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    Treatment of Cervical Spondylotic Myelopathy

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    encrownter
    Cervical spondylotic myelopathy (CSM) is a progressive disease caused by compression of the spinal cord. Management involves non-operative or operative options depending on symptoms and imaging. Operative options include anterior decompression via diskectomy or corpectomy, posterior decompression via laminectomy or laminoplasty, or combined approaches. Complications vary based on approach but may include instability, deformity, nerve injury, and adjacent segment degeneration long-term. Younger age, less severe preoperative symptoms, and single level disease predict better prognosis following treatment.

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    Treatment of Cervical Spondylotic Myelopathy

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    encrownter
    90 views49 pages
    Cervical spondylotic myelopathy (CSM) is a progressive disease caused by compression of the spinal cord. Management involves non-operative or operative options depending on symptoms and imaging. Operative options include anterior decompression via diskectomy or corpectomy, posterior decompression via laminectomy or laminoplasty, or combined approaches. Complications vary based on approach but may include instability, deformity, nerve injury, and adjacent segment degeneration long-term. Younger age, less severe preoperative symptoms, and single level disease predict better prognosis following treatment.

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    Cervical spondylotic myelopathy (CSM) is a progressive disease caused by compression of the spinal cord. Management involves non-operative or operative options depending on symptoms and imaging. Operative options include anterior decompression via diskectomy or corpectomy, posterior decompression via laminectomy or laminoplasty, or combined approaches. Complications vary based on approach but may include instability, deformity, nerve injury, and adjacent segment degeneration long-term. Younger age, less severe preoperative symptoms, and single level disease predict better prognosis following treatment.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    90 views49 pages

    Treatment of Cervical Spondylotic Myelopathy

    Uploaded by

    encrownter
    Cervical spondylotic myelopathy (CSM) is a progressive disease caused by compression of the spinal cord. Management involves non-operative or operative options depending on symptoms and imaging. Operative options include anterior decompression via diskectomy or corpectomy, posterior decompression via laminectomy or laminoplasty, or combined approaches. Complications vary based on approach but may include instability, deformity, nerve injury, and adjacent segment degeneration long-term. Younger age, less severe preoperative symptoms, and single level disease predict better prognosis following treatment.

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    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 49

    Akinsulire A.

    Introduction Natural History Treatment options


    Non operative Operative
    Anterior Posterior Combined

    Complications Prognosis

    Cervical Spondylotic Myelopathy (CSM) is a disease of variable progression Management based on understanding of pathogenesis,clinical features and correct neuroimaging investigation.

    Many patients have evidence of significant compression on MRI but relatively asymptomatic Spinal cord has high degree of tolerance to chronic deformation

    75%

    Stepwise deterioration

    20%

    Steady progressive deterioration

    5%

    Improvement

    Clarke E, Robinson PK: Cervical myelopathy: A complication of cervical spondylosis. Brain

    Typically slowing progressive Step ladder progression Once moderate symptoms occur, prognosis poor

    Non operative

    Operative

    Indications
    Neuroradiological evidence of compression but no symptom/sign of myelopathy Mild neuropathy
    Slight gait disturbance No functional deficit/ weakness

    Plateau phase

    Intermittent cervical collar Anti-inflammatory Active discouragement of high risk activities Physiotherapy Regular monitoring/ follow up Epidural steroid injection

    Severity of disease Nurick 3- 5 Pain Rate of progression Compression with severe neuroradiologic findings
    Kyphosis Myelomalcia Small cord area Cord atrophy

    Posterior approach
    Laminoplasty Laminectomy +/- fusion procedures

    Anterior approach
    Multiple anterior diskectomies with fusion Corpectomy with fusion +/- anterior instrumentation

    Combined

    Indirect technique Increases transverse diameter and size of canal Requires posterior shift of cord to diminish effect of anterior compression

    Canal expansion by opening the posterior elements in a trapdoor fashion effective diameter of the spinal canal from C3 to C7 by shifting the laminae dorsally Osseous posterior arch not completely removed Post op instability reduced muscular and osseous support preserved

    Decompression of spinal canal by removal of part of posterior elements useful alternative for multiple-level decompression in patients with preserved cervical lordosis Lateral margins are the junctions of the lateral masses and laminae

    May require posterior instrumentation to prevent kyphosis or instability Visible expansion of the dural sac intraoperatively and pulsation of the dura suggest good canal expansion

    Allows anterior decompression of dura Choice of type depending on location of compression Confined to disc@ 1-3 levels anterior cervical diskectomy + grafting Disc,PLL,end plates corpectomy with strut graft

    Direct decompression the removal of disc material and posterior osteophytes impinging on the spinal cord at the level of the disc space cartilaginous end plate is completely removed, the thin osseous end plate preserved Bone graft inserted into interspace

    Advantage
    Dissection along fascial planes Relative preservation of stability of spinal column Low prevalence of graft extrusion

    Disadvantage
    Decreased visalization- incomplete decompression or injury to cord Not recommended for primary tx of severe congenital spinal stenosis

    Removal of the cervical body and intervening disc 15 to 19-mm central trough is removed from the anterior aspect of the vertebral body provides a safety margin of 5 mm to the medial border of the foramen transversarium PLL also resected Defected filled with graft +/- Instrumentation

    Post laminectomy kyphosis Patients with severe osteoporosis Multilevel corpectomy in 3 or more levels

    No single preferred approach both have been used successfully Neither is optimal for every patient although either may be appropriate Both approaches give similar results with appropriate patient selection Various determinants of choice of approach

    No of levels Cervical kyphosis Instability Spinal canal size/presence of stenosis Revision Surgeons expertise

    Anterior Advantages Direct decompression

    posterior Less loss of motion

    Stabilization with arthrodesis Not as technically demanding Correction of deformity Good axial pain relief Disavantages Technically demanding Graft complications Post op bracing Loss of motion Adjacent segment degeneration Indirect decompression Late instability Inconsistent axial pain results Pre op kyphosis/instability limitation Less bracing needed Avoids graft complications

    Approach related Decompression related Graft related Long term

    Approach related
    RL nerve hoarseness Dysphagia Upper airway compromise- edema,hematoma

    Decompression related
    Spinal cord /nv root injury C5 nerve injury Vertebral ay injury Spinal fluid leaks

    Graft related
    Dislodgement Fracture Severe settling into cancellous bone Displacement with esophageal injury

    Anterior approach
    Pseudoarthrosis Adjacent segment degeneration

    Laminectomy
    Post laminectomy kyphosis, Instability with neurological deteroriation

    Laminoplasty
    Inadvertent closure with recurrent stenosis Incomplete decompression

    Age Shorter duration of symptoms Single level Severity of myelopathy before intervention Larger transverse area of cord Preoperative bladder dysfunction

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