Short Form-36 outcomes following focal 1- and 2-level cervical laminectomy with multilevel instrumented fusion.
BACKGROUND
Multilevel laminectomy with instrumented fusion addresses diffuse dorsal cord compression with an adequately preserved cervical lordosis. However, for patients with only 1 to 2 laminar impingement, more "focal" laminectomy and fusion may suffice, the shortened laminectomy allowing for a more simple spinous process fusion skipping the 1 or 2 lamina that have been removed.


METHODS
Fourteen patients presented with severe spastic myeloradiculopathy (Nurick grade IV) attributed to magnetic resonance imaging- and CT-documented 1- to 2-level laminar compression, stenosis, and ossification of the yellow ligament. Magnetic resonance images also revealed 1- to 2-level hyperintense signals within the cord at the levels of maximal compromise. Surgical procedures included 1- to 2-level laminectomies and average 6.4-level posterior fusions. Dynamic x-ray/CT studies, which were obtained 3, 6, and up to 12 months postoperatively, followed progression toward fusion. Outcomes were assessed using Nurick grades (0-V) and SF-36 questionnaires assessed preoperatively and up to 12 months postoperatively.


RESULTS
Patients improved on all 8 SF-36 Health Scales within the first postoperative year. Maximal improvement was observed on 5 Health Scales within the first 6 postoperative months (physical function, mental health, vitality, general health, role physical). The preoperative average Nurick grade (3.8) improved postoperatively (0.7 at 6 months, 0.5 at 1 year). Dynamic x-ray and CT studies documented fusion for all 14 patients by the sixth postoperative month.


CONCLUSIONS
One- and two-level cervical laminectomies with multilevel-instrumented fusion effectively decompressed "focal" cord compression, whereas fusion maintained the cervical lordotic curvature and provided stability to avert future disease progression.
Epstein
Nancy E
NE
Department of Neurological Surgery, The Albert Einstein College of Medicine, Bronx, NY 10461, USA. dch3@columbia.edu
Epstein
Joseph A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000706:statistics & numerical data* / Q000639:trends; D007796:Laminectomy / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D017843:Ligamentum Flavum / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000639:trends; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011542:Pseudarthrosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D013117:Spinal Cord Compression / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D013128:Spinal Osteophytosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome