Abstract
Operative results of microsurgical anterior discectomy for cervical spondylotic radiculomyelopathy are reported. Anterior discectomy was carried out using Smith & Robinson's method under an operating microscope and all compressive components against the spinal cord and the radicula, such as degenerated disks, osteophytes, barridges and calcified ligaments, were completely removed using curettes and air-drills. Uncectomy was also performed whenever necessary to relieve the radicular compression. A total of 38 patients, 24 males and 14 females, on whom conservative treatment had not been effective, underwent surgery. Myelopathy was present in all 38 patients, and among these moderate weakness of the lower extremities and spastic gait were seen in 19 patients (50%), and severe paraparesis including a bed-ridden state were noted in 9 patients (24%). Neurogenic bladders were observed in 13 patients (34%). Radiculopathy was also present in 20 patients. In roentgenograms, sagittal A-P diameter of the cervical vertebral canal at C5 ranged between 16.4 mm and 10.4 mm (mean 13.5±1.6), and developmental narrow canals with a value of less than 12.0 mm were noticed in 9 patients. Discectomy at a single level was performed on 22 patients, two levels on 14 and three levels on 3. There was a total of fifty-six discectomies. Fortyseven spaces were fused by autogenous iliac bone grafts and nine were without grafts. Follow up results over 6 months were evaluated on 36 patients (average observation period: 20 months) according to a modified Odom's scale. Twenty patients were judged as excellent, ten good and six fair. As a result 30 out of 36 cases (83%) regained full daily activity with minimum disabilities. Radiculopathy was relieved in 19 patients (95%). Neurogenic bladder disappeared in all 13 patients. There was no operative deterioration. Ages over 60 years old and preoperative periods of over a year were considered as factors deferring postoperative recovery. Severe myelopathy showing a transverse syndrome was also a poor prognostic factor, but all four of the bed-ridden patients became ambulatory. In summary, total removal of the compressing components of cervical spondylosis under a microscope proved to be warrantted treatment for both myelopathy and radiculopathy.
