Cervical Spondylotic Myelopathy Caused by Single-Level Vertebral Spontaneous Fusion
Citation: Yan N, Yu S, Hou T, Gu G, Zhang H, et al. (
Cervical Spondylotic Myelopathy Caused by Single-Level Vertebral Spontaneous Fusion
Ning Yan." 0
Shunzhi Yu." 0
Tiesheng Hou 0
Guangfei Gu 0
Hailong Zhang 0
Shan Zhao 0
Shisheng He 0
Paul Park, University of Michigan, United States of America
0 Department of Orthopedic Surgery, Shanghai 10th People's Hospital, Tongji University School of Medicine , Shanghai , China
Purpose: To evaluate the clinical features, imaging characteristics, surgical options, and clinical outcomes of patients with Cervical spondylotic myelopathy (CSM) caused by single-level vertebral spontaneous fusion (SLVSF). Methods: Sixteen consecutive patients with SLVSF who underwent anterior surgery were included in this study and 38 patients with CSM caused by spinal degeneration were enrolled as a control group. Demographic features, clinical presentations, imaging characteristics, surgery strategy, Nurick grade, Japanese Orthopedic Association (JOA) score, neck disability index (NDI), and complications were evaluated. Results: There were significant differences between the two groups in the mean age and the average duration of neck pain. There was no significant difference between the two groups in length of cervical spine. In the SLVSF group, 13 patients had upper segment translational instability and none had rotational instability. Pre- and postoperative Nurick grades were 2.9460.77 and 2.1960.54 in the SLVSF group, and 2.9760.72 and 2.1660.64 in the control group. Pre- and postoperative JOA scores were 9.2562.02 and 11.6961.62 in the SLVSF group, and 9.8762.58 and 12.5362.69 in the control group. Pre- and postoperative NDI values were 28.567.75 and 15.5665.51 in the SLVSF group, and 1666.13 and 11.2964.58 in the control group. Conclusions: Patients with SLVSF have necks of normal lengths, which can be used to distinguish this disorder from KlippelFeil syndrome. There are three main features of SLVSF: (1) hypoplasia at both of the spontaneously fused vertebral bodies; (2) a major pathological feature of translational instability of the upper vertebra to the fused level; and (3) severe neck pain. Anterior surgery has a good therapeutic effect for patients with cervical SLVSF.
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. These authors contributed equally to this work.
" These authors are co-first authors on this work.
Cervical spondylotic myelopathy (CSM) is the most common cause
of spinal cord dysfunction in the elderly [1]. Typically caused by spinal
degeneration, cervical congenital malformations such as
developmental stenosis may predispose to CSM. In addition to congenital cervical
spinal stenosis [2], spontaneous fusion of the cervical vertebrae is a
type of congenital malformation that is also a known cause of CSM.
However, to the best of our knowledge, this type of CSM has not been
described in detail. From 2002 to 2012, we treated 16 patients with
CSM because of single-level vertebral spontaneous fusion (SLVSF) of
the cervical vertebrae in our hospital. Here, we summarized the
diagnosis and treatment of patients with SLVSF compared to those of
patients with CSM caused by spinal degeneration.
Materials and Methods
This retrospective study was approved by the Ethical
Committee of Shanghai 10th Peoples Hospital. All participants gave their
informed written consent for publication of their medical
documents and images to the Ethical Committee of Shanghai
10th Peoples Hospital.
Patients
The survey pertained to all CSM patients who had undergone
anterior surgery from July 2002 to June 2012 in our institution.
According to the lateral X-ray, we collected 23 patients with
cervical vertebra body fusion. Patients with cervical spinal trauma,
tumors, tuberculosis, infection, surgery, ossification of the posterior
longitudinal ligament (OPLL), upper cervical deformity,
developmental cervical spinal stenosis, or incomplete records were
excluded. Finally, a total of 16 patients (11 women and 5 men;
median age, 48.564.9 years; age range, 4163 years) were
included in this study as a SLVSF group. Radiological diagnoses
were established in each patient via routine preoperative cervical
anteroposterior, lateral, and flexion-extension radiographs and
cervical magnetic resonance imaging (MRI) or computed
tomography (CT) scans. The level of spontaneously fused segments,
spinal cord segments with lesions, and surgical segment were
recorded.
Patients diagnosed with CSM caused by spinal degeneration
and underwent anterior cervical surgery between 2010 and 2012
were included as a control group. The extent of compression was
no more than three segments in all patients. Besides the exclusion
criteria of the SLVSF group, those who underwent cervical
artificial disc implantation were also excluded. Of the 134 patients
with CSM caused by spinal degeneration and underwent anterior
cervical surgery, 96 patients were excluded and 38 patients were
included in this study.
All surgeries were performed by a single surgeon (H.T.) with
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