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Anterior Neurodecompression of Kyphotic Spondylogenic Myelopathy Ranawat Grade III and Posterior Decompression of Lordotic Spine Improve Walking Ability

The aim of our study was to present the results of surgically treated spondylogenic myelopathy. From January 1, 1998 to December 31, 2007 a total of 77 patients with spondylogenic myelopathy graded as Ranawat III were referred to our Department. Exclusion criteria were coexisting anterolateral sclerosis (ALS) or multiple sclerosis (MS). The curvature of the spine was determined on radiographs. Myelopathy was clinically quantified using the Nurick grading scale, the modified Japanese Orthopedic Association (mJOA) grading scale and walking test. Radiological quantification was made by transverse cord and subarachnoid space areas. Anterior corpectomy with fusion was performed in the kyphotic, open door laminoplasty in the lordotic, and laminectomy with lateral mass fusion in the straightened spines. Improvement was measured as the difference between preoperative and one- year follow- up results. The Smirnov-Kolmogorov test was used for data distribution, and paired samples t-test to evaluate the difference between preoperative and postoperative data. Forty-four male and 31 female patients (mean age 61) were surgically treated. Two patients with electrophysiological signs of ALS were excluded. The preoperative and postoperative mJOA index (mean ± SD) was 9.15± 0.982 (range, 8-11) and 13.08± 1.421 (p), the Nurick grade 3.05± 0.7 (range, 2-5) and 1.76± 0.633 (p), the walking time (sec) 64.4± 3.214 and 46.21± 3.264 (p), and the number of steps 69.72± 4.363 and 57.61± 2.842 (p) respectively. The preoperative and postoperative transverse cord area (mean± SD, mm2) measured 46.73± 5.424 and 60.20± 2.589 (p), and the subarachnoid space 48.0± 4.904 and 68.81± 8.532 (p<0.001) respectively. Our results suggest that patients with spondylogenic cervical myelopathy improved significantly their ability to walk and quality of life after thorough surgical decompression, the type of which was selected according to spinal curvature.

spondylogenic myelopathy; neurodecompression; walking ability; spinal curvature

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