Laminectomy and Fusion for Cervical Spondylotic Myelopathy
Cervical spondylotic myelopathy accounts for the majority of cases of spinal cord dysfunction in older adults. This common cause of neck pain results from degenerative changes in the cervical spine, including age-related damage to the joints, discs, ligaments, and connective tissue in the neck, that results in spinal cord compression. The treatment for this condition will depend on the extent of the degeneration and symptoms but typically involves laminectomy and spinal fusion.
Symptoms of cervical spondylotic myelopathy usually develop gradually and may be confused for other conditions, such as multiple sclerosis, amyotrophic lateral sclerosis and even spine tumours. Symptoms may include:
- Neck stiffness
- Arm pain
- Numbness in the hands
- Weakness in the hands and legs
- Neck pain
Diagnosing Cervical Spondlyotic Myelopathy
Patients are usually diagnosed on the basis of magnetic resonance imaging that shows spinal stenosis caused by the growth of bone spurs, disc herniation, and/or overgrowth of the ligamentum flavum. These degenerative changes can result in spinal cord compression when the person is at rest (i.e. static mechanical), compression when in motion (dynamic mechanical), or spinal cord ischaemia (where blood flow is cut off to areas of the spine).
Treatment choice often involves a decision to undergo back surgery to decompress the spinal cord, as well as, in some cases, to fuse the spine to restore stability. One surgical option is a laminectomy with spinal fusion, a type of surgery that removes part of the stiff ligament at the back of the spine in order to allow the interior structures more space and thereby reduce cord compression.
How Safe and Effective is Laminectomy and Fusion for Neck Pain?
In one recent retrospective study, 58 patients who underwent cervical laminectomy and fusion for cervical spondylotic myelopathy had a statistically significant improvement between their score on the modified Japanese Orthopedic Association scale (mJOA) before surgery and after surgery. The average pre-operative score was 13.2 and postoperative was 16.1, with an average improvement of 2.9 points.
In this study 85.5% of patients improved with neck surgery, and the remainder had no change in their mJOA score. The patients’ average neurological recovery rate was 56.6% but there was a 10.3% overall complication rate. The most common complication after laminectomy and fusion was nerve palsy at C5, which occurred in some 6.9% of patients. These nerve palsies completely resolved, leading the authors to conclude that cervical laminectomy and fusion is a safe and effective procedure to treat cervical spondylotic myelopathy.
Changes in the cervical spine that put pressure on the nerves and spinal cord can lead to irreversible damage, chronic pain, weakness, paralysis and even death. Anyone who suspects that they have cervical spondylotic myelopathy should consult their physician for a thorough assessment as early intervention can help prevent further damage and reduce the risk of serious complications if the condition is left untreated.
Reference
Chang V, Lu DC, Hoffman H, Buchanan C, Holly LT. Clinical results of cervical laminectomy and fusion for the treatment of cervical spondylotic myelopathy in 58 consecutive patients. Surg Neurol Int. 2014 Apr 16;5(Suppl 3):S133-7. doi: 10.4103/2152-7806.130670. eCollection 2014.
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