[Spinal Fusion, Microdiscectomy & Laminectomy Procedures] Cervical Surgical Techniques for the Treatment of Cervical Spondylotic Myelopathy (PDF)

[Justin]

Journal of Neurosurgery: Spine 11:130–141, August 2009

Cervical Surgical Techniques for the Treatment of Cervical Spondylotic Myelopathy

Praveen V. Mummaneni, M.D.1, Michael G. Kaiser, M.D.2, Paul G. Matz, M.D.3, Paul A. Anderson, M.D.4, Michael W. Groff, M.D.5, Robert F. Heary, M.D.6, Langston T. Holly, M.D.7, Timothy C. Ryken, M.D.8, Tanvir F. Choudhri, M.D.9, Edward J. Vresilovic, M.D., Ph.D.10, and Daniel K. Resnick, M.D.11
1Department of Neurosurgery, University of California at San Francisco, California; 2Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York; 3Division of Neurological Surgery, University of Alabama, Birmingham, Alabama; 4Departments of Orthopaedic Surgery and 11Neurological Surgery, University of Wisconsin, Madison, Wisconsin; 5Department of Neurosurgery, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts; 6Department of Neurosurgery, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, New Jersey; 7Division of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, California; 8Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; 9Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York; and 10Department of Orthopaedic Surgery, Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, Hershey, Pennsylvania
Abbreviations used in this paper: ACCF = anterior cervical corpectomy with fusion; ACD = anterior cervical discectomy; ACDF = ACD with fusion; CSM = cervical spondylotic meylopathy; JOA = Japanese Orthopaedic Association; ROM = range of motion.

Address correspondence to: Paul G. Matz, M.D., Neurosurgery and Neurology, LLC, 232 South Woods Mill Road, Chesterfield, Missouri 63017. email: matzpg at yahoo.com.

Object
The objective of this systematic review was to use evidence-based medicine to compare the efficacy of different surgical techniques for the treatment of cervical spondylotic myelopathy (CSM).

Methods
The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to anterior and posterior cervical spine surgery and CSM. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.

Results
A variety of techniques have improved functional outcome after surgical treatment for CSM, including anterior cervical discectomy with fusion (ACDF), anterior cervical corpectomy with fusion (ACCF), laminoplasty, laminectomy, and laminectomy with fusion (Class III). Anterior cervical discectomy with fusion and ACCF appear to yield similar results in multilevel spine decompression for lesions at the disc level. The use of anterior plating allows for equivalent fusion rates between these techniques (Class III). If anterior fixation is not used, ACCF may provide a higher fusion rate than multilevel ACDF but also a higher graft failure rate than multilevel ACDF (Class III). Anterior cervical discectomy with fusion, ACCF, laminectomy, laminoplasty, and laminectomy with arthrodesis all provide near-term functional improvement for CSM. However, laminectomy is associated with late deterioration compared with the other types of anterior and posterior surgeries (Class III).

Conclusions
Multiple approaches exist with similar near-term improvements; however, laminectomy appears to have a late deterioration rate that may need to be considered when appropriate.

KEYWORDS: cervical spine; cervical spondylosis; cervical myelopathy; practice guidelines; surgical technique; treatment outcome.

©1944-2009 by the American Association of Neurosurgeons