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New technique for surgical management of vertebrogenic cervical myelopathy
Spine - Cervical Disc Herniation andSpondylosis
Tuesday, 8 July 1997
5169
patients who were operated upon for cervical spondylosis using anterior (mod- The graft allowed to preserve sull icient inle rbody space that prevented ified Trans-Unco-Discal) approach over the past 10 years in our hospital. The kyphosis and fusion in the operated spinal segment. Autodermic metaplasy in operative findings were analyzed and also the correlation between preopera- fibrous tissue allowed motions of the operated spinal segment up to 45% of its tive clinicoradiological factors and postoperat ive clinical results were statistically primary volume. assessed . be recommended for a wider The authors conclude that the technique may use. The major results were as follows: (1) Clinical results were graded excellent in 63%, good in 30%, fair in 6%, and poor in 1%. Improvement rate was 88% in Japanese Orthopaedic Association's scale. P-4-44SI Surgical treatment of cervical myeloradiculopathy (2) Clinical results in radiculopathy was statistically significant better than A.V. Kedrov, A.M. Kyselev, I.A. Katchkov. Moscow Regional ResearchClinical 0.05). As to the number of osthose in myelopathy and radiculomyelopath y<(p tnstitute, Moscow y1es was statistically teophytes, clinical results in patients with less than 3 osteoph < 0.05). significant better than in those with more than 4 osteophy1es(p Surgical treatment of cervical myeloradiculopathywas performed in 25 cases . (3) As to age, duration of symptoms , disc space narrowing, developmental Decompression01 spinal cord, its radices and radiculomedullar arteries was canal stenosis, number of operated levels and material of bone graft, clinicalperformed by removal of intervertebral discs, sometimes vertebral bodies and results were not significantly different. distraction. A special vertebral distractor was used. With this, it was possible (4) Improvement rates in myelopathy and radiculomyelopathy were 50% in to perform local distraction (on the desired level only) of the adjacent vertebral Nurick's grade and 85% in Kadoya's grade. bodies of5-12 mm. After this, a grid of special form was implanted. Marked (5) The rates of complications were 16% and most complications were related widening of intervertebral foramens could be achieved besides decomp ression to bone graft. There was no significant correlation between the complicationsof the spinal canal. We treated 16 patients (64%) with medullary form, 7 (28%) and clinical results in all cases. with radiculomedullary form and 2 (8%) with radicular form of the disease. The According to the 2 results, the modified Trans-Unco-Discal approach couldherniated discs were located at the level C3-4 in 3 cases, C4-5 in C~ 10, in 17, C6-7 in 6, CrTh, in 1 case. The neurological improvement was marked on the be recommended for the surgical treatmen t of the cervical spondylosis. ist-znd day in 14 cases (56%),1-3 weeks in 10 cases (40%). There was no neurological improvement in 1 case (4%) .
I
IP-4-446 ! Stabilization of the spinal segment by disc fenestration in cervical osteochondrosis
T. Chizhikova, N. Kryukova , E. Parfyonova. NeurosurgicalClinic,
Novokuznetsk;Russia
IP-4-449 l Clinical research of reoperation for cervical spondylotic myelopathy
Hong-Yun Huang, Zong-Huiliu, Guo-Sheng Duan, Tao Feng, Xing Yu, One of the causes of reflexocompress ive syndromes of cervical osteochondrosis Ji-Xiang Du.Departmentof Neurosurgery, Naval General Hospital, Beijing, PR is instability of the spinal segment resulting from degenerative and dystrophic China is attributed to changes of the intervertebral disc . Natural recovery of instability fibrosis in the disc that leads to sufficient stability of the spinal segment andIntroductJon:Although the results of surgery for cervical spondylotic myelopa disappearance of clinical signs of osteochondros is. Therefore, fibrosis seemsthy (CSM) were much better than before, in recent years a few patients still had poor recovery after operation. Some of them needed to be reoperated . The to be the best of orthopaedic compensations. In our neurosurgical clinic fenestration of the disc was pertormed in 49 pa-purpose of this article is to study the value of reoperation. Methods: Eighteen patients with CSM had poor results after operation. tients with cervicalosteochondrosisand instability of the spinal segment. Age .80/0) instability was observed in There were 12 men and 6 women; their ages ranged from 38 to 77 years. The varied from 30 to 45 years . In 45 cases (87 initial procedures had been performed by anterior interbody fusion in 5 patients, several spinal segments mainly in midcervical segments3-4 (C and C 4-5) andlor laminoplasty 39 (79.6%) patients. In 37 (75.5%) patients pathological mobility was caused by subtotal vertebrectomy in 2, by posterior laminectomy by impairment of fixative ability of the disc