title: Surgical management of cervical spondylotic myelopathy with laminectomy and instrumented fusion.
abstract: OBJECTIVE
  The indications for treating cervical spondylotic myelopathy (CSM) with laminectomy and instrumented fusion remain ill-defined. Cervical laminectomy without instrumented fusion has been associated with suboptimal outcomes, particularly in the setting of cervical kyphosis. This work's purpose is to retrospectively review our experience in patients who underwent laminectomy with instrumented fusion for CSM and to assess the neurological and radiological outcomes of patients treated with this technique.
  
  
  METHODS
  Fifty-four consecutive patients underwent multilevel laminectomy and instrumented fusion for CSM. The indications were patients with (1) cervical stenosis > or = 3 spinal segments and (2) absence of a cervical kyphosis or (3) patients older than 65 years with significant medical comorbidities. Nurick myelopathy grades and cervical radiographs were obtained preoperatively and at 3, 6, 12 and 24 months post-operatively. Perioperative complications, radiographic and clinical outcomes were assessed and reported in this paper.
  
  
  RESULTS
  Forty-four (81%) of patients showed improvement in Nurick grade after surgery by a mean of 17 months. Ten patients (19%) demonstrated stable but unimproved myelopathy. Increasing pre-operative Nurick grade was associated with an improved post-operative outcome (p<0.02). Increasing duration of pre-operative myelopathy was associated with a decreased likelihood of myelopathy improvement (p<0.001).
  
  
  CONCLUSIONS
  Multilevel cervical laminectomy with instrumented fusion for patients with CSM resulted in an improvement in myelopathy in the majority of cases. Efficacy was similar for patients who may not have tolerated an anterior decompression, such as elderly patients with significant medical comorbidities. Hardware-related complication rates were relatively low.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287, USA.
authors.forename: Beril
authors.initials: B
authors.lastname: Gok
authors.forename: Gregory S
authors.initials: GS
authors.lastname: McLoughlin
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Kaisorn L
authors.initials: KL
authors.lastname: Chaichana
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D013118:Spinal Cord Diseases / Q000601:surgery*; D013123:Spinal Fusion; D055009:Spondylosis / Q000601:surgery*; D016896:Treatment Outcome