gms | German Medical Science

Objective: The treatment for cervical spondylotic myelopathy (CSM) is realized by different surgical approaches to the spine. Over the decades, surgical procedures became more refined, incorporating techniques causing less trauma to the stabilizing structures of the cervical spine. In alternative to the overwhelming percentage of surgery via an anterior approach, dorsal approaches like laminoplasty or laminectomy plus fusion are also performed. We are presentig results of a novel approach to dorsal cervical decompression with unilateral hemi-laminectomy and bilateral decompression reducing muscle trauma.

Methods: In this prospective non randomized study, patients with cervical spinal canal stenosis undergoing surgery were evaluated preoperatively, postoperatively, 6 weeks, 6 and 12 month after surgery by analyzing step count for 25 meters, JOA and NDI score, neurological status. Pre-op MRI and pre- and postop computer tomography was performed and compared for volume of stenotic area. The surgical approach was performed by midline skin incision, ipsilateral muscle fascia incision and muscle detachement only from the hemi-lamina, followed by interlaminar fenestration or hemilaminectomy, depending on extension of CSM, completed by contralateral undercutting of spinous process and removal of yellow ligament (Figure 1 [Fig. 1], Figure 2 [Fig. 2]).

Results: In total 44 patients were included with a mean age of 66 (±9.9) years. The volume of stenotic area according to CT scan was 5.1 cm³ preoperatively and improved to 6.7 cm³ postoperatively (p<0.001). Preoperative MRI-based classification of myelopathy in CSM (Avadhani et al.) resulted in 25, 12, 7 patients matching grade I, II and III. Postoperatively, none of the patients presented with neurological worsening. The JOA score showed improvement postoperatively (p=0.001), after 6 weeks (p=0.002) and 6 months (p=0.034), but not after 1 year (p=0.083). NDI showed significant improvement 6 weeks postoperatively (p=0.02), but not postoperatively, after 6 and 12 months (p=0.54, p=0.13; p=0.15). No significant differences were found in step count postoperatively (p=0.33), after 6 weeks (p=0.73), 6 months (p=0.91) and 12 months (p=0.74)

Conclusion: This novel approach to cervical spine in cervical spondylotic myelopathy can be considereda safe procedure. Results are comparable to previous studies describing clinical outcome after laminectomy and laminoplasty but with less muscle trauma and deficits related to it.