Revision surgery for cervical spondylotic myelopathy: surgical results and outcome
The role of additional or revision surgery in patients with cervical spondylotic myelopathy (CSM) is challenging. Postoperative pseudoarthrosis, instability, hardware failure, and recurrent cervical stenosis are conditions that require detailed clinical and radiographic assessment to define the path...
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Veröffentlicht in: | Neurosurgery 2008-08, Vol.63 (2), p.292-298 |
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creator | Gok, Beril Sciubba, Daniel M McLoughlin, Gregory S McGirt, Matthew Ayhan, Selim Wolinsky, Jean-Paul Bydon, Ali Gokaslan, Ziya L Witham, Timothy F |
description | The role of additional or revision surgery in patients with cervical spondylotic myelopathy (CSM) is challenging. Postoperative pseudoarthrosis, instability, hardware failure, and recurrent cervical stenosis are conditions that require detailed clinical and radiographic assessment to define the pathology and assess the need for surgical decompression and fusion. The purpose of this study is to assess the neurological outcome, radiological outcome, and complications of patients undergoing additional or revision surgery for CSM.
Between 2002 and 2006, 30 patients with CSM and postoperative pseudoarthrosis, instability, hardware failure, or recurrent stenosis underwent surgical decompression and stabilization. The specific procedure was selected according to each patient's medical condition, cervical sagittal alignment, and extent of stenosis. All patients underwent an anterior, posterior, or combined anterior and posterior decompression and instrumented fusion. The charts of these patients were reviewed to assess neurological and radiographic outcomes.
Twenty-five patients (83%) improved postoperatively as measured by the Nurick Myelopathy Scale over a mean follow-up period of 19 months (range, 2-64 mo). The overall complication rate was 27%, consisting of transient monoradiculopathy (7%), dysphagia (10%), and infection (7%). The incidence of nonunion during the follow-up period was 3%.
Although patients with CSM and postoperative pseudoarthrosis, instability, hardware failure, or junctional stenosis who require revision surgery may risk a substantial likelihood of surgical complications (25% in this series), a significant proportion of patients may experience improved neurological outcomes. In our experience, the cervical sagittal alignment and the extent of stenosis are critical factors to consider when selecting the eventual procedure. |
doi_str_mv | 10.1227/01.NEU.0000320441.86936.99 |
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Between 2002 and 2006, 30 patients with CSM and postoperative pseudoarthrosis, instability, hardware failure, or recurrent stenosis underwent surgical decompression and stabilization. The specific procedure was selected according to each patient's medical condition, cervical sagittal alignment, and extent of stenosis. All patients underwent an anterior, posterior, or combined anterior and posterior decompression and instrumented fusion. The charts of these patients were reviewed to assess neurological and radiographic outcomes.
Twenty-five patients (83%) improved postoperatively as measured by the Nurick Myelopathy Scale over a mean follow-up period of 19 months (range, 2-64 mo). The overall complication rate was 27%, consisting of transient monoradiculopathy (7%), dysphagia (10%), and infection (7%). The incidence of nonunion during the follow-up period was 3%.
Although patients with CSM and postoperative pseudoarthrosis, instability, hardware failure, or junctional stenosis who require revision surgery may risk a substantial likelihood of surgical complications (25% in this series), a significant proportion of patients may experience improved neurological outcomes. In our experience, the cervical sagittal alignment and the extent of stenosis are critical factors to consider when selecting the eventual procedure.</description><identifier>ISSN: 0148-396X</identifier><identifier>EISSN: 1524-4040</identifier><identifier>DOI: 10.1227/01.NEU.0000320441.86936.99</identifier><identifier>PMID: 18797359</identifier><language>eng</language><publisher>United States</publisher><subject>Cervical Vertebrae - diagnostic imaging ; Cervical Vertebrae - surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications - diagnostic imaging ; Postoperative Complications - surgery ; Pseudarthrosis - diagnostic imaging ; Pseudarthrosis - etiology ; Pseudarthrosis - surgery ; Radiography ; Reoperation ; Retrospective Studies ; Spinal Cord Diseases - diagnostic imaging ; Spinal Cord Diseases - surgery ; Spondylosis - diagnostic imaging ; Spondylosis - surgery ; Treatment Outcome</subject><ispartof>Neurosurgery, 2008-08, Vol.63 (2), p.292-298</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c260t-979da6da4699cdb6e07805cf82d6a138bb7d89591f75762ec4f6a9f2c21d8a223</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18797359$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gok, Beril</creatorcontrib><creatorcontrib>Sciubba, Daniel M</creatorcontrib><creatorcontrib>McLoughlin, Gregory S</creatorcontrib><creatorcontrib>McGirt, Matthew</creatorcontrib><creatorcontrib>Ayhan, Selim</creatorcontrib><creatorcontrib>Wolinsky, Jean-Paul</creatorcontrib><creatorcontrib>Bydon, Ali</creatorcontrib><creatorcontrib>Gokaslan, Ziya L</creatorcontrib><creatorcontrib>Witham, Timothy F</creatorcontrib><title>Revision surgery for cervical spondylotic myelopathy: surgical results and outcome</title><title>Neurosurgery</title><addtitle>Neurosurgery</addtitle><description>The role of additional or revision surgery in patients with cervical spondylotic myelopathy (CSM) is challenging. Postoperative pseudoarthrosis, instability, hardware failure, and recurrent cervical stenosis are conditions that require detailed clinical and radiographic assessment to define the pathology and assess the need for surgical decompression and fusion. The purpose of this study is to assess the neurological outcome, radiological outcome, and complications of patients undergoing additional or revision surgery for CSM.
