Surgical management of multilevel cervical spine stenosis and spinal cord injury

Surgical management of multilevel cervical spine stenosis and spinal cord injury

Zhao-Wan Xu and Deng-Xing Lun evaluate the safety and feasibility of using open-door expansive laminopathy in combination with transpedicular screw fixation to treat conditions complicated by cervical spine fracture

Introduction
Operative treatment of cervical spine stenosis remains controversial [1]. Several options are commonly used, including anterior subtotal corpectomy combined with bone graft fusion and internal fixation [2,3], anterior discectomy combined with bone graft fusion and internal fixation [4,5], and posterior laminoplasty with or without internal fixation [6]. However, there are limitations with these options [1,6]. For instance, the multiple cervical vertebrae fusion with a large bone graft through anterior route could lead to severe disability of cervical mobility or poor fusion and severe complications, such as dysphagia and dyspnea [7–9]. On the other hand, posterior laminoplasty is a relatively simple operation, which could preserve cervical mobility with fewer postoperative complications; therefore, posterior laminoplasty has become one of the most effective approaches for multilevel cervical spinal stenosis.
However, there is a lack of clinical study on the surgical strategy for multilevel cervical spinal stenosis and spinal cord injury complicated by unstable fracture. Although complete decompression could be achieved for spinal stenosis by posterior laminoplasty, the deterioration on the cervical vertebrae due to surgery could aggravate the instability of cervical vertebrae [2,6]. In contrast, the stability of cervical vertebrae could be reconstructed by anterior surgery, but at the cost of insufficient spinal decompression and more postoperative complications [3]. Therefore, to fulfill the requirements of both complete decompression and satisfactory stability of reconstruction is one of the challenges in clinical practice. The purpose of the current study was to evaluate the safety and feasibility of open-door expansive laminoplasty in combination with transpedicular screw fixation via posterior route for the treatment of multilevel cervical spinal stenosis complicated by cervical spine fracture.

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