Laminectomy for cervical myelopathy.
METHODS
Cervical laminectomy with or without fusion, or laminoplasty, successfully address congenital or acquired stenosis, multilevel spondylosis, ossification of the posterior longitudinal ligament (OPLL), and ossification of the yellow ligament (OYL). To optimize surgical results, however, these procedures should be applied to carefully selected patients.


OBJECTIVE
To determine the clinical, neurodiagnostic, appropriate posterior cervical approaches to be employed in patients presenting with MR- and CT-documented multilevel cervical disease. To limit perioperative morbidity, dorsal decompressions with or without fusions should be performed utilizing awake intubation and positioning and continuous intraoperative somatosensory-evoked potential monitoring.


METHODS
United States of America.


METHODS
The clinical, neurodiagnostic, and varied dorsal decompressive techniques employed to address pathology are reviewed. Techniques, including laminectomy, laminoforaminotomy, and laminoplasty are described. Where preoperative dynamic X-rays document instability, simultaneous fusions employing wiring or lateral mass plate/screw or rod/screw techniques may be employed. Nevertheless, careful patient selection remains one of the most critical factors to operative success as older individuals with prohibitive comorbidities or fixed long-term neurological deficits should not undergo these procedures.


RESULTS
Short- and long-term outcomes following dorsal decompressions with or without fusions vary. Those with myelopathy over 65 years of age often do well in the short-term, but demonstrate greater long-term deterioration. Factors that correlated with greater susceptibility to deterioration include advanced age (>70 years at the time of the first surgery), severe original myelopathy, and recent trauma.


CONCLUSIONS
Success rates of laminectomy with or without fusion, or laminoplasty may be successfully employed to address multilevel cervical pathology in a carefully selected population of patients.
The Albert Einstein College of Medicine, Bronx, NY, USA.
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Epstein
D001864:Bone Wires; D002574:Cervical Vertebrae; D019299:Decompression, Surgical / Q000379:methods; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods; D013118:Spinal Cord Diseases / Q000473:pathology / Q000601:surgery*; D013122:Spinal Diseases / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D013514:Surgical Procedures, Operative; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome