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Addressing Stretch Myelopathy in Multilevel Cervical Kyphosis with Posterior Surgery Using Cervical Pedicle Screws
Bijjawara Mahesh1, Bidre Upendra1, Shekarappa Vijay1
1Department of Spine Surgery, Jain Institute of Spine Care and Research (JISAR), Bhagwan Mahaveer Jain Hospital, Bangalore, India.
Study Design:
Technique description and retrospective data analysis.
Purpose:
To describe the technique of cervical kyphosis correction with partial facetectomies and evaluate the outcome of single-stage posterior decompression and kyphosis correction in multilevel cervical myelopathy.
Overview Of Literature:
Kyphosis correction in multilevel cervical myelopathy involves anterior and posterior surgery. With the advent of cervical pedicle screw-rod instrumentation, single-stage posterior kyphosis correction is feasible and can address stretch myelopathy by posterior shortening.
Methods:
Nine patients underwent single-stage posterior decompression and kyphosis correction for multilevel cervical myelopathy using cervical pedicle screw instrumentation from March 2011 to February 2014 and were evaluated preoperatively and postoperatively with modified Japanese Orthopaedic Association (mJOA) scoring and computed tomography scans for radiological measurements. Kyphosis assessment was made with Ishihara curvature index and C2-C7 Cobb's angle. The linear length of the spinal canal and the actual spinal canal length were also evaluated. The average follow-up was 40.56 months (range, 20 to 53 months).
Results:
The average preoperative C2-7 Cobb's angle of 6.3° (1° to 12°) improved to 2° (10° to -9°). Ishihara index improved from -15.8% (-30.5% to -4.7%) to -3.66% (-14.5% to +12.6%). The actual spinal canal length decreased from 83.64 mm (range, 76.8 to 91.82 mm) to 82.68 mm (range, 75.85 to 90.78 mm). The preoperative mJOA score of 7.8 (range, 3 to 11) improved to 15.0 (range, 13 to 17).
Conclusions:
Single-stage posterior decompression and kyphosis correction using cervical pedicle screws for multilevel cervical myelopathy may address stretch myelopathy, in addition to decompression in the transverse plane. However, cervical lordosis was not achieved with this method as predictably as by the anterior approach. The present study shows evidence of mild shortening of cervical spinal canal and a positive correlation between canal shortening and clinical improvement.
