Hitchon Cervical

8/7/2019 Hitchon Cervical

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Posterior decompressionand/or fusion in cervical

degenerative disease Professor of Neurosurgery andBioengineering Director of Spine Fellowship University of Iowa Hospitalsand Clinics

Patrick W. Hitchon, MD


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Posterior decompression

and/or fusion in cervicaldegenerative disease


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Address pathology

Anterior

PosteriorBoth


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7/7/0848 yr old manmyelpoathy with

arm weakness


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7/7/08

Cerv stenosis with myelopathy


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Surgery 9/23/08C4-5 corpectomy,PEEK grafting,Anterior plating

Post op dysphagia

Follow-up 7/23/09


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PEG removed 4/27/09Follow-up 7/23/09

Improved symptomsStill myelopathic,imbalance,uncoordinated


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Address pathology

Anterior

PosteriorBoth


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Patient RL

62-year-old male with tingling andnumbness in the left leg. Progressed to leftupper extremity, and now in the rightupper extremity.

Difficulty walking, sways and falls to theleft. Clumsy in his left hand.

Motor 5/4 R/L. RAMs impaired on left


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12/29/09

C3-4

C4-5


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6/15/10


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6/15/10


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Address pathology

Anterior

PosteriorBoth


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7/28/08Extension

69 year old ladyKyphotic deformity of neckNeck pain

Holds chin up with hand


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7/28/08

Flexion


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7/17/08CT


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What to do?A fair amount of correction

One time operation


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9/18/08


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9/18/08Improved,still having neck painNot entirely happy


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Report of the AANS Study Group


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Cervical laminectomy for cervicalmyelopathy AANS, JNS Spine 2009

Laminectomy recommended forsymptomatic CSM in whom the risk ofkyphosis is minimal (Class III, strength D).

Limitations of laminectomy are increasedrisk of kyphosis compared to anteriorapproaches, or lami with fusion. Kyphosisdoes not diminish clinical outcome (ClassIII, strength D)


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Gock, Sciubba et alNeurosurgery 63 (2):292-8,

2008


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Between 2002-2006, 30 patients with CSM and postoperativepseudoarthrosis, instability, hardware failure, orrecurrrent stenosis underwent surgical decompression andstabilization. The specific procedure was individualized.Charts were reviewed retrospectivelyMean F/U 19 mo (2-64 mo)


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4

15

21


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Complications

Ant approach (4): 0/4 Post only (15): 2 transient weakness, 2

transient dysphagia Ant+Post (11): 1 PEG, 1 infection, 1 fell in

hospital with quadriplegia

Overall 27%


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Revision surgery for recurrentcervical myelopathy

Complication rate 27% Improvement 25/30

Improvement worthwhile in spite of

complications


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Cervical stenosisRecommendations:

Lordotic, stenosis up to 3 levels: ACDF Lordotic, stenosis > 3 levels: Post

decomp+/-PL instrumentation+fusion Kyphotic: Ant+Post decomp+Inst


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Lordosis lineGwinn, Iannotti et al JNS Spine 2009


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Hitchon Cervical

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