Tags

Type your tag names separated by a space and hit enter

Long-term follow-up results and radiographic findings of anterior surgery with Cloward trephination for cervical spondylotic myelopathy.
J Spinal Disord Tech. 2009 Apr; 22(2):105-13.JS

Abstract

STUDY DESIGN

Serial retrospective long-term follow-up study.

OBJECTIVE

To assess the long-term results of anterior surgery with Cloward trephination and iliac strut grafting for cervical spondylotic myelopathy.

SUMMARY OF BACKGROUND DATA

Anterior surgery remains the most common surgical option and generally gives good results, although early and late deterioration after initial postoperative improvement has been noted. Although anterior decompression with trephination is a variant of the Cloward technique, little information is available concerning the long-term results after this procedure.

METHODS

One hundred sixty-eight consecutive patients treated with this technique by the same author from the years 1978 to 1992 were followed serially. One hundred and seven patients were followed for over 10 years (mean: 14.1 y) (follow-up rate: 71.8%). Clinical results were evaluated according to the Japanese Orthopedic Association system and the results at different postoperative intervals were analyzed. Thirty-six patients returned for the final follow-up. Plain radiographs were taken in neutral and flexion-extension positions and computed tomography scans were taken at fused segments and unfused levels.

RESULTS

The mean recovery rate was 56.8% at final follow-up. Deterioration of 2 Japanese Orthopedic Association points or more was experienced in 44 patients at various postoperative periods and was more frequent at over 10 years follow-up. Kyphosis of fused segments was noted frequently on the radiographies of the 36 patients with a mean of 7.8 degrees. A straight or misaligned cervical spine was found in 28 (77.8%) patients and these deformities were more serious in multilevel fusions. Stenosis of the canal at fused segments was found in 15 (41.7%) patients owing to osteogenesis resulting from inadequate decompression or pseudoarthrosis. At unfused levels, the incidence of spondylolisthesis, bony bridge, disc hernia, and thickening or bulging of the ligament flavum was 19.4%, 27.8%, 33.3%, 19.4%, respectively, and these abnormalities almost always occurred at levels adjacent to the fusion. Radiographic abnormalities were pejorative for long-term clinical results.

CONCLUSIONS

Anterior surgery with Cloward trephination provides generally acceptable long-term results with considerable incidences of deterioration and radiographic abnormalities. This underlines the need for thorough decompression and preservation of the subchondral endplate bone for solid fusion and maintenance of the cervical lordotic curvature.

Authors+Show Affiliations

Department of Orthopaedics, Shandong Province Hospital, Jinan, Shandong, PR China. xubshn@yahoo.com.cnNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19342932

Citation

Xu, Bao-Shan, et al. "Long-term Follow-up Results and Radiographic Findings of Anterior Surgery With Cloward Trephination for Cervical Spondylotic Myelopathy." Journal of Spinal Disorders & Techniques, vol. 22, no. 2, 2009, pp. 105-13.
Xu BS, Zhang ZL, Le Huec JC, et al. Long-term follow-up results and radiographic findings of anterior surgery with Cloward trephination for cervical spondylotic myelopathy. J Spinal Disord Tech. 2009;22(2):105-13.
Xu, B. S., Zhang, Z. L., Le Huec, J. C., Xia, Q., & Hu, Y. C. (2009). Long-term follow-up results and radiographic findings of anterior surgery with Cloward trephination for cervical spondylotic myelopathy. Journal of Spinal Disorders & Techniques, 22(2), 105-13. https://doi.org/10.1097/BSD.0b013e31816d6579
Xu BS, et al. Long-term Follow-up Results and Radiographic Findings of Anterior Surgery With Cloward Trephination for Cervical Spondylotic Myelopathy. J Spinal Disord Tech. 2009;22(2):105-13. PubMed PMID: 19342932.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term follow-up results and radiographic findings of anterior surgery with Cloward trephination for cervical spondylotic myelopathy. AU - Xu,Bao-Shan, AU - Zhang,Zuo-Lun, AU - Le Huec,Jean-Charles, AU - Xia,Qun, AU - Hu,Yong-Cheng, PY - 2009/4/4/entrez PY - 2009/4/4/pubmed PY - 2009/7/15/medline SP - 105 EP - 13 JF - Journal of spinal disorders & techniques JO - J Spinal Disord Tech VL - 22 IS - 2 N2 - STUDY DESIGN: Serial retrospective long-term follow-up study. OBJECTIVE: To assess the long-term results of anterior surgery with Cloward trephination and iliac strut grafting for cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: Anterior surgery remains the most common surgical option and generally gives good results, although early and late deterioration after initial postoperative improvement has been noted. Although anterior decompression with trephination is a variant of the Cloward technique, little information is available concerning the long-term results after this procedure. METHODS: One hundred sixty-eight consecutive patients treated with this technique by the same author from the years 1978 to 1992 were followed serially. One hundred and seven patients were followed for over 10 years (mean: 14.1 y) (follow-up rate: 71.8%). Clinical results were evaluated according to the Japanese Orthopedic Association system and the results at different postoperative intervals were analyzed. Thirty-six patients returned for the final follow-up. Plain radiographs were taken in neutral and flexion-extension positions and computed tomography scans were taken at fused segments and unfused levels. RESULTS: The mean recovery rate was 56.8% at final follow-up. Deterioration of 2 Japanese Orthopedic Association points or more was experienced in 44 patients at various postoperative periods and was more frequent at over 10 years follow-up. Kyphosis of fused segments was noted frequently on the radiographies of the 36 patients with a mean of 7.8 degrees. A straight or misaligned cervical spine was found in 28 (77.8%) patients and these deformities were more serious in multilevel fusions. Stenosis of the canal at fused segments was found in 15 (41.7%) patients owing to osteogenesis resulting from inadequate decompression or pseudoarthrosis. At unfused levels, the incidence of spondylolisthesis, bony bridge, disc hernia, and thickening or bulging of the ligament flavum was 19.4%, 27.8%, 33.3%, 19.4%, respectively, and these abnormalities almost always occurred at levels adjacent to the fusion. Radiographic abnormalities were pejorative for long-term clinical results. CONCLUSIONS: Anterior surgery with Cloward trephination provides generally acceptable long-term results with considerable incidences of deterioration and radiographic abnormalities. This underlines the need for thorough decompression and preservation of the subchondral endplate bone for solid fusion and maintenance of the cervical lordotic curvature. SN - 1539-2465 UR - https://www.unboundmedicine.com/medline/citation/19342932/Long_term_follow_up_results_and_radiographic_findings_of_anterior_surgery_with_Cloward_trephination_for_cervical_spondylotic_myelopathy_ L2 - http://dx.doi.org/10.1097/BSD.0b013e31816d6579 DB - PRIME DP - Unbound Medicine ER -