Introduction: Extreme cervical stenosis is defined as antero-posterior spinal canal diameter of 5 mm or less (Figure 1) and is frequently associated with progressive myelopathy. The optimal surgical approach for treating cervical spondylotic myelopathy is uncertain, and to our knowledge no study has specifically focused on the clinical outcome in patients with extreme degrees of cervical canal compromise. In this case series we sought to determine the safety and basic clinical outcome of posterior non-instrumented decompression for extreme multilevel cervical stenosis.
Methods: We identified 35 patients with extreme cervical stenosis who underwent multilevel cervical laminectomy or laminoplasty at our institution between 2007 and 2011. Retrospective chart review and phone surveys were employed to assess pre- and post-operative neurological function and outcome parameters such as Nurick score, Cooper upper and lower extremity scores, Prolo economic and functional scores, the visual analog pain scale (VAS), subjective impression of improvement, and overall surgical satisfaction. Results were compared using analysis of variance (ANOVA).
Results: We observed a trend in Nurick (2.9 to 2.6), Cooper upper extremity (2.3 to 1.9), Cooper lower extremity (1.6 to 1.5), and Prolo economic (2.7 to 2.9) scores to improve and Prolo functional (2.6 to 2.4) and VAS (3.1 to 4.2) scores to deteriorate postoperatively, although based on ANOVA statistics these changes were not significant. Among our survey respondents, 76% reported improvement or no change in dysesthesia symptoms and 24% reported worsening of dysesthesia symptoms. Overall subjective impression of the surgery was positive or neutral in 69% of the patients and negative in 31% of the patients.
Conclusions: Given inherent limitations in interpretation of clinical case series data, we believe posterior non-instrumented decompressive surgery for extreme cervical stenosis is a generally safe procedure that does not worsen the condition and possibly prevents further decline.
Patient Care: This study assesses general safety and basic clinical outcome of posterior non-instrumented decompressive surgery as a first step in determining optimal treatment strategies for patients with extreme multilevel cervical stenosis. Randomized trials comparing various treatment strategies will be the next step towards this goal.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the significance of extreme multilevel cervical stenosis; 2) Discuss potential surgical strategies to treat this condition; and 3) Appreciate that posterior non-instrumented decompressive surgery is a generally safe and effective treatment option.