Modified Transvertebral Anterior Decompression without Fusion for Cervical Myelopathy

Abstract

Transvertebral anterior decompression (TVAD), primary aim of which is to treat multi-level anterior spinal cord disorders directly, provides anterior decompression at a greater width to expose the nerve root and the vertebral artery. In this series, we have achieved good results using a modified method of the transvertebral anterior decompression (TVAD), i.e., by exposing the dura mater of the spinal cord at a shorter width without approaching laterally. We report the details of our surgical experience with modified TVAD for anterior spinal cord disorders presenting with myelopathy. This procedure was performed on 28 patients with cervical myelopathy (with average age 65.0 years). These cases included cervical spondylosis, disc herniation and OPLL. The range of anterior decompression included 1 to 4 intervertebral spaces with an average of 2.3. The width of anterior decompression was 6 to 15mm with an average of 10.5mm. Surgical results were evaluated in accordance with the Neurosurgical Cervical Spine Scale (NCSS). The average of preoperative score was 9.1, with the score being 12.1, the score remained at the same level one month later and one year after the surgery. The surgery was found to be efficiently reduce the symptoms, especially regarding the improvement of lower limb weakness. No instability was observed. Modified TVAD has high potential for anterior decompression because this technique can be performed not only on the disc level, but also continuously on the vertebral body level. Furthermore, it may be unnecessary to extend the width of vertebrectomy to the lateral side for patients suffering from myelopathy.