Outcome of decompression, correction and fusion for cervical spondylotic myelopathy with kyphotic deformity

M. Anowarul Islam; Asim Kumar Saha; Zafri Ahmed Fahim; Afia Ibnat Islam; Sanjida Aziz; Pinto Chandra Das

doi:10.18203/2320-6012.ijrms20253932

Authors

M. Anowarul Islam Department of Orthopedic Surgery, Bangladesh Medical University (BMU), Dhaka, Bangladesh
Asim Kumar Saha Department of Orthopedic Surgery, Bangladesh Medical University (BMU), Dhaka, Bangladesh
Zafri Ahmed Fahim Department of Orthopedic Surgery, Bangladesh Medical University (BMU), Dhaka, Bangladesh
Afia Ibnat Islam Department of Spine Surgery, Holy Family and Red Crescent Medical College and Hospital, Dhaka, Bangladesh
Sanjida Aziz Department of Critical Care Medicine, Bangladesh Medical University (BMU), Dhaka, Bangladesh
Pinto Chandra Das Department of Orthopedic Surgery, Bangladesh Medical University (BMU), Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20253932

Keywords:

Cervical spondylotic myelopathy, Kyphotic deformity, Laminectomy, Lateral mass fixation, Posterior decompression

Abstract

Background: Cervical spondylotic myelopathy (CSM) with kyphotic deformity is a common degenerative spinal disorder that leads to progressive spinal cord compression and neurological deterioration. Objectives were to evaluate the outcome of decompression by laminectomy with correction by lateral mass fixation and fusion for CSM with kyphotic deformity.

Methods: Assessments were done pre-operatively and postoperatively at 1-, 2-, 3-, and 6-months using visual analogue score (VAS), modified Japanese orthopedic association (mJOA), Odom criteria, Nurick’s grading, and cervical curvature index. Data were analyzed using standard statistical methods via the statistical package for social sciences (SPSS) version 25 (IBM®, Armonk, USA). A p<0.05 was considered statistically significant.

Results: The mean VAS score significantly improved from 6.27±1.75 to 0.73±0.59 at 6 months. The mean mJOA score increased from 11.27±0.80 preoperatively to 16.53±0.74 at the final follow-up, indicating substantial neurological improvement. According to the modified Odom criteria, 33.3% of patients had excellent outcomes, 60.0% had good outcomes, and 6.7% had fair outcomes. Functional status measured by Nurick’s grading improved significantly, with 93.3% of patients in grade III preoperatively and 100% improving to either grade 0 or I by 6 months (p<0.001). The cervical curvature index showed marked radiological correction, improving from -8.24±2.59 preoperatively to 21.94±1.35 postoperatively (p<0.001).

Conclusions: Posterior decompression by laminectomy with lateral mass fixation and fusion is an effective and safe surgical technique for managing CSM with kyphotic deformity. It significantly improves neurological function, pain status, and cervical alignment.

Metrics

Metrics Loading ...

References

Singh DK, Kumar V, Yadav K, Mohammad K, Sharma PK. Comparative outcome analysis of lateral mass fixation and trans-facet fixation with posterior decompression in the management of cervical spondylotic myelopathy: An institutional experience. J Craniovert Junct Spine. 2022;13(3):357-63. DOI: https://doi.org/10.4103/jcvjs.jcvjs_51_22

Adnan M, Khan MJ, Rehman AUR, Shams S, Zahid H, Mumtaz S. Comparison of Laminoplasty with Laminectomy and Fusion in the management of Multilevel Cervical Spondylotic Myelopathy. Pak J Med Health Sci. 2020;14(1):5-8.

Guan L, Hai Y, Yang JC, Zhou LJ, Chen XL. Anterior cervical discectomy and fusion may be more effective than anterior cervical corpectomy and fusion for the treatment of cervical spondylotic myelopathy. BMC Musculosk Dis 2015;16(1):1-9. DOI: https://doi.org/10.1186/s12891-015-0490-9

Du W, Zhang P, Shen Y, Zhang Y, Ding W, Ren L. Enlarged laminectomy and lateral mass screw fixation for multilevel cervical degenerative myelopathy associated with kyphosis. Spine J. 2014;14(1):57-64. DOI: https://doi.org/10.1016/j.spinee.2013.06.017