Between 2002 and 2006, 30 patients with CSM and postoperative pseudoarthrosis, instability, hardware failure, or recurrent stenosis underwent surgical decompression and stabilization. The specific procedure was selected according to each patient's medical condition, cervical sagittal alignment, and extent of stenosis. All patients underwent an anterior, posterior, or combined anterior and posterior decompression and instrumented fusion. The charts of these patients were reviewed to assess neurological and radiographic outcomes.
Twenty-five patients (83%) improved postoperatively as measured by the Nurick Myelopathy Scale over a mean follow-up period of 19 months (range, 2-64 mo). The overall complication rate was 27%, consisting of transient monoradiculopathy (7%), dysphagia (10%), and infection (7%). The incidence of nonunion during the follow-up period was 3%.
Although patients with CSM and postoperative pseudoarthrosis, instability, hardware failure, or junctional stenosis who require revision surgery may risk a substantial likelihood of surgical complications (25% in this series), a significant proportion of patients may experience improved neurological outcomes. In our experience, the cervical sagittal alignment and the extent of stenosis are critical factors to consider when selecting the eventual procedure.</description><subject>Cervical Vertebrae - diagnostic imaging</subject><subject>Cervical Vertebrae - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Postoperative Complications - diagnostic imaging</subject><subject>Postoperative Complications - surgery</subject><subject>Pseudarthrosis - diagnostic imaging</subject><subject>Pseudarthrosis - etiology</subject><subject>Pseudarthrosis - surgery</subject><subject>Radiography</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Spinal Cord Diseases - diagnostic imaging</subject><subject>Spinal Cord Diseases - surgery</subject><subject>Spondylosis - diagnostic imaging</subject><subject>Spondylosis - surgery</subject><subject>Treatment Outcome</subject><issn>0148-396X</issn><issn>1524-4040</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkF1LwzAYhYMobk7_ghQvvGtN0nzuTsb8gKEwHHgX0iTVStvMpB3031u3wd6bc_Oc88IDwB2CGcKYP0CUvS03GRwvx5AQlAkmc5ZJeQamiGKSEkjgOZhCRESaS_Y5AVcx_kCIGOHiEkyQ4JLnVE7Beu12Vax8m8Q-fLkwJKUPiXFhVxldJ3HrWzvUvqtM0gyu9lvdfQ_zPbwHgot93cVEtzbxfWd8467BRanr6G6OOQObp-XH4iVdvT-_Lh5XqcEMdqnk0mpmNWFSGlswB7mA1JQCW6ZRLoqCWyGpRCWnnGFnSMm0LLHByAqNcT4D94fdbfC_vYudaqpoXF3r1vk-KiYpFYzSEZwfQBN8jMGVahuqRodBIaj-jSqI1GhUnYyqvVEl5Vi-PX7pi8bZU_WoMP8D9zB0Jg</recordid><startdate>200808</startdate><enddate>200808</enddate><creator>Gok, Beril</creator><creator>Sciubba, Daniel M</creator><creator>McLoughlin, Gregory S</creator><creator>McGirt, Matthew</creator><creator>Ayhan, Selim</creator><creator>Wolinsky, Jean-Paul</creator><creator>Bydon, Ali</creator><creator>Gokaslan, Ziya L</creator><creator>Witham, Timothy F</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200808</creationdate><title>Revision surgery for cervical spondylotic myelopathy: surgical results and outcome</title><author>Gok, Beril ; Sciubba, Daniel M ; McLoughlin, Gregory S ; McGirt, Matthew ; Ayhan, Selim ; Wolinsky, Jean-Paul ; Bydon, Ali ; Gokaslan, Ziya L ; Witham, Timothy F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c260t-979da6da4699cdb6e07805cf82d6a138bb7d89591f75762ec4f6a9f2c21d8a223</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Cervical Vertebrae - diagnostic imaging</topic><topic>Cervical Vertebrae - surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Postoperative Complications - diagnostic imaging</topic><topic>Postoperative Complications - surgery</topic><topic>Pseudarthrosis - diagnostic imaging</topic><topic>Pseudarthrosis - etiology</topic><topic>Pseudarthrosis - surgery</topic><topic>Radiography</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Spinal Cord Diseases - diagnostic imaging</topic><topic>Spinal