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Criteria for preferring anterior approach in surgical treatment of cervical spondylotic myeloradiculopathy

Year 2014, Volume: 39 Issue: 4, 669 - 678, 22.07.2014
https://doi.org/10.17826/cutf.08252

Abstract

Cervical spondylosis is a progressive, chronic and insidious degenerative disease, which origins from the cervical intervertebral disc and then diffuses to surrounding bony and soft tissues. If the spine and nerve roots are involved due to degenerative changes, this is called as cervical spondylotic myeloradiculopathy (CSMR) and it is the most frequent cause of myelopathy over age of 50. Cases with progressive character and functional neurological deficits and cases with a prolonged course refractory to conservative therapy shall be treated surgically. The aim of the surgical treatment is to relieve the pressure on the spinal cord and nerve roots, to preserve the proper anatomical alignment of the cervical vertebrae or to reestablish correct anatomical positioning if it is distorted and lastly to increase the life quality by relieving patients neurological signs and complaints. While achieving these goals, complications shall be avoided as much as possible. These goals can be accomplished by anterior or posterior surgical approaches to the cervical vertebrae. The style of the surgical approach can only be decided by a detailed evaluation of the patient"s clinical and radiological features. The utmost aim of the surgical procedure, which is to achieve sufficient neurological decompression and to preserve/establish proper cervical vertebral alignment, can be provided best by anterior approaches. In our current study, the criteria to prefer anterior approach in surgical treatment of CSMR will be reviewed.