and appeared as the posterior, orin 9 and by subtotal vertebrectomy and laminoplasty in 2. All patients had anterior compressive pathology in imaging examinations inclUding X-ray films, t2 (24.5%) patients showed rarely anterior, dislocation of the vertebral bodies. extension subluxat ion. Functional spondylography was the main method for di-myelography, postmyelographic CT and MRI. The pathology ranged in extent segment!fin7 agnosis. Clinical signs were reflex and pain syndromes and reflexocompressivefromC3-4 to C7-T1, with two segments in 8 patients, with three and with four segments in 3. The patients were treated by means of improved syndromes of the cervical osteochondrosiswhich depended upon static and dynamic loads on the cervical spine. Dynamic compression of the spinal cord insubtotal vertebrectomy so the spinal cord could be sufficiently decompressed . The median duration of follow up was 16 months (range 6 months to 2 years). narrow spinal canal (less than 14 mm) was present in 6 (12.2%) patients. Fenestration of the disc was pertormed by the right anterior-lateral approach . Results:Of the 18 patients, 17 (94.4%) patients showed improvem ent and An aperture was cut out in the anterior area of the fibrotic ring up to pulp nucleus.13 (72.2%) showed remarkable improvement. Neurological signs did not imThe latter was not removed. Immobilization was pertormed by Schanz' cervical prove in 1 patient. No patient was worse from the operative procedure. : The causes of operative failure for the pacollar. Fenestration is a quite simple intervention from the technical point of Discussionand Conclusions view. None of the patients showed any complications. 45 (91.8%) of them had tients with CSM were(1) that the posterior decompression was an incorrect procedure in the patients with kyphotic deformity and (2) that the spinal cord positive outcomes. Thus , fenestration led both to a decrease of disc height and elimination ofwas not sufficiently decompressed by the anterior decompress ion. Therefore the patients with poor results after operation should be analysed in time. The clinical signs of instability due to disc fibrosis. Movement volume in the cervical If the spinal decompressive operation should be performed as soon as possible. spine was not disturbed after the operation. cord is still compressed . Satisfactory results will be obtained if the spinal cord is sufficiently decompressed, provided that it has not sustained seriou s organic damage. P-4-447 I Newtechnique for surgical management of
I
vertebrogenic cervical myelopathy
V. Karpenko , G. Karpenko, J. Churlyaev, A. Epifantsev. NeurosurgicalClinic,
Novokuznetsk, Russia
I P-4-450 I Dermatomal somatosensory evoked potentials in
compressive versus non-compressive myelopathies
The optimal technique of surgica i management of verteb rogenic cervicai Hristo Kovatchev, Rossen Roussell , IIiya Valkov. Department of Neurosurgery, myelopathy remains controversial. The main surgical goals are decompresMedicalUniversity.Pleven, Bulgaria sion of neurovascularformations, elimination of focus of pathological activity, restoration of topographic and anatomic interrelations prevention of degenera-Somatosensory evoked potentials after dermatomal stimu lation (DSEP) were tive and dystrophic lesions of spinal segments adjacent to the operated ones.investigated in 30 patients with cervical spondylot ic myelopathy (mean age However, there is practically no technique nowadays which complies with the 58.6,39-78), in 13 persons with compress ion from other causes (mean age modem principles of reconstructive surge ry. 38.5. 14-68) and in 12 subjects with subacute or chronic spinal syndromes , A new technique of surgical management of vertebrogenic cervical myelopa- that proved to be demyelinating or inflammatory in ethiology (mean age 32.6, thy has been used in theNovokuznetskNeurosurg ical Clinic since 1984. Sixty- 18-70). The Diagnoses were finalized after clinical observation , imaging evidence (MRI and/or CT-myelography) , CSF findings and operative verif ication eight patients of various ages underwent surgery. The routinediscectomywas modified . Its volume was extended up to the in the compressive cases. DSEP changes were classified as monoradicular, ional and diffuse. Altogether sensitivity , removal ofosteocartilaginousvegetations compressing ventral spinal cord and polyradicular, circumscribedtransseC1 78.7-95.9% at its radicles via interbody space. The anterior foraminotomy was pertormed inreached 82.3% in spondylotic myelopathy (confidence interval compression of radicles of the spinal nerves. Microsurgical technique allowed aP 0.95) with polyradicular and circumscribed types dominating. In other compressions the transverse lesion type was most frequent, with a sensitiv ity of completedecompressionand radiculomeningolysis . The removed intervertebral 92.4% (Cl 78.0-100.0% at P 0.95). In non-compressivespinal syndromes disc was replaced with autodermic graft of necessary thickness.