Cord Diseases - surgery</topic><topic>Spondylosis - diagnostic imaging</topic><topic>Spondylosis - surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gok, Beril</creatorcontrib><creatorcontrib>Sciubba, Daniel M</creatorcontrib><creatorcontrib>McLoughlin, Gregory S</creatorcontrib><creatorcontrib>McGirt, Matthew</creatorcontrib><creatorcontrib>Ayhan, Selim</creatorcontrib><creatorcontrib>Wolinsky, Jean-Paul</creatorcontrib><creatorcontrib>Bydon, Ali</creatorcontrib><creatorcontrib>Gokaslan, Ziya L</creatorcontrib><creatorcontrib>Witham, Timothy F</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gok, Beril</au><au>Sciubba, Daniel M</au><au>McLoughlin, Gregory S</au><au>McGirt, Matthew</au><au>Ayhan, Selim</au><au>Wolinsky, Jean-Paul</au><au>Bydon, Ali</au><au>Gokaslan, Ziya L</au><au>Witham, Timothy F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Revision surgery for cervical spondylotic myelopathy: surgical results and outcome</atitle><jtitle>Neurosurgery</jtitle><addtitle>Neurosurgery</addtitle><date>2008-08</date><risdate>2008</risdate><volume>63</volume><issue>2</issue><spage>292</spage><epage>298</epage><pages>292-298</pages><issn>0148-396X</issn><eissn>1524-4040</eissn><abstract>The role of additional or revision surgery in patients with cervical spondylotic myelopathy (CSM) is challenging. Postoperative pseudoarthrosis, instability, hardware failure, and recurrent cervical stenosis are conditions that require detailed clinical and radiographic assessment to define the pathology and assess the need for surgical decompression and fusion. The purpose of this study is to assess the neurological outcome, radiological outcome, and complications of patients undergoing additional or revision surgery for CSM.
Between 2002 and 2006, 30 patients with CSM and postoperative pseudoarthrosis, instability, hardware failure, or recurrent stenosis underwent surgical decompression and stabilization. The specific procedure was selected according to each patient's medical condition, cervical sagittal alignment, and extent of stenosis. All patients underwent an anterior, posterior, or combined anterior and posterior decompression and instrumented fusion. The charts of these patients were reviewed to assess neurological and radiographic outcomes.
Twenty-five patients (83%) improved postoperatively as measured by the Nurick Myelopathy Scale over a mean follow-up period of 19 months (range, 2-64 mo). The overall complication rate was 27%, consisting of transient monoradiculopathy (7%), dysphagia (10%), and infection (7%). The incidence of nonunion during the follow-up period was 3%.
Although patients with CSM and postoperative pseudoarthrosis, instability, hardware failure, or junctional stenosis who require revision surgery may risk a substantial likelihood of surgical complications (25% in this series), a significant proportion of patients may experience improved neurological outcomes. In our experience, the cervical sagittal alignment and the extent of stenosis are critical factors to consider when selecting the eventual procedure.</abstract><cop>United States</cop><pmid>18797359</pmid><doi>10.1227/01.NEU.0000320441.86936.99</doi><tpages>7</tpages></addata></record> |
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subjects | Cervical Vertebrae - diagnostic imaging Cervical Vertebrae - surgery Female Follow-Up Studies Humans Male Middle Aged Postoperative Complications - diagnostic imaging Postoperative Complications - surgery Pseudarthrosis - diagnostic imaging Pseudarthrosis - etiology Pseudarthrosis - surgery Radiography Reoperation Retrospective Studies Spinal Cord Diseases - diagnostic imaging Spinal Cord Diseases - surgery Spondylosis - diagnostic imaging Spondylosis - surgery Treatment Outcome |
title | Revision surgery for cervical spondylotic myelopathy: surgical results and outcome |
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