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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(01): 140-147
DOI: 10.4103/ajns.AJNS_303_17
Original Article

Effect of sub-axial cervical lateral mass screw fixation on functional outcome in patients with cervical spondylotic myelopathy

Ali Hamdan
Department of Neurosurgery, South Valley University, Qena
,
Radwan Mahmoud
1   Department of Neurosurgery, Asyut University, Asyut
,
Momen Al Mamoun
2   Department of Neurosurgery, Sohage University, Sohage
,
Eslam El Khateeb
Department of Neurosurgery, South Valley University, Qena
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Background: The role of laminectomy alone as an etiology of postoperative cervical instability is well known. Cervical sagittal malalignment of the spine has been linked to unfavorable functional outcome, so the effect of restoration of sagittal spinal alignment on functional outcomes and treatment effectiveness has recently gained attention. Objective: This is a prospective observational study aims to observe the possible relation between cervical sagittal alignment and functional outcomes following sub-axial cervical lateral mass screw fixation in patients with cervical spondylotic myelopathy. Patients and Methods: Thirty patients were included in this study all suffering from cervical spondylotic mylopathy (CSM) who underwent cervical laminectomy and screw-rod fixation and followed up over 6 months. Functional outcome accessed using Nurick myelopathy score and neck disability index (NDI)?. We also used the Cobb angle method (C2–C7) as a parameter for radiographic assessment of the cervical sagittal alignment which was measured preoperatively and postoperatively on lateral neutral views of cervical X-ray. Results: All the patients underwent cervical laminectomy and fixation in a range of 3–5 levels. Two intraoperative facet fractures and four facet joint violations were observed. All the patients were followed-up for at least 6 months. There were significant improvements of the motor power (88.5%), Nurick score (90%), and NDI (90%) postoperatively. The mean preoperative Cobb angle for all patients was −8.51° ± 14.07° standard deviation (SD) which changed to −10.29 ± 12.43 SD at the end of follow-up. Conclusion: Combing posterior decompression with lateral mass screw– rod in patients with CSM was effective in improving or at least maintaining cervical alignment with the good functional outcome.

Key-words:

Cervical sagittal alignment - functional outcomes - sub-axial lateral mass fixation

