Google Scholar 

  51. Kostuik JP, Connolly PJ, Esses SI, et al (1993) Anterior cervical plate fixation with the titanium hollow screw plate system. Spine 18:1273–1278

    CAS  PubMed  Google Scholar 

  52. Kreuz FP, Hyatt GW, Turner TC, Bassett AL (1951) The preservation and clinical use of freeze-dried bone. J Bone Joint Surg Am 33:863–872

    Google Scholar 

  53. Law MD, Bernhardt M, White AA (1994) Evaluation and management of cervical spondylotic myelopathy. J Bone Joint Surg Am 6:1420–1433

    Google Scholar 

  54. Law M. Bernhard M, White AA (1995) Evaluation and management of cervical spondylotic myelopathy. Instr Course Lect 44:99–110

    PubMed  Google Scholar 

  55. Levine DN (1997) Pathogenesis of cervical spondylotic myelopathy. J Neurol Neurosurg Psychiatry 62:334–440

    CAS  PubMed  Google Scholar 

  56. Limbeek J van, Jacobs WCH, Anderson PG, Pavlov PW (2000) A systematic literature review to identify the best method for a single level anterior cervical interbody fusion. Eur Spine J 9:129–136

    Google Scholar 

  57. Lunsford LD, Bissonette DJ, Jannetta PJ, et al (1980) Anterior surgery for cervical disc disease. I. Treatment of lateral cervical disc herniation in 253 cases. J Neurosurg 53:1–11

    CAS  PubMed  Google Scholar 

  58. MacDonald R, Fehlings M, Tator C, Fleming J, Bernstein M, Tasker R (1997) Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg 86:990–997

    CAS  PubMed  Google Scholar 

  59. Majd ME, Vadhva M, Holt RT (1999) Anterior cervical reconstruction using titanium cages with anterior plating. Spine 24:1604–1610

    Article  CAS  PubMed  Google Scholar 

  60. Maurice-Williams RS, Dorward NL (1996) Extended anterior cervical discectomy without fusion: a simple and sufficient operation for most cases of cervical degenerative disease. Br J Neurosurg 10:261–266

    Article  CAS  PubMed  Google Scholar 

  61. Müller ME, Allgöwer M, Schneider R, Willenegger H (1991) Manual of internal fixation: techniques recommended by the AO-ASIF group, 3rd edn. Springer, Berlin Heidelberg New York

    Google Scholar 

  62. Muschler G, Lane JM (1992) Spinal fusion: principles of bone fusion. In: Rothmann RH, Simeone FA (eds) The spine, vol 2, 3rd edn. Saunders, Philadelphia

  63. O'Brien TJ, Rapoff AJ, Ghanayem AJ, et al (1997) Anterior plate stabilization of multilevel cervical corpectomies: a biomechanical analysis of alternative plating techniques. Proceedings of the Cervical Spine Research Society 24th Annual Meeting. Orthop Trans 24:474

    Google Scholar 

  64. Okada K, Shirasaki N, Hayashi H, et al (1991) Treatment of cervical spondylotic myelopathy by enlargement of the spinal canal anteriorly, followed by arthrodesis. J Bone Joint Surg Am 73:352–364

    CAS  PubMed  Google Scholar 

  65. Orr RD, Zdeblick TA (1999) Cervical spondylotic myelopathy$$; approaches to surgical treatment. Clin Orthop 359:58–66

    PubMed  Google Scholar 

  66. Panjabi MM, Isomi T, Wang JL (1999) Loosening at the screw-vertebra junction in multilevel anterior cervical plate constructs. Spine 24:2383–2388

    Article  CAS  PubMed  Google Scholar 

  67. Papadopoulos SM, Kalfas IH, Sonntag VKH (1993) Anterior Instrumentation of the cervical spine. In Whitecloud TS III, Dunsker SB (eds) Anterior cervical spine surgery. Raven, New York, pp 89–103

  68. Paramore CG, Dickman CA, Sonntag VKH (1996) Radiographic and clinical follow-up review of Caspar plates in 49 patients. J Neurosurg 84:957–961

    CAS  PubMed  Google Scholar 

  69. Pelker RR, Friedlander GE, Markham TC (1984) Biomechanical aspects of bone autografts and allografts. Orthop Clin North Am 18:235–239

