MD Thesis
Volume 2, No.2
October 1998
 Yahya M. AI-Muazen
 Dept, of Neurosurgery
 King Faisal University
 College of Medicine and
 Medical Sciences
 AI-Khobar, 31952
 Correspondence:
 AI-Muazen
 Neurosurgery Department
 King Fahd Hospital of its Univ
 P.O. Box 2208
 Saudi Arabia
 
Surgical Outcome of Cervical Spondolytic Radiculomyelopathy

   ABSTRACT

Cervical spondylosis (C.S.) is a common disease among middle aged and elderly people. Cervical radiculopathy, radioculomyelopathy and myelopathy are frequent sequalae of chronic degenerative cervical spine disease. Although the pathogenesis, clinical manifestation and natural history of this disease are known, the outcome of operative intervention is variable. Surgical intervention improves cervical spondylotic radiculomyelopathy. Operative intervention only alters marginally the natural history of the cervical spondylotic myelopathy.
Careful selection of patients for appropriate treatment modality (conserative, anterior, or posterior decompression surgery) is crucial to the management. Sixty seven cases of cervical spondylosis were operated on in the neurosurgery department of King Fated Hospital of the University over ten years (1982-1992) are reviewed and analysed. Simple discectomy without fusion in 49.2 %, Cloward's in 34.3% and laminectomy in 16.4%. All patients were followed up at one month, 6 months and 12 months respectively. We found in the early follow up simple discectomy without fusion had the best outcome, but in the late follow up, all the operative techniques showed significant improvement (P<0.0078, and P<0.0006). Furthermore, the significant prognostic factors affecting prognosis were:


a) The age of patient (P<0.0001, P<0.0113, P<0.522).
b) Clinical score either mild moderate or severe neurological deficits (P<0.0001, P<0.0018, P<0.0031)
c) Operative techniques (P<0.0025, P<0.0050, P<0.0131)
d) Symptoms of the patient either radiculopathy, radiculomyelopathy, or myelopathy (P<0.0001)

We concluded that for anterior decompression, microsurgical discetomy without fusion was the most appropriate technique in single level compression, unless there was cervical subluxation or instability, otherwise Cloward's standard with or without bone graft fusion is the option. Posterior laminectomy decompression is reserved to multiple level disc herniation associated with congenital or acquired cervical canal stenosis over a large segment.

CONCLUSION

The careful section of each of the surgical modalities either anterior decompression, or posterior decompression is of paramount importance.

In our series of 67 cases treated by laminectomy, Cloward's or simple disectomy without fusion, the latter is most effective, safe and has lowest risk of postoperative complications. We recommend simple disectomy without fusion especially in radiculopathy and soft disc herniation, but Cloward if there is spondylotic myelopathy complicated by the cervical spine instability or subluxation. The posterior decompression laminectomy can be done for multiple level disc herniation associated with congenital or acquired cervical canal stenosis. This conclusion is consistent with contemporary studies.

Age of the patient, preoperative neurological status, evaluated by the neurological scoring system, and operation technique are of prognostic value in the surgical outcome.

This study also fulfils several other goals such as:

a) Able to analyze Saudi experience compared with contemporary work in the world
b) Able to highlight the presence of the modern approach to the treatment of cervical spondylotic radiculomyelopathy in one of the leading Saudi Arabian teaching hospitals
c) Able to serve as modest mediator in popularising the modern approach to this problem.

 

 


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