Outcome and surgical indications of one-stage combined anterior and posterior approach for cervical myelopathy

English Keywords:Cervical spine  Decompression  Anterior approach  Laminoplasty

English Abstract:

  【Absract】 Objective：To evaluate the outcome and surgical indications of one-stage combined anterior and posterior approach for cervical myelopathy.Method：From January 2002 to December 2007，48 patients underwent one-stage combined anterior and posterior approach for cervical myelopathy in our department.The enrollment criteria were multi-level involvement and severe spinal cord compression ventrally/C5（6） nerve root compression ventrally.The procedures were posterior bilateral open-door laminoplasty and decompression followed by anterior discectomy or corpectomy together with anterior fusion and internal fixation.Result：The operation time was 160-535min（average，226.5min） and the blood loss was 180－1200ml（average，367.6ml）.No one died of the operation.The complications included 1 delayed skin incision healing，1 cerebrospinal fluid leakage and 1 C5 right nerve root palsy.All patients were followed up for 10－38 months（average，15.8 months）.All patients achieved bony fusion and no instrument failure was noted.The average JOA score improved from 8.5 of pre-operation to 14.4 of post-operation，with the recovery rate of 67.7%.Conclusion：One-stage combined anterior and posterior approach，which has the features of sufficient decompression，good reconstruction of the cervical stability，lower risk of spinal cord injury compared with single anterior approach and lower incidence of nerve root palsy compared with single posterior approach，is reliable at preliminary stage and is indicated for patients with multi-level involvement and severe spinal cord or nerve root compression ventrally，and with good general condition.