    Google Scholar 

  70. Rejeda BV, Peelan JG, de Groot K (1977) Tricalcium phosphate as a bone substitute. J Bioeng 1:93–97

    PubMed  Google Scholar 

  71. Riew KD, Palumbo M, Hilibrand A, Carlson G, Bohlman H (1998) Complications of anterior cervical corpectomy in postlaminectomy patients. Federation of Spine Associations, Thirteenth Annual Meeting, New Orleans, Louisiana, March 1998

  72. Riew KD, Sethi NS, Devney J, et al (1999) Complications of buttress plate stabilization of cervical corpectomy. Spine 24:2404–2410

    Article  CAS  PubMed  Google Scholar 

  73. Riley LH, Robinson RA, Johnson KA, Walker AE (1969) The results of anterior interbody fusion of the cervical spine. J Neurosurg 30:127–133

    PubMed  Google Scholar 

  74. Rish BL, McFadden JT, Penix JO (1976) Anterior cervical fusion using homologous bone grafts: a comparative study. Surg Neurol 5:119–121

    CAS  PubMed  Google Scholar 

  75. Robinson RA, Walker AE, Ferlic DC, Wiecking DK (1962) The results of anterior interbody fusion of the cervical spine. J Bone Joint Surg Am 4:1569–1587

    Google Scholar 

  76. Rushton SA, Albert TJ (1998) Cervical degenerative disease. Spinal Fusion 29:755–777

    CAS  Google Scholar 

  77. Russegger L, Monstadt H, Wenz F (1997) First experiences with a distractible titanium implant in ventral cervical disc surgery: report on 30 consecutive cases. Eur Spine J 6:70–73

    CAS  PubMed  Google Scholar 

  78. Saunders RL, Bernini PH, Shirreffs TG, Reeves AD (1991) Central corpectomy for cervical spondylotic myelopathy: a consecutive series with long-term follow-up evaluation. J Neurosurg 74:163–170

    CAS  PubMed  Google Scholar 

  79. Sawin PD, Traynelis VC, Menezes AH (1998) A comparative analysis of fusion rates and donor-site morbidity for autogenetic rib and iliac crest bone grafts in posterior cervical fusions. J Neurosurg 88:255–265

    CAS  PubMed  Google Scholar 

  80. Schaffer JW, Field GA, Goldberg VM, Davy DT (1985) Fate of vascularized and nonvascularized autografts. Clin Orthop 197:32–43

    PubMed  Google Scholar 

  81. Schimandle JH, Boden SD (1992) Bone grafts and bone graft substitutes for spinal fusion. In Rothman RH, Simeone FA (eds) The spine, vol 2, 3rd edn. Saunders, Philadelphia, pp 1610–1629

  82. Schneider JR, Bright RW (1976) Anterior cervical fusion using preserved bone allografts. Transplant Proc 8 [Suppl]:73–6

    Google Scholar 

  83. Seifert V (1995) Anterior decompressive microsurgery and osteosynthesis for the treatment of multisegmental cervical spondylosis. Pathophysiological considerations, surgical indications, results and complications: a survey. Acta Neurochir (Wien) 135:105–121

    Google Scholar 

  84. Seifert V, Stolke D (1991) Multisegmental cervical spondylosis: treatment by spondylectomy, microsurgical decompression and osteosynthesis. Neurosurgery 29:498–503

    CAS  PubMed  Google Scholar 

  85. Shapiro S (1996) Banked fibula and the locking anterior cervical plate in anterior cervical fusions following cervical discectomy. J Neurosurg 84:161–165

    CAS  PubMed  Google Scholar 

  86. Smith GW, Robinson RA (1958) The treatment of certain cervical spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40:607–624

    Google Scholar 

  87. Stahlman GC, Hanley EN, Phillips E (1992) Allograft bone in spinal surgery. In Rothman RH, Simeone FA (eds) The spine, vol 2, 3rd edn. Saunders, Philadelphia, pp 1601–1606

  88. Summers BN, Eisenstein SM (1989) Donor site pain from the ilium: a complication of lumbar spine fusion. J Bone Joint Surg Br 71:677–680

    CAS  PubMed  Google Scholar 

  89. Takeda M (1985) Experience in posterior lumbar interbody fusion: unicortical versus bicortical autogenous grafts. Clin Orthop 193:120–126

    PubMed  Google Scholar 

  90. Tegos S, Rizos K, Papthanasiu A, Kyriakopoulos K (1994) Results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy. Eur Spine J 3:62–65

    CAS  PubMed  Google Scholar 

  91. Thalgott JS, Fritts K, Giuffre JM, Timlin M (1999) Anterior interbody fusion of the cervical spine with coralline hydroxyapatite. Spine 24:1295–1299