Uchida K, Nakajima H, Sato R. Cervical Spondylotic Myelopathy Associated with Kyphosis or Sagittal Sigmoid Alignment: Outcome after Anterior or Posterior Decompression. J Neurosurg. 2009;11:521-8. DOI: https://doi.org/10.3171/2009.2.SPINE08385

Kawakami M, Tamaki T, Iwasaki H, Yoshida M, Ando M, Yamada H. A Comparative Study of Surgical Approaches for Cervical Compressive Myelopathy. Clin Orthopaed Rel Res. 2000;381:129-36. DOI: https://doi.org/10.1097/00003086-200012000-00016

Rhee JM, Basra S. Posterior Surgery for Cervical Myelopathy: Laminectomy, Laminectomy with Fusion, and Laminoplasty. Asian Spine J. 2008;2(2):114. DOI: https://doi.org/10.4184/asj.2008.2.2.114

Highsmith JM, Dhall SS, Haid RW, Rodts GE, Mummaneni PV. Treatment of cervical stenotic myelopathy: A cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion-Clinical article. J Neurosurg Spine. 2011;14(5):619-25. DOI: https://doi.org/10.3171/2011.1.SPINE10206

Chen Y, Guo Y, Chen D, Wang X, Lu X, Yuan W. Long-term outcome of laminectomy and instrumented fusion for cervical ossification of the posterior longitudinal ligament. Int Orthopaed. 2009;33(4):1075-80. DOI: https://doi.org/10.1007/s00264-008-0609-9

Arab AA, Eltantawy MH, Elawady MA. Lateral Mass Screw Fixation in Sub-Axial Cervical Spine Combined with Decompression Laminectomy in Multi-Level Cervical Spondylotic Myelopathy; Safety and Clinical Outcome. Zagazig University Med J. 2023;29(2):505-11.

Du W, Wang HX, Zhang JT, Wang F, Zhang X, Shen Y, et al. Cervical alignment and clinical outcome of anterior decompression with fusion vs. posterior decompression with fixation in kyphotic cervical spondylotic myelopathy. Front Neurosci. 2022;16:1029327. DOI: https://doi.org/10.3389/fnins.2022.1029327

Sarathy RP, Bansal S, Sekar A, Patnaik A, Sahu RN. An Observational Study Comparing Laminoplasty versus Lateral Mass Screw Fixation in Multilevel Cervical Compressive Myelopathy. J Spinal Surg. 2024;11(4):134-41. DOI: https://doi.org/10.4103/joss.joss_28_24

Ahsan MK, Islam SS, Joshi SR. Laminoplasty versus Laminectomy for Multilevel Cervical Spondylotic Myelopathy-A Prospective Study in a Tertiary Level Hospital. Int J Ortho Res and Tram. 2022;01:01.

Fang Z, Li Y, Huang Z, Luo G, Yang H, Cheng H, et al. Evaluation of enlarged laminectomy with lateral mass screw fixation in relieving nerve root symptoms and correcting kyphosis for cervical myelopathy and radiculopathy. Front Surg. 2023;10:1103804. DOI: https://doi.org/10.3389/fsurg.2023.1103804

Hussein M, Abdelrazek MA, Eladawy A. Decompressive Cervical Laminectomy and Lateral Mass Screw-Rod Fusion for Multisegmental Cervical Spondylotic Myelopathy with Flexible Sagittal Cervical Alignment. Adv Spine J. 2022;41(2):81-91. DOI: https://doi.org/10.57055/2314-8969.1261

Tracy JA, Bartleson BJ. Cervical spondylotic myelopathy. Neurologist. 2010;16(3):176-87. DOI: https://doi.org/10.1097/NRL.0b013e3181da3a29

Ahsan MK, Awwal MA, Khan SI, Zaman N, Haque MH, Zahangiri Z. Open-door Laminoplasty for Multilevel Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament (OPLL) using Titanium Reconstruction Miniplate and Screws. Mymensingh Med J. 2017;26(3):558-68.

Jain A, Rustagi T, Prasad G, Deore T, Bhojraj SY. Does Segmental Kyphosis Affect Surgical Outcome after a Posterior Decompressive Laminectomy in Multisegmental Cervical Spondylotic Myelopathy? Asian Spine J. 2017;11(1):24-30. DOI: https://doi.org/10.4184/asj.2017.11.1.24