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Tuesday, 8 July 1997
5169
patients who were operated upon for cervical spondylosis using anterior (mod- The graft allowed to preserve sull icient inle rbody space that prevented ified Trans-Unco-Discal) approach over the past 10 years in our hospital. The kyphosis and fusion in the operated spinal segment. Autodermic metaplasy in operative findings were analyzed and also the correlation between preopera- fibrous tissue allowed motions of the operated spinal segment up to 45% of its tive clinicoradiological factors and postoperat ive clinical results were statistically primary volume. assessed . be recommended for a wider The authors conclude that the technique may use. The major results were as follows: (1) Clinical results were graded excellent in 63%, good in 30%, fair in 6%, and poor in 1%. Improvement rate was 88% in Japanese Orthopaedic Association's scale. P-4-44SI Surgical treatment of cervical myeloradiculopathy (2) Clinical results in radiculopathy was statistically significant better than A.V. Kedrov, A.M. Kyselev, I.A. Katchkov. Moscow Regional ResearchClinical 0.05). As to the number of osthose in myelopathy and radiculomyelopath y<(p tnstitute, Moscow y1es was statistically teophytes, clinical results in patients with less than 3 osteoph < 0.05). significant better than in those with more than 4 osteophy1es(p Surgical treatment of cervical myeloradiculopathywas performed in 25 cases . (3) As to age, duration of symptoms , disc space narrowing, developmental Decompression01 spinal cord, its radices and radiculomedullar arteries was canal stenosis, number of operated levels and material of bone graft, clinicalperformed by removal of intervertebral discs, sometimes vertebral bodies and results were not significantly different. distraction. A special vertebral distractor was used. With this, it was possible (4) Improvement rates in myelopathy and radiculomyelopathy were 50% in to perform local distraction (on the desired level only) of the adjacent vertebral Nurick's grade and 85% in Kadoya's grade. bodies of5-12 mm. After this, a grid of special form was implanted. Marked (5) The rates of complications were 16% and most complications were related widening of intervertebral foramens could be achieved besides decomp ression to bone graft. There was no significant correlation between the complicationsof the spinal canal. We treated 16 patients (64%) with medullary form, 7 (28%) and clinical results in all cases. with radiculomedullary form and 2 (8%) with radicular form of the disease. The According to the 2 results, the modified Trans-Unco-Discal approach couldherniated discs were located at the level C3-4 in 3 cases, C4-5 in C~ 10, in 17, C6-7 in 6, CrTh, in 1 case. The neurological improvement was marked on the be recommended for the surgical treatmen t of the cervical spondylosis. ist-znd day in 14 cases (56%),1-3 weeks in 10 cases (40%). There was no neurological improvement in 1 case (4%) .
I
IP-4-446 ! Stabilization of the spinal segment by disc fenestration in cervical osteochondrosis
T. Chizhikova, N. Kryukova , E. Parfyonova. NeurosurgicalClinic,
Novokuznetsk;Russia
IP-4-449 l Clinical research of reoperation for cervical spondylotic myelopathy
Hong-Yun Huang, Zong-Huiliu, Guo-Sheng Duan, Tao Feng, Xing Yu, One of the causes of reflexocompress ive syndromes of cervical osteochondrosis Ji-Xiang Du.Departmentof Neurosurgery, Naval General Hospital, Beijing, PR is instability of the spinal segment resulting from degenerative and dystrophic China is attributed to changes of the intervertebral disc . Natural recovery of instability fibrosis in the disc that leads to sufficient stability of the spinal segment andIntroductJon:Although the results of surgery for cervical spondylotic myelopa disappearance of clinical signs of osteochondros is. Therefore, fibrosis seemsthy (CSM) were much better than before, in recent years a few patients still had poor recovery after operation. Some of them needed to be reoperated . The to be the best of orthopaedic compensations. In our neurosurgical clinic fenestration of the disc was pertormed in 49 pa-purpose of this article is to study the value of reoperation. Methods: Eighteen patients with CSM had poor results after operation. tients with cervicalosteochondrosisand instability of the spinal segment. Age .80/0) instability was observed in There were 12 men and 6 women; their ages ranged from 38 to 77 years. The varied from 30 to 45 years . In 45 cases (87 initial procedures had been performed by anterior interbody fusion in 5 patients, several spinal segments mainly in midcervical segments3-4 (C and C 4-5) andlor laminoplasty 39 (79.6%) patients. In 37 (75.5%) patients pathological mobility was caused by subtotal vertebrectomy in 2, by posterior laminectomy by impairment of fixative ability of the disc and appeared as the posterior, orin 9 and by subtotal vertebrectomy and laminoplasty in 