Download - Hitchon Cervical
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Posterior decompressionand/or fusion in cervical
degenerative disease Professor of Neurosurgery andBioengineering Director of Spine Fellowship University of Iowa Hospitalsand Clinics
Patrick W. Hitchon, MD
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Posterior decompression
and/or fusion in cervicaldegenerative disease
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Address pathology
Anterior
PosteriorBoth
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7/7/0848 yr old manmyelpoathy with
arm weakness
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7/7/08
Cerv stenosis with myelopathy
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Surgery 9/23/08C4-5 corpectomy,PEEK grafting,Anterior plating
Post op dysphagia
Follow-up 7/23/09
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PEG removed 4/27/09Follow-up 7/23/09
Improved symptomsStill myelopathic,imbalance,uncoordinated
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Address pathology
Anterior
PosteriorBoth
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Patient RL
62-year-old male with tingling andnumbness in the left leg. Progressed to leftupper extremity, and now in the rightupper extremity.
Difficulty walking, sways and falls to theleft. Clumsy in his left hand.
Motor 5/4 R/L. RAMs impaired on left
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12/29/09
C3-4
C4-5
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6/15/10
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6/15/10
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Address pathology
Anterior
PosteriorBoth
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7/28/08Extension
69 year old ladyKyphotic deformity of neckNeck pain
Holds chin up with hand
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7/28/08
Flexion
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7/17/08CT
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What to do?A fair amount of correction
One time operation
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9/18/08
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9/18/08Improved,still having neck painNot entirely happy
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Report of the AANS Study Group
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Cervical laminectomy for cervicalmyelopathy AANS, JNS Spine 2009
Laminectomy recommended forsymptomatic CSM in whom the risk ofkyphosis is minimal (Class III, strength D).
Limitations of laminectomy are increasedrisk of kyphosis compared to anteriorapproaches, or lami with fusion. Kyphosisdoes not diminish clinical outcome (ClassIII, strength D)
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Gock, Sciubba et alNeurosurgery 63 (2):292-8,
2008
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Between 2002-2006, 30 patients with CSM and postoperativepseudoarthrosis, instability, hardware failure, orrecurrrent stenosis underwent surgical decompression andstabilization. The specific procedure was individualized.Charts were reviewed retrospectivelyMean F/U 19 mo (2-64 mo)
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4
15
21
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Complications
Ant approach (4): 0/4 Post only (15): 2 transient weakness, 2
transient dysphagia Ant+Post (11): 1 PEG, 1 infection, 1 fell in
hospital with quadriplegia
Overall 27%
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Revision surgery for recurrentcervical myelopathy
Complication rate 27% Improvement 25/30
Improvement worthwhile in spite of
complications
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Cervical stenosisRecommendations:
Lordotic, stenosis up to 3 levels: ACDF Lordotic, stenosis > 3 levels: Post
decomp+/-PL instrumentation+fusion Kyphotic: Ant+Post decomp+Inst
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Lordosis lineGwinn, Iannotti et al JNS Spine 2009
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