References

  • Nadiri S. Servikal spondilotik miyelopatide cerrahi yaklaşımın seçimi. Türk Nöroşirurji Dergisi. 2000;10:137–43.
  • Erol F. Servikal spondilotik myelopatide klinik, tanı ve ayırıcı tanı. In: Servikal Dejeneratif Disk Hastalığı ve Üst Ekstremite Tuzak Nöropatileri, (Eds Koç RK): Ankara, Buluş Tasarım ve Matb. 2009;234-44.
  • Zileli M. Servikal Spondilotik Myelopatide Lamin ektomi. In: Servikal Dejeneratif Disk Hastalığı ve Üst Ekstremite Tuzak Nöropatileri, (Eds Koç RK): Ankara, Buluş Tasarım ve Matb., 2009;285-96..
  • Çaylı SR. Servikal Spondilotik Myelopatide Anterior Dekompresyon ve Füzyon. In: Servikal Dejeneratif Disk Hast alığı ve Üst Ekstremite Tuzak Nöropatileri, (Eds Koç RK): Ankara, Buluş Tasarım ve Matb., 2009;262-9.
  • Alvin MD, Lubelski D, Benzel EC, Mroz T. Ventral fusion versus dorsal fusion: determining the optimal treatment for cervical spondylotic myelopathy. Neurosurg Focus. 2013;35:E5.
  • König SA, Spetzger U. Surgical management of cervical spondylotic myelopathy – indications for anterior, posterior or combined procedures for decompression and stabilisation. Acta Neurochir. 2014;156:253–8.
  • Dalbayrak S. Posterior Longitudinal Ligaman Ossifikasyonu. In: Servikal Dejeneratif Disk Hastalığı ve Üst Ekstremite Tuzak Nöropatileri, (Eds Koç RK):Ankara, Buluş Tasarım ve Matb., 2009;245-61.
  • Janssen M, Bono C, Sasso R, Dekutoski M, Gokaslan ZL. Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy. Outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients. Spine. 2013;38:2247-52.
  • Fehlings MG, Barry S, Kopjar B, Yoon ST, Arnold P, Massicotte EM, Vaccaro A, Brodke DS, Shaffrey C, Smith JS, Woodard E, Banco RJ, Chapman J, Liu X, Min S, Zhang H, Zhou Z, Wang H, Jin A. Anterior corpectomy versus posterior laminoplasty for multilevel cervical myelopathy: A systematic review and meta-analysis. Eur Spine J. 2014;23:362–72.
  • Vaccaro AR, Fisher CG, Whang PG, Patel AA, Prasad SK, Angevine PD, Mulpari K, Thomas KC. Evidence-based recommendations for spine surgery. Spine.2010;35:178-88.
  • Traynelis VC, Arnold PM, Fourney DR, Bransford RJ, Fischer DJ, Skelly AC. Alternative procedures for the treatment of cervical spondylotic myelopathy: arthroplasty, oblique corpectomy, skip laminectomy: evaluation of comparative effectiveness and safety. Spine 2013;38: 210-31.
  • Pereira EAC, Chari A, Hempenstall J, Leach J, Chandran H, Cadoux-Hudson T. Anterior cervical discectomy plus intervertebral polyetheretherketone cage fusion over three and four levels without plating is safe and effective long-term. Journal of Clinical Neuroscience. 2013;20:1250–5.
  • Yu S, Li F, Yan N, Yuan C, He S, Hou T. Anterior Fusion technique for multilevel cervical spondylotic myelopathy: A Retrospective analysis of surgical outcome of patients with different number of levels fused. Plos One. 2014;9:e91329.
  • Li Z, Guo Z, Hou S, Zhao Y, Zhong H, Yu S, Hou T. Segmental anterior cervical corpectomy and fusion with preservation of middle vertebrae in the surgical management of 4-level cervical spondylotic myelopathy. Eur Spine J 2014;586-014.
  • Shamji MF, Massicotte EM, Traynelis VC, Norvell DC, Hermsmeyer JT, Fehlings MG. Comparison of anterior surgical options for the treatment of multilevel cervical spondylotic myelopathy: a systematic review. Spine.2013;38:195-209.
  • George B, Gauthier N, Lot G. Multisegmental cervical spondylotic myelopathy and radiculopathy treated by multilevel oblique corpectomies without fusion. Neurosurgery. 1999;44:81-90.
  • Chacko AG, Turel MK, Sarkar S, Prabhu K, Daniel RT. Clinical and radiological outcomes in 153 patients undergoing oblique corpectomy for cervical spondylotic myelopathy. Br J Neurosurg. 2014;28:49
  • Koç RK. Servikal Spondilotik Myelopatide Oblik Korpektomi. In: Servikal Dejeneratif Disk Hastalığı ve Üst Ekstremite Tuzak Nöropatileri, (Eds Koç RK): Ankara, Buluş Tasarım ve Matb., 2009;278-84.. Ozer AF, Oktenoğlu BT, Sarioğlu AC. A new surgical technique: open-window corpectomy in the treatment of ossification of the posterior longitudinal ligament and advanced cervical spondylosis: technical note.
  • Neurosurgery. 1999;45:1481-5 discussion 1485-6.
  • Ozer AF, Oktenoglu T, Cosar M, Sasani M, Sarioglu AC. Long-term follow-up after open-window corpectomy in patients with advanced cervical spondylosis and/or ossification of the posterior longitudinal ligament. J Spinal Disord Tech. 2009;22:14-20.
  • Yazışma Adresi / Address for Correspondence: Dr.Kerem Mazhar Özsoy Çukurova ÜniversitesiTıp Fakültesi Beyin ve Sinir Cerrahisi Anabilim Dalı ADANA E-mail: mazhartac95@hotmail.com G eliş tarihi/Received on : 02.05.2014
  • Kabul tarihi/Accepted on: 30.05.2014

Servikal Spondilotik Myeloradikülopati"nin Cerrahi Tedavisinde Anterior Yaklaşımın Seçilme Nedenleri

Year 2014, Volume: 39 Issue: 4, 669 - 678, 22.07.2014
https://doi.org/10.17826/cutf.08252

