Addressing Stretch Myelopathy in Multilevel Cervical Kyphosis with Posterior Surgery Using Cervical Pedicle Screws

Area of Science:

• Neurosurgery
• Spinal Surgery
• Orthopedics

Background:

• Multilevel cervical myelopathy traditionally requires combined anterior and posterior surgical approaches for kyphosis correction.
• Advancements in cervical pedicle screw-rod instrumentation enable single-stage posterior correction, potentially addressing stretch myelopathy via posterior shortening.

Purpose of the Study:

• To detail the technique of cervical kyphosis correction employing partial facetectomies.
• To evaluate the outcomes of a single-stage posterior decompression and kyphosis correction procedure for multilevel cervical myelopathy.

Main Methods:

• Retrospective analysis of nine patients with multilevel cervical myelopathy who underwent single-stage posterior decompression and kyphosis correction using cervical pedicle screws.
• Preoperative and postoperative assessments included modified Japanese Orthopaedic Association (mJOA) scores and radiological measurements (Cobb's angle, Ishihara index, spinal canal length) via CT scans.
• Average follow-up duration was 40.56 months.

Main Results:

• Significant improvement in kyphosis: average C2-7 Cobb's angle improved from 6.3° to 2°, and Ishihara index improved from -15.8% to -3.66%.
• Average mJOA score improved substantially from 7.8 to 15.0, indicating better neurological function.
• A mild decrease in cervical spinal canal length was observed (83.64 mm to 82.68 mm), correlating positively with clinical improvement.

Conclusions:

• Single-stage posterior decompression and kyphosis correction with cervical pedicle screws effectively treats multilevel cervical myelopathy and stretch myelopathy.
• The technique provides transverse plane decompression but does not predictably restore cervical lordosis compared to anterior approaches.
• Observed mild shortening of the cervical spinal canal is associated with positive clinical outcomes.