The clinico-pathological variants and operative treatment of cervical myelopathy

Abstract

Objective: to conduct the retrospective analysis of diagnostics and treatment outcomes at patients suffered from various types of vertebrogenic and vascular cervical myelopathy. Material and methods. We operated 404 patients with cervical myelopathy from 1993 till 2013. The neurological as well as neurophysiological, radiological and statistical methods of examination were used. The following types of operations were performed: decompressive and stabilization operations (250 patients), decompressive and plastic operations with autodermoplasty or functional disc prostheses (88 patients), laminoplasty at 28 patients with multilevel compression of spinal cord by osteochondral vertebral hyperplasia; stabilizing operations at 24 patients with forceps mechanism of dynamic compression of spinal cord as well as reconstructive operations of vertebral arteries (14 patients). Results. While analyzing the clinical signs and data of instrumental methods of examination the 3 types of cervical myelopathy were defined: 1) compressive myelopathy (69,3% of patients); 2) compressive-vascular myelopathy (21,8% of patients); 3) vascular myelopathy (8,9%). The spinal-cerebral vascular syndrome caused by compression or stenosis of vertebral arteries feeding the cervical enlargement was diagnosed at 36 (8,9%) patients. The excellent and good surgical treatment outcomes were reliably more often seen at patients with compressive myelopathy (34,2%) comparing with compressive-vascular myelopathy (9,4%) and vascular myelopathy (13,9%). It could be explained by development of irreversible spinal ischemic damages in the last two groups of patients.