Abstract

Servikal spondilosis; servikal intervertebral diskte başlayıp, daha sonra çevre kemik ve yumuşak dokularda devam eden, ilerleyici, süreğen ve sinsi bir dejeneratif hastalıktır. Bu dejeneratif değişikliklere bağlı omurilik ve sinir kökü tutulumu olur ise servikal spondilotik myeloradikülopati (SSMR) olarak isimlendirilir ve 50 yaş üzerinde myelopatinin en sık sebebidir. İlerleyici ve fonksiyonel nörolojik defisite sahip olan olgular ile uzun süreli tanı almış ve konservatif tedaviye yanıt vermeyen yakınmaları bulunan olguların cerrahi olarak tedavi edilmeleri gerekir. Cerrahi tedavinin amacı omurilik ve sinir kökleri üzerindeki basıyı ortadan kaldırmak, servikal omurganın dizilimini korumak veya bozulmuş ise bunu yeniden oluşturmak, hastanın nörolojik bulgularını ve yakınmalarını ortadan kaldırarak yaşam kalitesini artırmak ve bunları yaparken de mümkün olduğu kadar komplikasyona neden olmamaktır. Bu hedefler servikal omurgaya anterior veya posterior cerrahi yaklaşım yolları ile sağlanabilir. Cerrahi yaklaşımın şekline ancak hastanın klinik ve radyolojik olarak çok ayrıntılı değerlendirilmesi ile karar verilebilir. Cerrahi yaklaşımın en büyük amacı olan yeterli nöral dekompresyon ve servikal dizilimin korunması/sağlanması en iyi anterior yaklaşımlar ile sağlanabilir. Bu çalışmamızda SSMR"nin cerrahi tedavisinde anterior yaklaşımın tercih edilme sebepleri özetlenecektir.

