gms | German Medical Science

The purpose of this study is to evaluate the complications after a surgical treatment of cervical myelopathy, from our own personal experience and the many publications in the literature (> 3 500 papers).

About two hundred papers were analyzed, specifically focused on the complications. The series are often short, and there are many procedures in treatment patients with multilevel cervical myelopathy. The follow-up is from few months to twenty two years after the surgery. The complications seemed to be rare and not related to procedure’s type anterior or posterior. We studied each surgical procedure with their complications. Variety of factors may influence surgical outcome in patients with cervical spondylotic myelopathy : age, duration of the symptoms, cervical curvature physiological evaluation by motor and sensory evokated potentials, neurological symptoms, studies of the spinal cords on the MRI. About one hundred fifteen patients beetween 1983 and 1998 were included in our study. Forty three had an anterior approach, fifty two posterior and fourteen a mixed with double approach.

Following anterior cervical corpectomy differents complications can be seen : the bone graft mobilisation, the non bony fusion if there is more two level corpectomy and the kyphotic change if the iliac graft is ptosed. Same authors used a plate which stabilized immediately the sagittal alignement. But there is sometimes a screen mobilisation, and more frequently pseudarthrosis. An other complication is the adjacent level degeneration, with persistent pain after more or less time. After the anterior cervical surgery, some patients have a dysphagia, 13% about immediately then six month later 2 or 3% a transitory dysphagia in 3 or 4%. The kyphotic evolution is in 10% of patients, without clinical symptoms. The risk evolution is the instability of the adjacent level and recurrent neurologic deterioration at an average of 13 years. After a posterior approach, an transient deterioration is more frequent, sensory and motor deficits. The cervical curvature modification is more important if the cervical spine is straight or kyphotic. So the good indication is a lordosis cervical spine. With a laminoplasty, the kyphosis is less frequent. Some authors proposed a posterior fusion and fixation for multilevel decompression. The first time for a combined procedure must be an anterior copectomie.

The complications after a surgery is not rare, it depend on many various factors. A best comprehension of the disease is necessary for minimal complications and possible improvement to have is long term outcomes. Prospective studies could show the usefull of the cervical prothesis.