Cervical spondylosis in patients presenting with "severe" myelopathy: Analysis of treatment by multisegmental spinal fixation - A case series.
Atlantoaxial dislocation
cervical spondylosis
decompressive laminectomy
osteophytes
spinal fixation
spinal instability
Journal
Journal of craniovertebral junction & spine
ISSN: 0974-8237
Titre abrégé: J Craniovertebr Junction Spine
Pays: India
ID NLM: 101536746
Informations de publication
Date de publication:
Historique:
entrez:
28
11
2019
pubmed:
28
11
2019
medline:
28
11
2019
Statut:
ppublish
Résumé
Surgical strategy of multisegmental spinal fixation that includes atlantoaxial joint for patients having cervical spondylosis-related symptoms of severe myelopathy is analyzed. Surgical outcome of patients presenting with "severe" symptoms of cervical myelopathy having multisegmental degenerative cervical spondylosis and treated by multisegmental spinal fixation is analyzed. Atlantoaxial joint was included in the fixation construct in majority of patients. No bone, soft tissue, osteophyte, or disc resection for decompression was done. Sixty-four patients having multisegmental cervical spondylosis who presented with symptoms of severe myelopathy were surgically treated during the period from March 2013 to December 2018. On the basis of the concept that instability is the primary cause of spinal degeneration, multisegmental spinal fixation was done in all patients. Atlantoaxial joint was included in the fixation construct in 48 patients. The levels of spinal fixation were determined on the basis of direct observation of facet joints and by manual manipulation and were guided by the presenting clinical features and radiological information. Clinical monitoring was done using Goel clinical grading, modified Japanese Orthopedic Association Score, and visual analog score parameters. Patient satisfaction index assessed the functional and symptomatic improvement. During the follow-up that ranged from 6 to 75 months, all patients improved in their clinical status. Fifty-five (85.9%) patients could walk independently or with mild support. Multisegmental spinal fixation that includes atlantoaxial joint in most patients forms a rational treatment strategy for patients of cervical spondylosis presenting with severe symptoms of myelopathy.
Sections du résumé
BACKGROUND
BACKGROUND
Surgical strategy of multisegmental spinal fixation that includes atlantoaxial joint for patients having cervical spondylosis-related symptoms of severe myelopathy is analyzed.
OBJECTIVE
OBJECTIVE
Surgical outcome of patients presenting with "severe" symptoms of cervical myelopathy having multisegmental degenerative cervical spondylosis and treated by multisegmental spinal fixation is analyzed. Atlantoaxial joint was included in the fixation construct in majority of patients. No bone, soft tissue, osteophyte, or disc resection for decompression was done.
MATERIALS AND METHODS
METHODS
Sixty-four patients having multisegmental cervical spondylosis who presented with symptoms of severe myelopathy were surgically treated during the period from March 2013 to December 2018. On the basis of the concept that instability is the primary cause of spinal degeneration, multisegmental spinal fixation was done in all patients. Atlantoaxial joint was included in the fixation construct in 48 patients. The levels of spinal fixation were determined on the basis of direct observation of facet joints and by manual manipulation and were guided by the presenting clinical features and radiological information. Clinical monitoring was done using Goel clinical grading, modified Japanese Orthopedic Association Score, and visual analog score parameters. Patient satisfaction index assessed the functional and symptomatic improvement.
RESULTS
RESULTS
During the follow-up that ranged from 6 to 75 months, all patients improved in their clinical status. Fifty-five (85.9%) patients could walk independently or with mild support.
CONCLUSIONS
CONCLUSIONS
Multisegmental spinal fixation that includes atlantoaxial joint in most patients forms a rational treatment strategy for patients of cervical spondylosis presenting with severe symptoms of myelopathy.
Identifiants
pubmed: 31772426
doi: 10.4103/jcvjs.JCVJS_82_19
pii: JCVJS-10-144
pmc: PMC6868535
doi:
Types de publication
Journal Article
Langues
eng
Pagination
144-151Informations de copyright
Copyright: © 2019 Journal of Craniovertebral Junction and Spine.
Déclaration de conflit d'intérêts
There are no conflicts of interest.
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