Financial support and sponsorship

Nil.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine (Phila Pa 1976) 1986;11:521-4.
  • 2 Ferch RD, Shad A, Cadoux-Hudson TA, Teddy PJ. Anterior correction of cervical kyphotic deformity: Effects on myelopathy, neck pain, and sagittal alignment. J Neurosurg 2004;100:13-9.
  • 3 Emery SE. Cervical spondylotic myelopathy: Diagnosis and treatment. J Am Acad Orthop Surg 2001;9:376-88.
  • 4 Harrison DE, Harrison DD, Cailliet R, Troyanovich SJ, Janik TJ, Holland B, et al. Cobb method or Harrison posterior tangent method: Which to choose for lateral cervical radiographic analysis. Spine (Phila Pa 1976) 2000;25:2072-8.
  • 5 Suk KS, Kim KT, Lee JH, Lee SH, Lim YJ, Kim JS, et al. Sagittal alignment of the cervical spine after the laminoplasty. Spine (Phila Pa 1976) 2007;32:E656-60.
  • 6 Nurboja B, Kachramanoglou C, Choi D. Cervical laminectomy vs. laminoplasty: Is there a difference in outcome and postoperative pain? Neurosurgery 2012;70:965-70.
  • 7 Olson KA, Joder D. Diagnosis and treatment of cervical spine clinical instability. J Orthop Sports Phys Ther 2001;31:194-206.
  • 8 McAllister BD, Rebholz BJ, Wang JC. Is posterior fusion necessary with laminectomy in the cervical spine? Surg Neurol Int 2012;3:S225-31.
  • 9 Epstein NE. Laminectomy for cervical myelopathy. Spinal Cord 2003;41:317-27.
  • 10 Inoue S, Moriyama T, Tachibana T, Okada F, Maruo K, Horinouchi Y, et al. Cervical lateral mass screw fixation without fluoroscopic control: Analysis of risk factors for complications associated with screw insertion. Arch Orthop Trauma Surg 2012;132:947-53.
  • 11 Heller JG, Carlson GD, Abitbol JJ, Garfin SR. Anatomic comparison of the Roy-Camille and Magerl techniques for screw placement in the lower cervical spine. Spine (Phila Pa 1976) 1991;16:S552-7.
  • 12 Barrey C, Mertens P, Jund J, Cotton F, Perrin G. Quantitative anatomic evaluation of cervical lateral mass fixation with a comparison of the Roy-Camille and the Magerl screw techniques. Spine (Phila Pa 1976) 2005;30:E140-7.
  • 13 Al Barbarawi MM, Audat ZA, Obeidat MM, Qudsich TM, Dabbas WF, Obeidat MH, et al. Decompresive cervical laminectomy and lateral mass screw rod arthrodesis. Surgical analysis outcome. Scoliosis 2011;6:1-6.
  • 14 Kim HS, Suk KS, Moon SH, Lee HM, Kang KC, Lee SH, et al. Safety evaluation of freehand lateral mass screw fixation in the sub-axial cervical spine: Evaluation of 1256 screws. Spine (Phila Pa 1976) 2015;40:2-5.
  • 15 Rajshekhar V, Kumar GS. Functional outcome after central corpectomy in poor-grade patients with cervical spondylotic myelopathy or ossified posterior longitudinal ligament. Neurosurgery 2005;56:1279-84.
  • 16 Macdonald RL, Fehlings MG, Tator CH, Lozano A, Fleming JR, Gentili F, et al. Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg 1997;86:990-7.
  • 17 Matsunaga S, Sakou T, Taketomi E, Komiya S. Clinical course of patients with ossification of the posterior longitudinal ligament: A minimum 10-year cohort study. J Neurosurg 2004;100:245-8.
  • 18 Holly LT, Matz PG, Anderson PA, Groff MW, Heary RF, Kaiser MG, et al. Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy. J Neurosurg Spine 2009;11:112-8.
  • 19 Naderi S, Benzel EC, Baldwin NG. Cervical spondylotic myelopathy: Surgical decision making. Neurosurg Focus 1996;1:e1.
  • 20 Nakashima H, Tetreault LA, Nagoshi N, Nouri A, Kopjar B, Arnold PM, et al. Does age affect surgical outcomes in patients with degenerative cervical myelopathy? Results from the prospective multicenter AOSpine International Study on 479 patients. J Neurol Neurosurg Psychiatry 2016;87:734-40.
  • 21 Ebersold MJ, Pare MC, Quast LM. Surgical treatment for cervical spondylitic myelopathy. J Neurosurg 1995;82:745-51.
  • 22 Fehlings MG, Kopjar B, Massicotte EM, Arnold PM, Yoon T, Vaccaro AR, et al. The impact of duration of symptoms on the outcomes of surgical management of cervical spondylotic myelopathy: Analysis of a prospective multicenter study. J Neurosur 2008;10:116-63.
  • 23 Suri A, Chabbra RP, Mehta VS, Gaikwad S, Pandey RM. Effect of intramedullary signal changes on the surgical outcome of patients with cervical spondylotic myelopathy. Spine J 2003;3:33-45.
  • 24 Guo Q, Ni B, Yang J, Liu K, Sun Z, Zhou F, et al. Relation between alignments of upper and sub-axial cervical spine: A radiological study. Arch Orthop Trauma Surg 2011;131:857-62.
  • 25 Benzel EC. Degenerative and inflammatory diseases of the spine. In: Benzel EC, editor. Biomechanics of Spine Stabilization. Chicago, Illinois: American Association of Neurological Surgeons; 2001. p. 45-60.
  • 26 Hamanishi C, Tanaka S. Bilateral multilevel laminectomy with or without posterolateral fusion for cervical spondylotic myelopathy: Relationship to type of onset and time until operation. J Neurosurg 1996;85:447-51.
  • 27 Yamazaki A, Homma T, Uchiyama S, Katsumi Y, Okumura H. Morphologic limitations of posterior decompression by midsagittal splitting method for myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine. Spine (Phila Pa 1976) 1999;24:32-4.
  • 28 McAviney J, Schulz D, Bock R, Harrison DE, Holland B. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther 2005;28:187-93.
  • 29 Kuntz C 4th, Levin LS, Ondra SL, Shaffrey CI, Morgan CJ. Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: A review and resynthesis of the literature. J Neurosurg Spine 2007;6:104-12.
  • 30 Shamji MF, Mohanty C, Massicotte EM, Fehlings MG. The association of cervical spine alignment with neurologic recovery in a prospective cohort of patients with surgical myelopathy: Analysis of a series of 124 cases. World Neurosurg 2016;86:112-9.
  • 31 Sielatycki JA, Armaghani S, Silverberg A, McGirt MJ, Devin CJ, O'Neill K, et al. Is more lordosis associated with improved outcomes in cervical laminectomy and fusion when baseline alignment is lordotic? Spine J 2016;16:982-8.
  • 32 Roguski M, Benzel EC, Curran JN, Magge SN, Bisson EF, Krishnaney AA, et al. Postoperative cervical sagittal imbalance negatively affects outcomes after surgery for cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2014;39:2070-7.