Decompressive Cervical Laminectomy and Lateral Mass Screw-Rod Fusion for Multisegmental Cervical Spondylotic Myelopathy with Flexible Sagittal Cervical Alignment

Abstract

Background data: Posterior cervical laminectomy and lateral mass screw-rod fusion techniques were classically recommended in fl exible sagittal cervical alignment relying on indirect decompression via posterior cord shift. Purpose : This study aims to investigate the ef fi cacy of posterior cervical laminectomy with lateral mass screw-rod fi xation for treating multisegmental cervical spondylotic myelopathy (MCSM) with fl exible sagittal cervical alignment. Study design: This was a prospective clinical cohort study. Patients and methods: In total, 38 patients with clinically symptomatic MCSM with instability and/or fl exible kyphosis were admitted to our Zagazig University hospitals for posterior cervical laminectomy and lateral mass screw-rod fusion (long-segment instrumented fusion ≥ 3 segments) and completed the 24-month follow-up period between April 2014 and June 2018, and the last follow-up visit took place in October 2020. Patients were categorized into lordotic, straight, and kyphotic groups according to the shape of the cervical spine curve on a neutral lateral radiographic view. Results: A total of 266 lateral mass screws were inserted in 134 levels in 38 patients (three levels in 20 patients, four levels in 16 patients, and fi ve levels in two patients); all the patients had a good fusion, and the cervical spine was stable, based on the absence of hardware failure or subsidence. All 38 (100%) patients gained more lordosis with a variable degree according to the preoperative cervical sagittal alignment. The mean percentage of neck pain improvement according to the visual analog scale for the lordotic group was 69.1%, for the straight group was 43.8%, and for the kyphotic group was 15.8%. The mean percentage of neurological function improvement (Japanese Orthopedic Association score) for the lordotic group was 83.17%, for the straight group was 43%, and for the kyphotic group was 17%. The mean percentage of disability improvement (Neck Disability Index score) for the lordotic group was 47.66%, for the straight group was 24.5%, and for the kyphotic group was 16.66%. Conclusion: Decompressive cervical spine laminectomy with lateral mass screw stabilization is effective in treating MCSM with fl exible sagittal cervical alignment (2022ESJ259).