ANTERIOR CERVICAL DECOMPRESSION AND ARTHRODESIS FOR THE TREATMENT OF CERVICAL SPONDYLOTIC MYELOPATHY - 2-YEAR TO 17-YEAR FOLLOW-UP

We reviewed the cases of 108 patients with cervical spondylotic myelop athy who had been managed with anterior decompression and arthrodesis at our institution. Operative treatment consisted of anterior discecto my, partial corpectomy, or subtotal corpectomy at one level or more, f ollowed by placement of autogenous bone graft from the iliac crest or the fibula, At the latest follow-up examination, thirty-eight of the e ighty-two patients who had had a preoperative gait abnormality had a n ormal gait, thirty-three had an improvement in gait, six had no change , four had improvement and later deterioration, and one had a worse ga it abnormality. Of the eighty-seven patients who had had a preoperativ e motor deficit, fifty-four had complete recovery; twenty-six, partial recovery; six, no change; and one had a worse deficit. The average gr ade according to the system of Nurick improved from 2.4 preoperatively to 1.2 (range, 0.0 to 5.0) postoperatively, A pseudarthrosis develope d in sixteen patients, thirteen of whom had had a multilevel discectom y. Only one of thirty-eight arthrodeses that had been performed with u se of a fibular strut graft was followed by a non-union. An unsatisfac tory outcome with respect to pain was significantly associated with ps eudarthrosis (p < 0.001), The development of complications other than non-union was associated,vith a history of one previous operative proc edure or more (p = 0.005), Recurrent myelopathy was rare, but when it occurred it was associated with a pseudarthrosis or stenosis at a new level. The strongest predictive factor for recovery from myelopathy wa s the severity of the myelopathy before the operative intervention - t hat is, better preoperative neurological function was associated with a better neurological outcome. Anterior decompression and arthrodesis with autogenous bone-grafting can be performed safely? and is associat ed with a high rate of neurological recovery, functional improvement, and pain relief, in patients who have cervical spondylotic myelopathy.