    Article  CAS  PubMed  Google Scholar 

  92. Tippets RH, Apfelbaum RI (1988) Anterior cervical fusion with the Caspar instrumentation system. Neurosurgery 22:1008–1013

    CAS  PubMed  Google Scholar 

  93. Vaccaro AR, Balderston RA (1997) Anterior plate instrumentation for disorders of the subaxial cervical spine. Clin Orthop 335:112–121

    PubMed  Google Scholar 

  94. Vaccaro Ar, Falatyn SP, Scuderi GJ, et al (1998) Early failure of long segment anterior cervical plate fixation. J Spinal Disord 11:410–415

    CAS  PubMed  Google Scholar 

  95. Vanichkachorn J, Albert TJ, Silveri CP, et al (1998) The anterior junctional plate in the cervical spine. Spine 23:2462–467

    Article  CAS  PubMed  Google Scholar 

  96. Wang JC, McDonough PW, Endow K, Kanim LE, Delamarter RB (1999) The effect of cervical plating on single-level anterior cervical discectomy and fusion. J Spinal Disord 12:476–471

    Google Scholar 

  97. Wang JC, McDonough PW, Endow KK, Delamarter RB (2000) Increased fusion rates with cervical plating for two-level anterior cervical discectomy and fusion. Spine 25:41–45

    Article  CAS  PubMed  Google Scholar 

  98. Watters WC, Levinthal R (1994) Anterior cervical discectomy with and without fusion: results, complications, and long-term follow-up. Spine 19:2343–2347

    PubMed  Google Scholar 

  99. Weikel AM, Habal MB (1977) Meralgia paresthetica: a complication of iliac bone procurement. Plast Reconstr Surg 60:572–574

    CAS  PubMed  Google Scholar 

  100. Weiland AJ, Phillips TW, Randolph MA (1984) A radiologic, histologic and biomechanical model comparing autografts, allografts and free-vascularized bone grafts. Plast Reconstr Surg 74:368–379

    CAS  PubMed  Google Scholar 

  101. White AA, Panjabi MM (eds) (1990) Clinical biomechanics of the spine. Lippincott, Philadelphia

  102. White AA, Southwick WO, DePonte RJ, Gainor JW, Hardy R (1973) Relief of pain by anterior cervical spine fusion for spondylosis: a report of sixty-five patients. Bone Joint Surg Am 5:525–534

    Google Scholar 

  103. Williams JL, Allen MB, Harkess JW (1968) Late results of cervical discectomy and interbody fusion: some factors influencing the results. J Bone Joint Surg Am 50:277–286

    CAS  PubMed  Google Scholar 

  104. Yonenobu K (2000) Cervical radiculopathy and myelopathy: when and what can surgery contribute to treatment? Eur Spine J 9:1–7

    Article  CAS  PubMed  Google Scholar 

  105. Yonenobu K, Fuji T, Ono K, Okada K, Yamamoto T, Harada N (1985) Choice of surgical treatment for multisegmental cervical spondylotic myelopathy. Spine 10:710–716

    CAS  PubMed  Google Scholar 

  106. Zdeblick TA, Bohlman HH (1989) Cervical kyphosis and myelopathy. Treatment by anterior corpectomy and strut-grafting. J Bone Joint Surg Am 71:170–182

    CAS  PubMed  Google Scholar 

  107. Zdeblick TA, Ducker TB (1991) The use of freeze-dried allograft bone for anterior cervical fusions. Spine 16:726–729

    CAS  PubMed  Google Scholar 

  108. Zdeblick TA, Cooke ME, Wilson D, Kunz DN, McCabe R (1993) Anterior cervical discectomy, fusion and plating. A comparative animal study. Spine 14:1974–1983

    Google Scholar 

  109. Zoega B, Karrholm J, Lind B (1998) One-level cervical spine fusion. A randomised study, with or without plate fixation using radiostereometry in 27 patients. Acta Orthop Scand 69:363–368

    CAS  PubMed  Google Scholar 

  110. Zoega B, Karrholm J, Lind B (1998) Plate fixation adds stability to two-level anterior fusion in the cervical spine: a randomised study using radiostereometry. Eur Spine J 7:302–307

    Article  CAS  PubMed  Google Scholar 

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    P. W. Pavlov

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Pavlov, P.W. Anterior decompression for cervical spondylotic myelopathy. Eur Spine J 12 (Suppl 2), S188–S194 (2003). https://doi.org/10.1007/s00586-003-0610-3

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