Cervical myelopathy: current diagnostic and treatment strategies☆☆☆★
Received 3 July 2002; accepted 23 September 2002.
Abstract
Cervical myelopathy is a varied clinical syndromes resulting from spinal cord dysfunction. Underlying causes are numerous, but spondylosis at one or more levels is the most common etiology. Natural history studies have demonstrated a variable clinical course with gradual neurologic deterioration in a majority of patients. While prospective clinical comparisons are limited, existing literature suggests that operative management reliably arrests the progression of myelopathy and may lead to functional improvement in a majority of patients. The selection of surgical procedures must be carefully individualized based on specific clinical and radiographic factors. Whereas anterior decompression and fusion procedures at one or two motion segments have predictable results, procedures involving three or more levels are associated with increased morbidity. Newer techniques for the treatment of multilevel cervical myelopathy include anterior decompression with 360-degree fusion, hybrid corpectomy/anterior cervical discectomy and fusion techniques and the use of dynamic anterior cervical plates. An alternative technique for patients with a lordotic sagittal alignment is laminoplasty, which has a proven track record of long-term good to excellent results.
aMaryland Spine Center, Mercy Hospital, 301 St. Paul Place, Baltimore, MD 21202 USA
bDepartment of Orthopedic Surgery, Washington University, 660 S. Euclid, St. Louis, MO 63110-1010 USA
cOrthopedic Surgery and Rehabilitation Medicine, Spine Medicine, University of Wisconsin Medical School, Research Park Clinic–Spine Medicine, 621 Science Drive, Madison, WI 53711-1074 USA
dThe Rothman Institute and Jefferson Medical College, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107-4216 USA
Corresponding author. Alexander R. Vaccaro, MD, The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA. Tel.: (215) 955-5367; fax: (215) 503-0580
☆ This Contemporary Concepts review article has been reviewed by the Board of the North American Spine Society (NASS). As such, it represents the current position of the state of knowledge of the above subject in spine care. This series is edited by Alexander Vaccaro, MD. Prior to entering the review process for The Spine Journal, the authors were assisted by members of the NASS Committee on Contemporary Concepts, Alexander Vaccaro, MD, Chair.
ABSTRACT