References

  • Nadiri S. Servikal spondilotik miyelopatide cerrahi yaklaşımın seçimi. Türk Nöroşirurji Dergisi. 2000;10:137–43.
  • Erol F. Servikal spondilotik myelopatide klinik, tanı ve ayırıcı tanı. In: Servikal Dejeneratif Disk Hastalığı ve Üst Ekstremite Tuzak Nöropatileri, (Eds Koç RK): Ankara, Buluş Tasarım ve Matb. 2009;234-44.
  • Zileli M. Servikal Spondilotik Myelopatide Lamin ektomi. In: Servikal Dejeneratif Disk Hastalığı ve Üst Ekstremite Tuzak Nöropatileri, (Eds Koç RK): Ankara, Buluş Tasarım ve Matb., 2009;285-96..
  • Çaylı SR. Servikal Spondilotik Myelopatide Anterior Dekompresyon ve Füzyon. In: Servikal Dejeneratif Disk Hast alığı ve Üst Ekstremite Tuzak Nöropatileri, (Eds Koç RK): Ankara, Buluş Tasarım ve Matb., 2009;262-9.
  • Alvin MD, Lubelski D, Benzel EC, Mroz T. Ventral fusion versus dorsal fusion: determining the optimal treatment for cervical spondylotic myelopathy. Neurosurg Focus. 2013;35:E5.
  • König SA, Spetzger U. Surgical management of cervical spondylotic myelopathy – indications for anterior, posterior or combined procedures for decompression and stabilisation. Acta Neurochir. 2014;156:253–8.
  • Dalbayrak S. Posterior Longitudinal Ligaman Ossifikasyonu. In: Servikal Dejeneratif Disk Hastalığı ve Üst Ekstremite Tuzak Nöropatileri, (Eds Koç RK):Ankara, Buluş Tasarım ve Matb., 2009;245-61.
  • Janssen M, Bono C, Sasso R, Dekutoski M, Gokaslan ZL. Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy. Outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients. Spine. 2013;38:2247-52.
  • Fehlings MG, Barry S, Kopjar B, Yoon ST, Arnold P, Massicotte EM, Vaccaro A, Brodke DS, Shaffrey C, Smith JS, Woodard E, Banco RJ, Chapman J, Liu X, Min S, Zhang H, Zhou Z, Wang H, Jin A. Anterior corpectomy versus posterior laminoplasty for multilevel cervical myelopathy: A systematic review and meta-analysis. Eur Spine J. 2014;23:362–72.
  • Vaccaro AR, Fisher CG, Whang PG, Patel AA, Prasad SK, Angevine PD, Mulpari K, Thomas KC. Evidence-based recommendations for spine surgery. Spine.2010;35:178-88.
  • Traynelis VC, Arnold PM, Fourney DR, Bransford RJ, Fischer DJ, Skelly AC. Alternative procedures for the treatment of cervical spondylotic myelopathy: arthroplasty, oblique corpectomy, skip laminectomy: evaluation of comparative effectiveness and safety. Spine 2013;38: 210-31.
  • Pereira EAC, Chari A, Hempenstall J, Leach J, Chandran H, Cadoux-Hudson T. Anterior cervical discectomy plus intervertebral polyetheretherketone cage fusion over three and four levels without plating is safe and effective long-term. Journal of Clinical Neuroscience. 2013;20:1250–5.
  • Yu S, Li F, Yan N, Yuan C, He S, Hou T. Anterior Fusion technique for multilevel cervical spondylotic myelopathy: A Retrospective analysis of surgical outcome of patients with different number of levels fused. Plos One. 2014;9:e91329.
  • Li Z, Guo Z, Hou S, Zhao Y, Zhong H, Yu S, Hou T. Segmental anterior cervical corpectomy and fusion with preservation of middle vertebrae in the surgical management of 4-level cervical spondylotic myelopathy. Eur Spine J 2014;586-014.
  • Shamji MF, Massicotte EM, Traynelis VC, Norvell DC, Hermsmeyer JT, Fehlings MG. Comparison of anterior surgical options for the treatment of multilevel cervical spondylotic myelopathy: a systematic review. Spine.2013;38:195-209.
  • George B, Gauthier N, Lot G. Multisegmental cervical spondylotic myelopathy and radiculopathy treated by multilevel oblique corpectomies without fusion. Neurosurgery. 1999;44:81-90.
  • Chacko AG, Turel MK, Sarkar S, Prabhu K, Daniel RT. Clinical and radiological outcomes in 153 patients undergoing oblique corpectomy for cervical spondylotic myelopathy. Br J Neurosurg. 2014;28:49
  • Koç RK. Servikal Spondilotik Myelopatide Oblik Korpektomi. In: Servikal Dejeneratif Disk Hastalığı ve Üst Ekstremite Tuzak Nöropatileri, (Eds Koç RK): Ankara, Buluş Tasarım ve Matb., 2009;278-84.. Ozer AF, Oktenoğlu BT, Sarioğlu AC. A new surgical technique: open-window corpectomy in the treatment of ossification of the posterior longitudinal ligament and advanced cervical spondylosis: technical note.
  • Neurosurgery. 1999;45:1481-5 discussion 1485-6.
  • Ozer AF, Oktenoglu T, Cosar M, Sasani M, Sarioglu AC. Long-term follow-up after open-window corpectomy in patients with advanced cervical spondylosis and/or ossification of the posterior longitudinal ligament. J Spinal Disord Tech. 2009;22:14-20.
  • Yazışma Adresi / Address for Correspondence: Dr.Kerem Mazhar Özsoy Çukurova ÜniversitesiTıp Fakültesi Beyin ve Sinir Cerrahisi Anabilim Dalı ADANA E-mail: mazhartac95@hotmail.com G eliş tarihi/Received on : 02.05.2014
  • Kabul tarihi/Accepted on: 30.05.2014
There are 22 citations in total.

Details

Primary Language Turkish
Journal Section Review
Authors

Yurdal Gezercan This is me

Kerem Mazhar Özsoy This is me

Nuri Eralp Çetinalp This is me

Kıvanç Olguner This is me

Kadir Oktay

Tahsin Erman This is me

Publication Date July 22, 2014
Published in Issue Year 2014 Volume: 39 Issue: 4

Cite

MLA Gezercan, Yurdal et al. “Servikal Spondilotik Myeloradikülopati"nin Cerrahi Tedavisinde Anterior Yaklaşımın Seçilme Nedenleri”. Cukurova Medical Journal, vol. 39, no. 4, 2014, pp. 669-78, doi:10.17826/cutf.08252.