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Cervical Myelopathy: Indication and Operative Procedure

  • Marcus CzabankaEmail author
  • Peter Vajkoczy
Chapter

Abstract

The most common cause of spinal cord dysfunction is related to nontraumatic, noninfectious and nononcologic causes such as degenerative disc disease, hypertrophy of the ligamentum flavum, ossification of the posterior longitudinal ligament (OPLL) and progressive kyphosis. Cervical spinal cord dysfunction due to these pathologies is referred to as degenerative cervical myelopathy (DCM) leading to neurological deterioration and reduced quality of life. Treatment options for DCM range from non-surgical conservative approaches to surgical 360° reconstruction procedures of the cervical spine. Optimal treatment requires thorough knowledge of the natural history of the disease, detailed expertise in surgical decision making, experience in anterior and posterior approaches to the cervical spine as well as medical expertise related to intra- and postoperative management of patients with (chronic) spinal cord injury. The following chapter outlines three different cases of DCM focusing on timing of treatment and treatment indication (Case 1), surgical decision making (anterior vs. posterior vs. combined technique, Case 2) and the special pathology of ossification of posterior longitudinal ligament (OPLL, Case 3). Rationale for surgical treatment derived from typical symptomatology and preoperative imaging/diagnostics is demonstrated. Surgical techniques, approaches and risks are discussed in relation to the pathoanatomical presentation of DCM based on three exemplary cases.

References

  1. 1.
    Fehlings MG, et al. A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression. Global Spine J. 2017;7:70S–83S.CrossRefGoogle Scholar
  2. 2.
    Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG. Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis. Spine (Phila Pa 1976). 2015;40:E675–93.CrossRefGoogle Scholar
  3. 3.
    Tetreault LA, et al. Change in function, pain, and quality of life following structured nonoperative treatment in patients with degenerative cervical myelopathy: a systematic review. Global Spine J. 2017;7:42S–52S.CrossRefGoogle Scholar
  4. 4.
    Tetreault L, Nouri A, Kopjar B, Côté P, Fehlings MG. The minimum clinically important difference of the modified Japanese Orthopaedic Association scale in patients with degenerative cervical myelopathy. Spine (Phila Pa 1976). 2015;40:1653–9.CrossRefGoogle Scholar
  5. 5.
    Lawrence BD, et al. Anterior versus posterior approach for treatment of cervical spondylotic myelopathy: a systematic review. Spine (Phila Pa 1976). 2013;38:S173–82.CrossRefGoogle Scholar
  6. 6.
    Wilson JR, et al. Frequency, timing, and predictors of neurological dysfunction in the nonmyelopathic patient with cervical spinal cord compression, canal stenosis, and/or ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976). 2013;38:S37–54.CrossRefGoogle Scholar
  7. 7.
    Tetreault LA, et al. The natural history of degenerative cervical myelopathy and the rate of hospitalization following spinal cord injury: an updated systematic review. Global Spine J. 2017;7:28S–34S.CrossRefGoogle Scholar
  8. 8.
    Matsumoto M, et al. Relationships between outcomes of conservative treatment and magnetic resonance imaging findings in patients with mild cervical myelopathy caused by soft disc herniations. Spine (Phila Pa 1976). 2001;26:1592–8.CrossRefGoogle Scholar
  9. 9.
    Yoshimatsu H, et al. Conservative treatment for cervical spondylotic myelopathy. Prediction of treatment effects by multivariate analysis. Spine J. 2001;1:269–73.CrossRefGoogle Scholar
  10. 10.
    Kato S, et al. Comparison of anterior and posterior surgery for degenerative cervical myelopathy: an MRI-based propensity-score-matched analysis using data from the prospective multicenter AOSpine CSM North America and International Studies. J Bone Joint Surg Am. 2017;99:1013–21.CrossRefGoogle Scholar
  11. 11.
    Tempel ZJ, et al. A multicenter review of superior laryngeal nerve injury following anterior cervical spine surgery. Global Spine J. 2017;7:7S–11S.CrossRefGoogle Scholar
  12. 12.
    Nagoshi N, et al. Risk factors for and clinical outcomes of dysphagia after anterior cervical surgery for degenerative cervical myelopathy: results from the AOSpine International and North America Studies. J Bone Joint Surg Am. 2017;99:1069–77.CrossRefGoogle Scholar
  13. 13.
    Tetreault LA, et al. A clinical prediction model to determine outcomes in patients with cervical spondylotic myelopathy undergoing surgical treatment: data from the prospective, multi-center AOSpine North America study. J Bone Joint Surg Am. 2013;95:1659–66.CrossRefGoogle Scholar
  14. 14.
    Li FN, et al. The treatment of mild cervical spondylotic myelopathy with increased signal intensity on T2-weighted magnetic resonance imaging. Spinal Cord. 2014;52:348–53.CrossRefGoogle Scholar
  15. 15.
    Fukui K, Kataoka O, Sho T, Sumi M. Pathomechanism, pathogenesis, and results of treatment in cervical spondylotic myelopathy caused by dynamic canal stenosis. Spine (Phila Pa 1976). 1990;15:1148–52.CrossRefGoogle Scholar
  16. 16.
    Shamji MF, et al. Comparison of anterior surgical options for the treatment of multilevel cervical spondylotic myelopathy: a systematic review. Spine (Phila Pa 1976). 2013;38:S195–209.CrossRefGoogle Scholar
  17. 17.
    Nakashima H, et al. Comparison of outcomes of surgical treatment for ossification of the posterior longitudinal ligament versus other forms of degenerative cervical myelopathy. J Bone Joint Surg. 2016;98:370–8.CrossRefGoogle Scholar
  18. 18.
    Abiola R, Rubery P, Mesfin A. Ossification of the posterior longitudinal ligament: etiology, diagnosis, and outcomes of nonoperative and operative management. Global Spine J. 2016;6:195–204.CrossRefGoogle Scholar
  19. 19.
    Iwasaki M, Kawaguchi Y, Kimura T, Yonenobu K. Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up. J Neurosurg Spine. 2002;96:180–9.CrossRefGoogle Scholar
  20. 20.
    Fehlings MG, et al. Laminectomy and fusion versus laminoplasty for the treatment of degenerative cervical myelopathy: results from the AOSpine North America and International Prospective Multicenter Studies. Spine J. 2017;17:102–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryCharitè – Universitätsmedizin BerlinBerlinGermany

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