2017 HONORABLE MENTION

Cervical spondylotic myelopathy (CSM) is a common degenerative disease in adults. The natural history of the disease may be insidious, and patients often develop debilitating spasticity and weakness. Surgical treatment of patients with multilevel CSM aims to decompress the spinal cord and restore a more physiologic sagittal alignment. Several surgical options, including anterior and posterior procedures, are available for the management of CSM. Posterior decompression and stabilization in lordosis allows for back shift of the spinal cord, leading to indirect decompression of the anterior neural elements.

This video shows the surgical technique for posterior decompression and instrumented fusion in a 59-year-old man with C5 through C7 CSM and numbness and weakness at the superior limbs. The surgical steps discussed in the video include lateral mass identification via anatomic landmarks, lateral mass screw fixation based on the technique described by Roy-Camille, cervical decompression via C5 through C7 laminectomy, and attempted fusion via bone graft positioning. Graphic illustrations are are included to support the video and better explain the technique.

A total of 40 patients with multilevel CSM underwent surgical treatment with the use of this technique and were followed clinically and electrophysiologically. One of those patients is shown in our video presentation. Of the 40 patients, 36 were clinically assessed at a mean follow-up of 5.7 years. European Myelopathy Scores, modified Japanese Orthopedic Association scores, and Neck Disability Index significantly improved (P < 0.001). Ninety percent of the patients underwent the same surgery again. No deterioration of cervical alignment occurred, posterior grafted bones completely fused, and no instrumentation failure occurred. The mean spinal cord back shift was 3.9 mm (range, 2.5 to 4.5 mm). European Myelopathy Score and modified Japanese Orthopedic Association score recovery rates were significantly correlated with postoperative posterior cord migration (P < 0.05).

Posterior decompression and stabilization in lordosis is a valuable procedure for patients with multilevel CSM, leading to considerable clinical improvement because of spinal cord back shift. Postoperative lordotic alignment of the cervical spine is a key factor for successful management. This video may help surgeons at any stage of their career understand how to approach and appropriately manage multilevel CSM.