Deglutition Disorders ; surgery ; Dyspnea ; surgery ; Humans ; Spondylosis

Humans ; Manipulation, Spinal ; methods ; Spondylosis ; surgery ; therapy

Cervical Vertebrae ; surgery ; Humans ; Spondylosis ; classification ; diagnosis ; surgery

Cervical Vertebrae ; surgery ; Humans ; Orthopedic Procedures ; methods ; Spinal Cord Diseases ; surgery ; Spondylosis ; surgery

There should be confusion about diagnosis and treatment for multiple segments cervical myelopathy in some respects. The author reviewed the literature and combined with clinical experience, proposed a new classification for cervical myelopathy according to responsibility segment areas, which dividing into single segment,double segments (continues or jumping type), multi-segment (≥ three segments). The responsible segments determination is the premise of diagnosis and also a key to determine surgical decompression segment. Decompression only according to imaging was not desirable, surgical segment should mainly relies on clinical, imaging, electrophysiological and comprehensive analysis to avoid surgery range expansion. Surgical approach and procedures are still the focus and hotspot of cervical myelopathy treatment, and no treatment standards and corresponding guidelines to consult. The author proposes that surgical approach should advocate the individual, and surgical procedure should follow simple instead of complicate, anterior and posterior combined decompression is not necessary in most cases, and anterior and posterior fixation are not need.
Cervical Vertebrae ; surgery ; Decompression, Surgical ; Humans ; Spondylosis ; diagnosis ; surgery ; Treatment Outcome

Adult ; Aged ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; Female ; Humans ; Male ; Middle Aged ; Spondylosis ; surgery ; Treatment Outcome

OBJECTIVETo discuss on the effect of cervical spondylotic myelopathy before and after surgery and assess its indications and efficacy.

METHODSFrom June 2002 to June 2006, 125 patients with cervical spondylotic myelopathy were analyzed retrospectively involving 58 anterior routine and 67 posterior routine, of which 71 cases of males, 54 cases of females, aged from 28 to 69 years (average 53.4 years). The course was 0.5 to 48 months (means 14 months). According to JOA score system preoperative and postoperative nerve function were analyzed, summarized anterior and posterior cervical spine surgery.

RESULTSAll patients were followed up for from 6 to 30 months (average of 18 months). According to JOA score criteria: anterior cervical surgery preoperative JOA score was (8.78 +/- 2.43) points, postoperative JOA score was (14.68 +/- 2.37) points, the results were excellent in 40 cases, good in 10 cases, effective in 6. Posterior surgical group preoperative JOA score was (8.49 +/- 2.58) points, postoperative JOA score was (14.26 +/- 2.83) points, the results were excellent in 42 cases, good in 12 cases, effective in 8. Invalid operation occurrenced in 6 cases included 2 of anterior, 4 of posterior. The postoperative symptoms had worsed in 1 case of posterior operation. The two groups had no statistical difference in efficacy, but there were differences statistically in the same approach comparing preoperative and postoperative.

CONCLUSIONBoth anterior and posterior approaches have fine effect to the treatment of cervical spondylotic myelopathy (CSM). But the selection of the indication is very important, the patients with the pressure from anterior, the short-level changes, and the main symptoms of pyramid trac compression, adopt anterior approach on principle. While the patients with the pressure of spinal cord from posterior, multilevel changes, main symptoms of sensory disturbances, and accompanied by cervical spine canal stenosis mainly is introduced posterior approach.

Adult ; Aged ; Cervical Vertebrae ; physiopathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spondylosis ; physiopathology ; surgery

OBJECTIVETo investigate the clinical effects of anterior cervical intervertebral space decompression under microscope in treating cervical spondylotic myelopathy in elderly patients.

