title: Complex cervical spondylotic myelopathy: a report of two cases and literature review.
abstract: A report of two cases with complex cervical spondylotic myelopathy (CSM) and review of the literature.
  
  
  
  To describe two unique patients with complex CSM due to simultaneous anomalies as anteroposterior compressions of the spinal cord in both upper and lower cervical spine, caused by hypertrophic transverse ligament of atlas (TLA), dysplasia of the posterior arch of atlas, disc herniation, hypertrophic ligamentum flavum and osteophytes.
  
  
  
  We present such two cases with clinical, imageological presentations, and describe the surgical procedure, to which both patients responded favorably.
  
  
  
  The neurological functions of both patients gradually improved according to the JOA scores and VAS scores in preoperative clumsiness and gait disturbance during the mean follow-up period lasted for 18 months. The latest plain radiographs and computed tomography (CT) revealed good fusion without instrumental failure and magnetic resonance imaging (MRI) showed good decompression of C1-7 spinal cord of both patients. Both patients are progressively followed-up.
  
  
  
  Posterior surgical approach as C1-7 laminectomy with fixations or occipital-cervical fusions may obtain better reconstructions of the cervical spine and good neurological recovery for the patients with complex CSM we present. However, the incidence and ethnic predisposition for the patients with complex CSM are still unclear.
authors.affiliation: Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Ma
authors.affiliation: Department of Orthopaedics, ShanxiDa Yi Hospital, No. 99 Long Cheng Street, Taiyuan, 030031, Shanxi Province, China.
authors.forename: Xun
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China. Soochowspine@139.com.
authors.forename: Huilin
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Orthopaedics, ShanxiDa Yi Hospital, No. 99 Long Cheng Street, Taiyuan, 030031, Shanxi Province, China.
authors.forename: Haoyu
authors.initials: H
authors.lastname: Feng
authors.affiliation: Department of Orthopaedics, ShanxiDa Yi Hospital, No. 99 Long Cheng Street, Taiyuan, 030031, Shanxi Province, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Chen
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000000981:diagnostic imaging; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000000981:diagnostic imaging; D008023:Ligaments, Articular / Q000000981:diagnostic imaging / Q000473:pathology; D017843:Ligamentum Flavum / Q000000981:diagnostic imaging / Q000473:pathology; D013117:Spinal Cord Compression / Q000150:complications / Q000000981:diagnostic imaging; D013128:Spinal Osteophytosis / Q000150:complications / Q000000981:diagnostic imaging; D055009:Spondylosis / Q000000981:diagnostic imaging / Q000209:etiology*
keywords: Cervical spondylotic myelopathy; Complex; Dysplasia; Fixation; Hypertrophy; Laminectomy; Posterior arch of atlas; Transverse ligament of atlas