Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 49 doc

Persson LC, Moritz U, Brandt L, et al. (1997) Cervical radiculopathy: pain, muscle weak- ness and sensory loss in p atients with cervical radiculopathy treated with surgery, phys- iotherapy or cervical collar. A prospective, controlled study. Eur Spine J 6:256 – 66 In this prospective study on 81 patients with cervical spondylotic radiculopathy, the authors found that a cervical collar, physiotherapy, or surgery were equally effective in the long term. However, better short-term pain relief was noted for the surgically treated patients. Robinson RA, Smith GW (1955) Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp 96:223 Smith GW, Ro binson RA (1958) The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40-A:607 –24 Cloward RB (1958) The anterior approach for removal of ruptur ed cervical disks. J Neu- rosurg 15:602 – 17 Classic articles on the technique of anterior cervical discectomy and fusion. Frykholm R (1951) Cervical nerve root compression resulting from disc degeneration and root-sleeve fibrosis. A clinical investigation. Acta Orthop Scand (Suppl) 160:1 –149 Classic article on the techniques of posterior foraminotomy. Bohlman HH, Emery SE, Goodfellow DB, Jones PK (1993) Robinson anterior cervi cal discectomy and a rthrodesis for ce rvical radiculopathy. Long-term follow-up of one hun- dred and twenty-two patients. J Bone J oint Surg (Am) 75-A:1298 – 1307 In this classic case series, Bohlman et al. demonstrated that the fusion results of ACDF are critically dependent on the amount of levels fused. The fusion rates for one, two and mul- tilevel fusions were 89%, 73% and 67 %, respectively. Savolainen S, Rinne J, Hernesniemi J (1998) A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnec- essary. Neurosurgery 43:51 – 5 In this RCT, the authors demonstrated that the radiological results indicated that com- plete bony union was achieved in almost all cases at 4years of follow-up. A slight kyphosis developed in 62.5% of the patients who had undergone discectomy, 40% of the patients who had undergone fusion, and 44% of the patients who had undergone fusion plus plat- ing.Theclinicaloutcomesweregoodfor76%ofthepatientswhohadundergonediscec- tomy, 82% who had undergone fusion, and 73% who had undergone fusion plus plating. The authors concluded that satisfactory results can be achieved by performing simple discectomy to treat single-level cervical root compressive disease. Grob D , Peyer JV, Dvorak J (2001) The use of plate fixation in anterior surgery of the degenerative cerv ical spine: a comparative prospective clinical study. Eur Spine J 10: 408 – 13 In this small RCT, the authors demonstrated that outcome and fusion rates of one- and two-level fusion were independent of anterior plating. WangJC,McDonoughPW,EndowKK,DelamarterRB(2000) Increased fusion rates with cervical plating for two-level anterior cervical discectomy and fusion. Spine 25:41 –5 This study demonstrates the benefits of anterior plating for three-level fusions on the radiological outcome. However, the study also indicated that a three-level procedure is still associated with a high non-union rate and additional posterior fusion may be indi- cated in these cases. Kadanka Z, Bednarik J, Vohanka S, Vlach O, Stejskal L, Chaloupka R, Filipovicova D, SurelovaD,AdamovaB,NovotnyO,NemecM,SmrckaV,UrbanekI(2000)Conservative treatment versus surgery in spondylotic cerv ical myelopathy: a prospective randomised study. Eur Spine J 9:538 –44 In a prospective randomized study, the authors compared the conservative and operative treatment of 48 patients with mild and moderate forms of cervical spondylotic myelopa- thy (CSM). The authors concluded that surgical treatment of mild to moderate forms of CSM in the present study design, comprising patients with no or very slow, insidious pro- gression and a relatively long duration of symptoms, did not show better results than con- servative treatment at 2-year follow-up. Degenerative Disorders of the Cervical Spine Chapter 17 467 Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K (1981)Operativeresults and postoperative progression of ossification among patients with ossification of cervi- cal posterior longitudinal ligament. Spine 6:354 – 64 Classic article on the technique of laminoplasty. Edwards CC, 2nd, Heller JG, Murakami H (2002) Corpectomy versus laminoplasty for multilevel cervical myelopathy: an independent matched-cohort analysis. Spine 27:1168 – 75 In this matched cohort study, the authors demonstrated that both multilevel corpectomy and laminoplasty reliably arrest myelopathic progression in multilevel cervical myelopa- thy. Significantneurological recovery and pain reduction can be expected in amajority of patients. The authors suggested that laminoplasty may be the preferred method of treat- ment for multilevel cervical myelopathy in the absence of preoperative kyphosis. Ratliff JK, Cooper PR (2003) Cervical laminoplasty: a critical review. J Neurosurg 98: 230 – 8 The authors conducted a metaanalysis on laminoplasty including more than 2000 patients from 71 studies. Twenty-three papers provided data on the percentage of patients improving (mean approximately 80%). The recovery was independent of the technique. A postoperative deterioration of cervical alignment was found in approximately 35%, and 10% developed postoperative kyphosis in the long term. In the long-term follow-up, progressive loss of cervical ROM was observed. Final ROM appears to be similar to that seen in patients who had undergone laminectomy and fusion. In only seven articles were the rates of postoperative axial neck pain quantified, noting an incidence between 6% and 60%. In approximately 8% of patients, C5 nerve root dysfunction was reported (in 12 articles). References 1. Abumi K, Kaneda K (1997) Pedicle screw fixation for nontraumatic lesions of the cervical spine. 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