2. All patients had anterior compressive pathology in imaging examinations inclUding X-ray films, t2 (24.5%) patients showed rarely anterior, dislocation of the vertebral bodies. extension subluxat ion. Functional spondylography was the main method for di-myelography, postmyelographic CT and MRI. The pathology ranged in extent segment!fin7 agnosis. Clinical signs were reflex and pain syndromes and reflexocompressivefromC3-4 to C7-T1, with two segments in 8 patients, with three and with four segments in 3. The patients were treated by means of improved syndromes of the cervical osteochondrosiswhich depended upon static and dynamic loads on the cervical spine. Dynamic compression of the spinal cord insubtotal vertebrectomy so the spinal cord could be sufficiently decompressed . The median duration of follow up was 16 months (range 6 months to 2 years). narrow spinal canal (less than 14 mm) was present in 6 (12.2%) patients. Fenestration of the disc was pertormed by the right anterior-lateral approach . Results:Of the 18 patients, 17 (94.4%) patients showed improvem ent and An aperture was cut out in the anterior area of the fibrotic ring up to pulp nucleus.13 (72.2%) showed remarkable improvement. Neurological signs did not imThe latter was not removed. Immobilization was pertormed by Schanz' cervical prove in 1 patient. No patient was worse from the operative procedure. : The causes of operative failure for the pacollar. Fenestration is a quite simple intervention from the technical point of Discussionand Conclusions view. None of the patients showed any complications. 45 (91.8%) of them had tients with CSM were(1) that the posterior decompression was an incorrect procedure in the patients with kyphotic deformity and (2) that the spinal cord positive outcomes. Thus , fenestration led both to a decrease of disc height and elimination ofwas not sufficiently decompressed by the anterior decompress ion. Therefore the patients with poor results after operation should be analysed in time. The clinical signs of instability due to disc fibrosis. Movement volume in the cervical If the spinal decompressive operation should be performed as soon as possible. spine was not disturbed after the operation. cord is still compressed . Satisfactory results will be obtained if the spinal cord is sufficiently decompressed, provided that it has not sustained seriou s organic damage. P-4-447 I Newtechnique for surgical management of
I
vertebrogenic cervical myelopathy
V. Karpenko , G. Karpenko, J. Churlyaev, A. Epifantsev. NeurosurgicalClinic,
Novokuznetsk, Russia
I P-4-450 I Dermatomal somatosensory evoked potentials in
compressive versus non-compressive myelopathies
The optimal technique of surgica i management of verteb rogenic cervicai Hristo Kovatchev, Rossen Roussell , IIiya Valkov. Department of Neurosurgery, myelopathy remains controversial. The main surgical goals are decompresMedicalUniversity.Pleven, Bulgaria sion of neurovascularformations, elimination of focus of pathological activity, restoration of topographic and anatomic interrelations prevention of degenera-Somatosensory evoked potentials after dermatomal stimu lation (DSEP) were tive and dystrophic lesions of spinal segments adjacent to the operated ones.investigated in 30 patients with cervical spondylot ic myelopathy (mean age However, there is practically no technique nowadays which complies with the 58.6,39-78), in 13 persons with compress ion from other causes (mean age modem principles of reconstructive surge ry. 38.5. 14-68) and in 12 subjects with subacute or chronic spinal syndromes , A new technique of surgical management of vertebrogenic cervical myelopa- that proved to be demyelinating or inflammatory in ethiology (mean age 32.6, thy has been used in theNovokuznetskNeurosurg ical Clinic since 1984. Sixty- 18-70). The Diagnoses were finalized after clinical observation , imaging evidence (MRI and/or CT-myelography) , CSF findings and operative verif ication eight patients of various ages underwent surgery. The routinediscectomywas modified . Its volume was extended up to the in the compressive cases. DSEP changes were classified as monoradicular, ional and diffuse. Altogether sensitivity , removal ofosteocartilaginousvegetations compressing ventral spinal cord and polyradicular, circumscribedtransseC1 78.7-95.9% at its radicles via interbody space. The anterior foraminotomy was pertormed inreached 82.3% in spondylotic myelopathy (confidence interval compression of radicles of the spinal nerves. Microsurgical technique allowed aP 0.95) with polyradicular and circumscribed types dominating. In other compressions the transverse lesion type was most frequent, with a sensitiv ity of completedecompressionand radiculomeningolysis . The removed intervertebral 92.4% (Cl 78.0-100.0% at P 0.95). In non-compressivespinal syndromes disc was replaced with autodermic graft of necessary thickness.
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