Tags

Type your tag names separated by a space and hit enter

Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome after anterior or posterior decompression.
J Neurosurg Spine. 2009 Nov; 11(5):521-8.JN

Abstract

OBJECT

The effects of sagittal kyphotic deformities or mechanical stress on the development of cervical spondylotic myelopathy, or the reduction and fusion of kyphotic sagittal alignment have not been consistently documented. The aim in this study was to determine the effects of kyphotic sagittal alignment of the cervical spine in terms of neurological morbidity and outcome after 2 types of surgical intervention.

METHODS

The authors retrospectively reviewed the records of 476 patients who underwent cervical spine surgeries for spondylotic myelopathy between 1993 and 2006 at their university medical center. Among these were identified 43 patients-30 men and 13 women, with a mean age of 58.8 years-who had cervical kyphosis exceeding 10 degrees on preoperative sagittal lateral radiographs obtained in the neutral position, and their cases were analyzed in this study. Anterior decompression with interbody fusion was conducted in 28 patients, and en bloc open-door C3-7 laminoplasty in 15 patients. Both pre- and postoperative neurological, radiographic, and MR imaging findings were assessed in both surgical groups.

RESULTS

The mean preoperative kyphotic angle in all 43 patients was 15.9 +/- 5.9 degrees in the neutral position. Segmental instability was noted in 26 patients (61%) and reversed dynamic spinal canal stenosis at the level above the local kyphosis in 22 (51%). Preoperative T2-weighted MR images showed high-intensity signal within the cord at and around the level of maximal compression or segmental instability in 28 patients (65%). The mean kyphotic angle in both the neutral and flexion positions was significantly smaller at 4-6 weeks after surgery in the anterior spondylectomy group than in the laminoplasty group (p < 0.001). Furthermore, the angle in the neutral position was significantly smaller on follow-up in the anterior spondylectomy group than in the laminoplasty group (p = 0.034). The transverse area of the spinal cord was significantly larger in the anterior spondylectomy group than in the laminoplasty group on follow-up (p = 0.037). Preoperative neurological scores (assessed using the Japanese Orthopaedic Association scale) and improvement on follow-up > or = 2 years after treatment (average 3.3 years) were not significantly different between the 2 groups; however, there was a significant difference in Japanese Orthopaedic Association score at 4-6 weeks postoperatively (p = 0.047).

CONCLUSIONS

Kyphotic deformity and mechanical stress in the cervical spine may play an important role in neurological dysfunction. In a select group of patients with kyphotic deformity > or = 10 degrees , adequate correction of local sagittal alignment may help to maximize the chance of neurological improvement.

Authors+Show Affiliations

Department of Orthopaedics and Rehabilitation Medicine, Fukui University Faculty of Medical Sciences, Eiheiji, Fukui, Japan. kuchida@u-fukui.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19929353

Citation

Uchida, Kenzo, et al. "Cervical Spondylotic Myelopathy Associated With Kyphosis or Sagittal Sigmoid Alignment: Outcome After Anterior or Posterior Decompression." Journal of Neurosurgery. Spine, vol. 11, no. 5, 2009, pp. 521-8.
Uchida K, Nakajima H, Sato R, et al. Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome after anterior or posterior decompression. J Neurosurg Spine. 2009;11(5):521-8.
Uchida, K., Nakajima, H., Sato, R., Yayama, T., Mwaka, E. S., Kobayashi, S., & Baba, H. (2009). Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome after anterior or posterior decompression. Journal of Neurosurgery. Spine, 11(5), 521-8. https://doi.org/10.3171/2009.2.SPINE08385
Uchida K, et al. Cervical Spondylotic Myelopathy Associated With Kyphosis or Sagittal Sigmoid Alignment: Outcome After Anterior or Posterior Decompression. J Neurosurg Spine. 2009;11(5):521-8. PubMed PMID: 19929353.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome after anterior or posterior decompression. AU - Uchida,Kenzo, AU - Nakajima,Hideaki, AU - Sato,Ryuichiro, AU - Yayama,Takafumi, AU - Mwaka,Erisa S, AU - Kobayashi,Shigeru, AU - Baba,Hisatoshi, PY - 2009/11/26/entrez PY - 2009/11/26/pubmed PY - 2009/12/31/medline SP - 521 EP - 8 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 11 IS - 5 N2 - OBJECT: The effects of sagittal kyphotic deformities or mechanical stress on the development of cervical spondylotic myelopathy, or the reduction and fusion of kyphotic sagittal alignment have not been consistently documented. The aim in this study was to determine the effects of kyphotic sagittal alignment of the cervical spine in terms of neurological morbidity and outcome after 2 types of surgical intervention. METHODS: The authors retrospectively reviewed the records of 476 patients who underwent cervical spine surgeries for spondylotic myelopathy between 1993 and 2006 at their university medical center. Among these were identified 43 patients-30 men and 13 women, with a mean age of 58.8 years-who had cervical kyphosis exceeding 10 degrees on preoperative sagittal lateral radiographs obtained in the neutral position, and their cases were analyzed in this study. Anterior decompression with interbody fusion was conducted in 28 patients, and en bloc open-door C3-7 laminoplasty in 15 patients. Both pre- and postoperative neurological, radiographic, and MR imaging findings were assessed in both surgical groups. RESULTS: The mean preoperative kyphotic angle in all 43 patients was 15.9 +/- 5.9 degrees in the neutral position. Segmental instability was noted in 26 patients (61%) and reversed dynamic spinal canal stenosis at the level above the local kyphosis in 22 (51%). Preoperative T2-weighted MR images showed high-intensity signal within the cord at and around the level of maximal compression or segmental instability in 28 patients (65%). The mean kyphotic angle in both the neutral and flexion positions was significantly smaller at 4-6 weeks after surgery in the anterior spondylectomy group than in the laminoplasty group (p < 0.001). Furthermore, the angle in the neutral position was significantly smaller on follow-up in the anterior spondylectomy group than in the laminoplasty group (p = 0.034). The transverse area of the spinal cord was significantly larger in the anterior spondylectomy group than in the laminoplasty group on follow-up (p = 0.037). Preoperative neurological scores (assessed using the Japanese Orthopaedic Association scale) and improvement on follow-up > or = 2 years after treatment (average 3.3 years) were not significantly different between the 2 groups; however, there was a significant difference in Japanese Orthopaedic Association score at 4-6 weeks postoperatively (p = 0.047). CONCLUSIONS: Kyphotic deformity and mechanical stress in the cervical spine may play an important role in neurological dysfunction. In a select group of patients with kyphotic deformity > or = 10 degrees , adequate correction of local sagittal alignment may help to maximize the chance of neurological improvement. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/19929353/Cervical_spondylotic_myelopathy_associated_with_kyphosis_or_sagittal_sigmoid_alignment:_outcome_after_anterior_or_posterior_decompression_ L2 - https://thejns.org/doi/10.3171/2009.2.SPINE08385 DB - PRIME DP - Unbound Medicine ER -