Only fixation for cervical spondylosis: Report of early results with a preliminary experience with 6 cases

Abstract

Aim: The author reports early post-operative outcome and preliminary experience with an alternative form of treatment of cervical degenerative or spondylotic disease leading to spinal canal stenosis that involves fixation-arthrodesis of the affected spinal segment using one or two (double insurance) transarticular screws for each joint.

Materials and methods: During the period of months from March 2013 to July 2013, six patients having cervical spondylotic cord compression were treated with transarticular method of screw fixation of the involved segments. The operation involved section of the spinous process at its base, opening up of the facet joint, denuding of articular cartilage, placement of intraarticular cavity bone graft chips and insertion of either a single or two transarticular screws at each level. The fixation was done in four levels in four patients and at two levels in two patients. Japanese Orthopedic Association score, visual analog scale (neck pain) and Odom's criteria were used to monitor the clinical status of the patients before and after the surgery and at follow-up.

Results: Immediate post-operative and a relatively short-term post-operative outcome was remarkably gratifying. During the average period of follow-up of 6 months (range: 3-8 months); there was varying degree of recovery of symptoms. The procedure resulted in firm stabilization and fixation of the spinal segment and provided a ground for arthrodesis. No patient worsened after treatment. During the period of follow-up, all patients showed remarkable and progressive recovery in symptoms.

Conclusions: Vertical instability and telescoping, listhesis or overriding of the facets on physical activity seems to be the defining phenomenon in pathogenesis of cervical spondylotic disease. The clinical outcome in our patients suggest that only fixation of the spinal segment can be a rationale form of treatment. Transarticular method of treatment is a simple, safe and effective method of spinal stabilization. The firm stabilization at the fulcrum of cervical spinal movements provided a ground for segmental spinal arthrodesis. Use of two or "double insurance" screws at each facet is possible and provides reassuring stability in selected cases.

Keywords: Arthrodesis; cervical spondylosis; instability; transarticular fixation.

Figure 1

Images of a 40-year-old male patient (a) T2 weighted sagittal magnetic resonance imaging shows degenerative spinal cord compression, more prominently at C5-6 and C6-7 levels (b) Computerized tomography scan shows presence of posterior osteophytes indenting into the spinal canal at C5-6 and C6-7. (c) Computerized tomography scan image through the facets. (d) Post-operative magnetic resonance imaging shows marginally reduced indentation of the osteophytes into the canal. (e) Post-operative computerised tomography scan showing an increase in the intervertebral and interlaminar spaces following surgery. (f) Image thorough the facets showing transarticular screws. (g) Radiograph showing two transarticular screws at each joint. (h) Lateral radiograph showing the four screws at each level superimposed