METHODSFrom June 2009 to March 2012, 43 patients with cervical spondylotic myelopathy were treated with anterior cervical intervertebral space decompression and intervertebral fusion under microscope. There were 26 males and 17 females, aged from 60 to 72 years old with an average of (64.9±3.7) years. Japanese Orthopaedic Association System (JOA) score was from 7 to 12 points with an average of (9.5±1.8) points before operation. The function of nerves was assessed before and after operation according to JOA.

RESULTSAll patients were followed up from 10 to 18 months with an average of (14.7±1.6) months. Postoperative JOA score was (13.81±1.44) points (ranged, 10 to 16), had significantly higher than preoperative (P<0.01). According to the rate of the improved JOA score, 9 cases got excellent results, 26 good, 7 fair, 1 poor.

CONCLUSIONAnterior cervical intervertebral space decompression under microscope for cervical spondylotic myelopathy in elderly patients is safe and effective.

Aged ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Microscopy ; Middle Aged ; Spondylosis ; surgery

Cervical Vertebrae/surgery* ; Esophagus ; Humans ; Spinal Fusion ; Spinal Osteophytosis ; Spondylosis/surgery*

OBJECTIVETo evaluate the value of the Centerpiece plate in the cervical single open-door laminoplasty and compared its advantages with conventional suture fixation methods.

METHODSFrom December 2009 to August 2011,32 patients with cervical spondylotic myelopathy were treated with operation. Of them, 15 cases underwent cervical single open-door laminoplasty and Centerpiece plate fixation (group A),there were 8 males and 7 females,aged from 51 to 65 years old with an average of 60.5 years and ranged in course of disease from 2 to 15 months; 17 cases underwent cervical single open-door laminoplasty and silk suture fixation (group B), there were 9 males and 8 females, aged from 49 to 66 years old with an average of 61.5 years and ranged in course of disease from 1 to 14 months. All the patients with unsteady gait symptom before operation and cervical MR imaging showed spinal cord compression and denaturation. According to standard of Japanese Orthopaedics Association (JOA) to evaluate the spinal nervers function before operation and at 6 months after operation;according to CT scan to determine the sagittal diameter (AP) of upper vertebral canal and cervical activity (ROM).

RESULTSAll the patients were followed up from 8 to 20 months with an average of 13 months. All the incisions healed well and no complications such as internal fixation loosening and breakage,spinal cord injury, reclose-door were found. Postoperative symptoms relieved obviously and MRI and CT showed vertebral canal volume expanded significantly. Operative time and blood loss in group A were respectively (155.0+/-12.3) min, (407.0+/-11.8) ml and in group B were respectively (148.0+/-14.4) min, (398.0+/-15.4) ml. There was no significantly differenc, between two groups (P>0.05). JOA score in group A improved from preoperative 9.1+/-2.6 to postoperative 15.5+/-1.8 and in group B improved from preoperative 9.3 +/- 2.1 to postoperative 13.1 +/- 2.5 (P<0.05). CT sagittal diameter (AP) in group A increased from preoperative (10.7+/-2.4) mm to postoperative (17.6+/-3.2) mm and in group B increased from preoperative (11.6+/-1.7) mm to postoperative (15.9+/-2.0) mm (P<0.05). Cervical activity (ROM) in group A be- fore and after operation were respectively (51.0+/-2.6) degrees, (45.0+/-3.5) degrees and in group B were respectively (52.0+/-1.8) and (42.0+/-2.4). There was no significantly difference before operation between two groups (P>0.05) and there was significantly difference after operation between two groups (P<0.05).

CONCLUSIONTreatment of cervical spondylotic myelopathy with posterior single open-door laminoplasty and Centerpiece plate fixation can enlarge spinal canal volume,keep original cervical activity, improve postoperative JOA score. The method has obviously advantages compared with traditional suture fixation methods.

Aged ; Bone Plates ; Cervical Vertebrae ; surgery ; Female ; Humans ; Laminectomy ; methods ; Male ; Middle Aged ; Spinal Canal ; surgery ; Spondylosis ; etiology ; surgery