Degenerative spondylolisthesis of the cervical spine: analysis of 58 patients treated with anterior cervical decompression and fusion |
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| Authors: | Clayton L Dean Josue P Gabriel Ezequiel H Cassinelli Michael J Bolesta Henry H Bohlman |
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| Institution: | 1. Emory University Spine Center, Emory University School of Medicine, 59 Executive Park South, Suite 3000, Atlanta, GA 30309, USA;2. Department of Orthopaedic Surgery, The Ohio State University School of Medicine, 2050 Kenny Road, Suite 3300, Columbus, OH 43221, USA;3. Peachtree Orthopaedic Clinic, 5505 Peachtree Dunwoody Road, Suite 600, Atlanta, GA 30342, USA;4. Department of Orthopaedic Surgery, The University of Texas Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas, TX 75235-8883, USA;5. University Hospitals Spine Institute and the Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA;1. Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-ku, Sungnam 463-707, Republic of Korea;2. Department of Orthopaedic Surgery, Washington University in St Louis, 660 S. Euclid Ave., Campus Box 8233, St Louis, MO 63110, USA;3. Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea;1. Department of General Neurosurgery, University of Cologne, Kerpener Straße 62, Cologne 50937, Germany;2. Molecular Neurotherapy and Imaging Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;3. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;4. Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;5. Institute of Neurophysiology, Medical Faculty, University of Cologne, Cologne, Germany;6. Department of Neurosurgery, University of Dresden, Fetscher Straße 74, Dresden, Germany;1. Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA;2. Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China;1. Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Severance Hospital, 134 Shinchon-dong Seodaemun-gu, Seoul 120-752, Korea;2. Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 25-2, Sungkyunkwan-ro, Seoul, Seoul 110-745, Korea;3. Department of Neurosurgery, Brain Korea 21 PLUS Project for Medical Science, College of Medicine, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, Seoul 120-749, Korea;1. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-gu, Seoul 110-744, South Korea;2. Neuroscience Research Institute, Seoul National University Medical Research Center, 103 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea;3. Clinical Research Institute, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea;4. Health Insurance Review and Assessment Service, 267 Hyoyeong-Ro, Seocho-Gu, Seoul 137-706, South Korea;5. Department of Medicine, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea;6. Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea;7. Department of Preventive Medicine, KonKuk University Medical School, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-701, South Korea;8. Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea |
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| Abstract: | Background contextDegenerative spondylolisthesis has been well described as a disorder of the lumbar spine. Few authors have suggested that a similar disorder occurs in the cervical spine. To our knowledge, the present study represents the largest series of patients with long-term follow-up who were managed surgically for the treatment of degenerative spondylolisthesis of the cervical spine.PurposeTo describe the clinical presentation and radiographic findings associated with degenerative cervical spondylolisthesis, and to report the long-term results of surgically managed patients.Study designAnalysis of 58 patients treated with anterior cervical decompression and fusion for degenerative spondylolisthesis of the cervical spine.Patient sampleFrom 1974 to 2003, 58 patients were identified as having degenerative spondylolisthesis of the cervical spine occurring in the absence of trauma, systemic inflammatory arthropathy, or congenital abnormality. These patients were identified from a database of approximately 500 patients with degenerative cervical spine disorders treated by the senior one of us.Outcome measuresPatient outcomes were evaluated with regard to neurologic improvement (Nurick grade myelopathy) and osseous fusion.MethodsThe records of 58 patients were reviewed. The average follow-up period was 6.9 years (range, 2–24 years). Seventy-two cervical levels demonstrated spondylolisthesis. In all cases, there was radiographic evidence of facet degeneration and subluxation. All patients were treated with anterior cervical decompression and arthrodesis with iliac crest structural graft. This most commonly involved corpectomy of the caudal vertebrae. Three patients required additional posterior facet fusion.ResultsFifty-eight patients demonstrated 72 levels of involvement. The C4–C5 level was most frequently involved (43%). Two radiographically distinct types of listhesis were observed based on the amount of disc degeneration and the degree of spondylosis at adjacent levels. The average neurologic improvement was 1.5 Nurick grades. The overall fusion rate was 92%. Three patients were treated with combined anterior-posterior arthrodesis. The prevalence of myelopathy and instability pattern was greater in the listheses occurring adjacent to spondylotic levels.ConclusionsDegenerative spondylolisthesis is relatively common in the cervical spine. Common to all cases is facet arthropathy and neurologic compression. Anterior cervical decompression and arthrodesis appears to yield excellent union rates and neurological improvement in those patients having cervical degenerative spondylolisthesis and significant neurological sequelae who have failed nonoperative treatments. |
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