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. 2022 Aug;16(5):890-898.
doi: 10.14444/8341. Epub 2022 Aug 31.

An Algorithmic Posterior Approach to the Treatment of Multilevel Degenerative Cervical Spine Disease: A Multicenter Prospective Study

Vadim A Byvaltsev  1   2   3 , Andrei A Kalinin  4   2 , Eugenii G Belykh  5 , Marat A Aliyev  4   6 , Valerii V Shepelev  4   7 , Mikhail Y Biryuchkov  8 , Bobur R Yusupov  4 , Bakhyt M Aglakov  4   6 , K Daniel Riew  9   10
Affiliations

An Algorithmic Posterior Approach to the Treatment of Multilevel Degenerative Cervical Spine Disease: A Multicenter Prospective Study

Vadim A Byvaltsev et al. Int J Spine Surg. 2022 Aug.

Abstract

Background: The choice of surgical method for the treatment of multilevel degenerative cervical spine disease is based on the assessment of neurological symptoms and anatomical source of compression. However, such decision-making process remains complex and poorly defined.

Purpose: To analyze the effectiveness of an algorithmic posterior approach to the surgical treatment of patients with multilevel degenerative disease of the cervical spine based on the preoperative clinical and imaging parameters.

Study design: Prospective nonrandomized multicenter cohort study.

Methods: The study included 338 patients with multilevel degenerative disease of the cervical spine. Two groups of patients were evaluated at 3 neurosurgical centers between 2015 and 2019. The prospective group (Group I, n = 214) consisted of patients who were treated using an algorithm to decide whether they should be treated with an instrumented arthrodesis or a nonfusion procedure. The control group (Group II, n = 124) consisted of patients who underwent posterior decompression with or without stabilization between 2007 and 2014. A total of 192 patients in Group I and 112 in Group II had more than 2 years of follow-up. Visual analog scale (VAS) neck pain, Neck Disability Index (NDI), MacNab and Nurick Scales were collected. Perioperative complications were identified.

Results: At 2-year follow-up, Group I had significantly better clinical outcomes based on VAS neck pain score (P = 0.02), NDI score (P = 0.01), satisfaction with surgery on the MacNab Scale (P < 0.001), and outcome of surgery based on the Nurick Scale (P < 0.001). Complication rate was lower in Group I, 5.7% compared with 34.8% in Group II, P = 0.004.

Conclusions: The algorithmic posterior approach to the surgical treatment of patients with multilevel degenerative disease of the cervical spine resulted in significant improvement of functional outcomes and a decrease in complications at a minimum 2 years of follow-up.

Keywords: cervical fusion; cervical spinal stenosis; laminoplasty; posterior cervical decompression; surgical algorithm.

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Conflict of interest statement

Declaration of Conflicting Interests: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Figure 1
Figure 1
Algorithm for the surgical treatment of patients with multilevel degenerative disease of the cervical spine. CT, computed tomography; FJ, facet joints; IVD, intervertebral discs; MRI, magnetic resonance imaging.
Figure 2
Figure 2
Flowchart for study selection. LF, laminectomy with lateral mass fixation; LP, laminoplasty; MRI, magnetic resonance imaging.
Figure 3
Figure 3
Computed tomography of the cervical spine after open-door laminoplasty was performed from C4 to C6 (A, B); posterior decompression and instrumented fusion were performed from C4 to C6 (C, D).
Figure 4
Figure 4
A total of 338 patients underwent surgery for multilevel degenerative cervical spine disease. Out of these, 34 patients were excluded. Reason *, loss of follow-up; Reason **, refusal to participate in the study; Reason ***, death unrelated to the operation (in these cases, there were no postoperative complications). f/u = follow-up; LP, open-door laminoplasty; LF, laminectomy with instrumented fusion; MRI, magnetic resonance imaging; NDI, Neck Disability Index; VAS, visual analog pain scale.
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References

    1. Head J, Rymarczuk G, Stricsek G, et al. . Ossification of the posterior longitudinal ligament: surgical approaches and associated complications. Neurospine. 2019;16(3):517–529. 10.14245/ns.1938222.111 - DOI - PMC - PubMed
    1. Fehlings MG, Tetreault LA, Wilson JR, Skelly AC. Cervical spondylotic myelopathy: current state of the art and future directions. Spine (Phila Pa 1976). 2013;38(22 Suppl 1):S1–8. 10.1097/BRS.0b013e3182a7e9e0 - DOI - PubMed
    1. Chen TP, Qian LG, Jiao JB, et al. . Anterior decompression and fusion versus laminoplasty for cervical myelopathy due to ossification of posterior longitudinal ligament: a meta-analysis. Medicine (Baltimore). 2019;98(1). 10.1097/MD.0000000000013382 - DOI - PMC - PubMed
    1. Piazza M, McShane BJ, Ramayya AG, et al. . Posterior cervical laminectomy results in better radiographic decompression of spinal cord compared with anterior cervical discectomy and fusion. World Neurosurg. 2018;110:e362–e366. 10.1016/j.wneu.2017.11.017 - DOI - PubMed
    1. Singhatanadgige W, Limthongkul W, Valone F, Yingsakmongkol W, Riew KD. Outcomes following laminoplasty or laminectomy and fusion in patients with myelopathy caused by ossification of the posterior longitudinal ligament: a systematic review. Global Spine J. 2016;6(7):702–709. 10.1055/s-0036-1578805 - DOI - PMC - PubMed

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