title: Surgical treatment of severe multilevel circumferential compressive myelopathy of the cervical spine: is circumferential procedure necessary?
abstract: OBJECTIVE
  To determine the necessity of circumferential decompression and fusion in patients with severe multilevel cervical spondylotic myelopathy with circumferential cord compression.
  
  
  METHODS
  This prospective study involved 51 patients with severe multilevel circumferential cervical myelopathy underwent two-stage circumferential procedure between July 2008 and June 2010. VAS scores, satisfaction surveys and JOA scores and imaging studies were obtained. Twenty-three patients (45.1%) underwent two-stage surgery (group A); the other 28 patients (54.9%) were satisfied with the outcomes after first-stage surgery, and the second-stage surgery was avoided (group B). Age, sex and symptom duration did not differ between the groups.
  
  
  RESULTS
  Patients were followed up for 3-5 years (mean, 42.5 months). In group A, VAS and JOA scores significantly improved from 63.3 and 7.9 to 38.3 and 10.4, respectively, at 3 months after the first-stage operation and 10.2 and 12.7, respectively, at 3 months after the second-stage operation. In group B, the VAS and JOA scores significantly improved from 62.7 and 7.9 to 31.1 and 11.2 respectively, at 3 months and 18.2 and 12.4, respectively at 6 months. Patient satisfaction rate significantly increased from 43.5% after the first-stage operation to 82.6% after the second-stage operation in group A. In group B, this rate was 89.3%. In group A, cervical spine lordosis increased from 12.8° preoperatively to 18.5° (p < .0001) and 19.1° (p > .05) at 3 months after the first-stage and second-stage operations, respectively. In group B, lordosis significantly increased from 12.5° preoperatively to 18.8° at 3 months. The total complication rate did not significantly differ from the rates after a single surgery (either anterior or posterior).
  
  
  CONCLUSIONS
  Only 45.1% patients required surgery via both approaches. Therefore, a two-stage procedure is a rational choice and safe procedure. If outcomes are unsatisfactory after the first-stage operation, a second-stage operation can be performed.
authors.affiliation: a Department of Orthopedics , Sixth People's Hospital, Shanghai Jiaotong University , Shanghai , China.
authors.forename: Xiao-Kang
authors.initials: XK
authors.lastname: Liu
authors.affiliation: a Department of Orthopedics , Sixth People's Hospital, Shanghai Jiaotong University , Shanghai , China.
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: a Department of Orthopedics , Sixth People's Hospital, Shanghai Jiaotong University , Shanghai , China.
authors.forename: Jian-Guang
authors.initials: JG
authors.lastname: Xu
authors.affiliation: a Department of Orthopedics , Sixth People's Hospital, Shanghai Jiaotong University , Shanghai , China.
authors.forename: Er-Zhu
authors.initials: EZ
authors.lastname: Yang
authors.affiliation: b Department of Orthopedics , Tenth People's Hospital, Tongji University , Shanghai , China.
authors.forename: Tie-Sheng
authors.initials: TS
authors.lastname: Hou
authors.affiliation: a Department of Orthopedics , Sixth People's Hospital, Shanghai Jiaotong University , Shanghai , China.
authors.forename: Bing-Fang
authors.initials: BF
authors.lastname: Zeng
authors.affiliation: a Department of Orthopedics , Sixth People's Hospital, Shanghai Jiaotong University , Shanghai , China.
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Lian
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008141:Lordosis / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: Multilevel; cervical myelopathy; circumferential cervical surgery; circumferential compression; two-stage