Document Detail


Degenerative spondylolisthesis of the cervical spine--symptoms and surgical strategies depending on disease progress.
MedLine Citation:
PMID:  15221569     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Degenerative spondylolisthesis of the cervical spine is rare. Patients show signs of progredient myelopathy, radiculopathy and pain. Treatment strategies include ventral, dorsal and combined fusion techniques with or without repositioning and decompression.
METHODS: In this study, we present 16 patients with degenerative cervical spondylolisthesis. The leading symptom was severe myelopathy in 8 patients, radiculomyelopathy in 5 patients and neck pain in 3 patients. However, neck pain was the initial symptom in all the patients and decreased when neurological symptoms became more evident. Radiographic examinations included plain radiography, MRI, CT, myelography and lateral tomography.
RESULTS: Spondylolisthesis was located five times at level C3/4, C4/5 and C5/6. In three cases spondylolisthesis was located at level C7/T1. There were two patients with spondylolisthesis on two levels. Instability could be demonstrated by flexion/extension radiography in five cases. Patients were divided into three groups according to a newly introduced classification system. The surgical approach corresponded to this classification. In ten patients the spondylolisthesis could be corrected by extension and positioning, so discectomy and fusion on one or two levels with cage, plate and screws was sufficient. In five cases a corpectomy was necessary due to severe spondylosis. In one case a combined approach with dorsal decompression and release followed by ventral fusion was applied due to additional dorsal spinal cord compression. The follow-up period was 6-52 months. After surgery, none of the patients showed any signs of neurological deterioration. In all cases, a stable fusion was achieved with no signs of instability on flexion/extension radiographs. Neurological improvement was seen in 6 of 8 patients with myelopathy and 4 of 5 patients with radiculomyelopathy. The others showed stable disease. Pain relief was seen in all patients who complained of pain preoperatively.
CONCLUSION: The aims of treatment for cervical spondylolisthesis are spinal cord decompression (ventral, dorsal or both), correction and fusion. The used procedure should depend on the severity of the cervical deformity, degree and side of the spinal cord compression, and the possibility of correction by extension and positioning.
Authors:
Christian Woiciechowsky; Ulrich-Wilhelm Thomale; Stefan-Nikolaus Kroppenstedt
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Publication Detail:
Type:  Journal Article     Date:  2004-06-22
Journal Detail:
Title:  European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society     Volume:  13     ISSN:  0940-6719     ISO Abbreviation:  Eur Spine J     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2005-01-21     Completed Date:  2005-06-30     Revised Date:  2013-03-14    
Medline Journal Info:
Nlm Unique ID:  9301980     Medline TA:  Eur Spine J     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  680-4     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Charité-Campus Virchow-Klinikum, University Medicine of Berlin, 13444, Berlin, Germany. christian.woiciechowsky@charite.de
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MeSH Terms
Descriptor/Qualifier:
Aged
Cervical Vertebrae / pathology,  radiography,  surgery*
Decompression, Surgical / methods*,  standards,  statistics & numerical data
Disease Progression
Female
Humans
Internal Fixators / standards,  statistics & numerical data,  trends
Magnetic Resonance Imaging
Male
Middle Aged
Neck Pain / etiology,  physiopathology,  surgery
Postoperative Complications
Radiculopathy / etiology,  physiopathology,  surgery
Retrospective Studies
Spinal Cord Compression / etiology,  physiopathology,  surgery*
Spinal Fusion / methods*,  standards,  statistics & numerical data
Spondylolisthesis / pathology,  physiopathology,  surgery*
Tomography, X-Ray Computed
Treatment Outcome
Comments/Corrections

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