Multisegmental cervical spondylosis: treatment by spondylectomy, microsurgical decompression, and osteosynthesis

Vertebral body replacement after spondylectomy, combined with microsurgical decompression and anterior plating, was performed in 22 patients as an aggressive therapeutic approach to multisegmental cervical spondylosis. The patients were 13 men and 9 women, ranging in age from 32 to 74 years. In 19 patients, the typical signs of cervical myelopathy were present. In three patients, pain was the major symptom, accompanied by moderate spastic paresis and hyperreflexia. Apart from cervical myelography and computed tomographic scanning, which was performed in 10 patients, magnetic resonance imaging was the radiological procedure of choice in 12 patients. During spondylectomy, one vertebra was removed in 14 patients, two vertebrae in seven patients, and three vertebrae in one patient. The time of postoperative follow-up ranged from 8 to 46 months, with an average interval of 21 months. In all 22 patients, satisfactory bony fusion was achieved as demonstrated by radiological control examinations. Seventeen patients (77%) were symptom free or had only minor residual symptoms. Three (14%) patients had intermittent nuchal or cervicobrachial pain, which responded well to analgesic medication or the application of a soft collar. Two (9%) patients still had myelopathic but not incapacitating symptoms. Of 15 patients who were employed before surgery, 13 returned to a full-time job. The only severe complication of surgery was a prevertebral abscess that healed without sequelae. It is concluded that aggressive surgical therapy of multisegmental cervical spondylosis by a combination of vertebrectomy, decompression (using the surgical microscope), bone grafting, and osteosynthesis is a straightforward and promising procedure for the treatment of this debilitating disease.