title: Smith-Robinson procedure with and without Caspar plating as a treatment for cervical spondylotic myelopathy: A 26-year follow-up of 23 patients.
abstract: The purpose of this study was to assess long-term follow-up data after anterior cervical decompression and fusion (ACDF) with and without Caspar plating (ACDF + PS) for the treatment of cervical spondylotic myelopathy (CSM) with special focus on functional outcome, pain, and repeat surgery for adjacent segment disease (ASD).
  
  
  
  Hospital records of 45 patients who were affected by CSM and underwent ACDF or ACDF + PS at least 17 years ago were reviewed. Information about diagnosis, surgical report, pre- and postoperative clinical process, and complications was analyzed. Clinical outcome was assessed using a standardized questionnaire including the Neck Disability Index (NDI), modified JOA-score, Odom's criteria, limitations in quality of life, and questions about the current neurological status and pain.
  
  
  
  Twenty-three patients with a mean follow-up of 26 years were evaluated. ACDF was performed in nine and ACDF + PS in 14 patients, respectively. At follow-up 78.3% of patients were free of pain, 91.3% had no motor deficit, 73.9% had no sensory deficit, and 60.7% had no gait disturbance. The current mean NDI is 14% (range 2-44%), the mean modified JOA-score was 17.2 (range 15-18). According to Odom's criteria 78.3% of patients had clinical success. In four patients repeat surgery was indicated due to pseudarthrosis or symptomatic ASD (17.4%).
  
  
  
  ACDF and ACDF + PS yield significant decrease in neck pain, a significant increase in sensorimotor function and a high rate of clinical success. Patients with preoperative gait disturbance completely recovered in about 60% of cases. Overall prevalence for ASD was 17.4% after 25 years.
authors.affiliation: Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrbergerstrasse 100, Building 90.5, 66421, Homburg, Saar, Germany. benedikt.burkhardt@gmail.com.
authors.forename: Benedikt W
authors.initials: BW
authors.lastname: Burkhardt
authors.affiliation: Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrbergerstrasse 100, Building 90.5, 66421, Homburg, Saar, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Brielmaier
authors.affiliation: Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrbergerstrasse 100, Building 90.5, 66421, Homburg, Saar, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Schwerdtfeger
authors.affiliation: Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan.
authors.forename: Salam
authors.initials: S
authors.lastname: Sharif
authors.affiliation: Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrbergerstrasse 100, Building 90.5, 66421, Homburg, Saar, Germany.
authors.forename: Joachim M
authors.initials: JM
authors.lastname: Oertel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology / Q000601:surgery; D019547:Neck Pain / Q000209:etiology / Q000601:surgery; D010147:Pain Measurement; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D012678:Sensation Disorders / Q000209:etiology / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D055009:Spondylosis / Q000601:surgery*
keywords: Adjacent segment disease; Anterior cervical discectomy and fusion; Cervical plating; Cervical spondylotic myelopathy; Long-term follow-up