Successful treatment of cervical myelopathy with minimal morbidity by circumferential decompression and fusion

Abstract

Circumferential cervical decompression and fusion (CCDF) is an important technique for treating patients with severe cervical myelopathy. While circumferential cervical decompression and fusion may provide improved spinal cord decompression and stability compared to unilateral techniques, it is commonly associated with increased morbidity and mortality. We performed a retrospective analysis of patients undergoing CCDF at the University of California, San Francisco (UCSF) between January 2003 and December 2004. We identified 53 patients and reviewed their medical records to determine the effectiveness of CCDF for improving myelopathy, pain, and neurological function. Degree of fusion, functional anatomic alignment, and stability were also assessed. Operative morbidity and mortality were measured. The most common causes of cervical myelopathy, instability, or deformity were degenerative disease (57%) and traumatic injury (34%). Approximately one-fifth of patients had a prior fusion performed elsewhere and presented with fusion failure or adjacent-level degeneration. Postoperatively, all patients had stable (22.6%) or improved (77.4%) Nurick grades. The average preoperative and postoperative Nurick grades were 2.1 +/- 1.9 and 0.4 +/- 0.9, respectively. Pain improved in 85% of patients. All patients had radiographic evidence of fusion at last follow-up. The most common complication was transient dysphagia. Our average clinical follow-up was 27.5 +/- 9.5 months. We present an extensive series of patients and demonstrate that cervical myelopathy can successfully be treated with CCDF with minimal operative morbidity. CCDF may provide more extensive decompression of the spinal cord and may be more structurally stable. Concerns regarding operation-associated morbidity should not strongly influence whether CCDF is performed.

Fig. 1

Schematic representation of the management of cervical stenosis at our institution by type of procedure performed. The majority of patients underwent anterior or posterior decompression and fusion, but 14.2% underwent circumferential fusion

Fig. 2

A 47-year old female suffered a motor vehicle accident 1 year prior to presentation with C6–7 jumped facets and complete motor and sensory loss corresponding to the C7 level at that time. She underwent reduction and in situ fusion with anterior cervical discectomy and fusion and posterior intraspinous wiring at that time (a–c). She now presented with increasing neck pain and rapidly deteriorating triceps function. She underwent a 540° fusion with removal of posterior instrumentation, osteotomy of posterior fusion mass, complete facetectomy, and placement of lateral mass screws from C3 to C6 and pedicle screws from C7 to T3, followed by removal of anterior instrumentation, C7 complete corpectomy, reduction of deformity, anterior cage and plating from C6 to T1, followed by posterior compression and rod insertion (d–f)

Fig. 3

A 66-year old male presented with central cord syndrome with pain and numbness in both hands. An MRI revealed degenerative spine disease (a, b) with severe canal stenosis due to C3–4 anterolisthesis and C5–6 retrolisthesis. He underwent C4–6 corpectomy and placement of an anterior expandable cage with plating. Posteriorly, he underwent laminectomy followed by C3–C6 lateral mass screws and C7–T1 pedicle screws