In-situ decompression to spinal cord during anterior controllable antedisplacement fusion treating degenerative kyphosis with stenosis: surgical outcomes and analysis of C5 nerve palsy based on 49 patients.

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In-situ decompression to spinal cord during anterior controllable antedisplacement fusion treating degenerative kyphosis with stenosis: surgical outcomes and analysis of C5 nerve palsy based on 49 patients.

World Neurosurg. 2018 Apr 21;:

Authors: Yang H, Sun J, Shi J, Yang Y, Guo Y, Zheng B, Wang Y

Abstract
OBJECTIVE: To observe outcomes of anterior controllable antedisplacement fusion (ACAF) in the treatment for degenerative kyphosis with stenosis (DKS) and analyze the probability of C5 nerve palsy.
METHODS: In the period from 2016 to 2017, a consecutive cohort of adults with DKS underwent ACAF. All these patients were performed cervical plain films, CT and MRI. The operation duration, blood loss and hospital stay was estimated. Radiologic assessment included kyphotic correction, decompression width and spinal canal area. Postoperative curvature of spinal cord was observed on sagittal MRI. The JOA scoring system was used to evaluate the neurological status. C5 nerve palsy and other complications were all recorded.
RESULTS: Fourty-nine patients were included in the study. There was significant kyphosis correction after operation (-19.4° vs. 3.5°, P<0.01). On cross-sectional CT images, the mean decompression width and spinal canal area was 19.0mm and 218.5 mm2. On sagittal MRI, the spinal cord curvature was classified into five types, type I-lordosis, type II-straight with no shifting, type III-straight with shifting, type IV-sigmoid, and type V-kyphosis. After ACAF, the spinal cord is kept in good curvature with no shifting in all patients. No patient presented with C5 nerve palsy. The mean postoperative JOA score was significantly better than preoperation (14.9 vs. 9.0 points, P<0.01), with a mean improvement rate of 79.8%.
CONCLUSIONS: ACAF provides an in-situ decompression and good curvature to the spinal cord. accordingly, it attains good neurological recovery and lower incidence of C5 nerve palsy when it is used in the treatment for DKS.

PMID: 29689396 [PubMed - as supplied by publisher]

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