Subaxial transfacet fixation with/without laminectomy for cervical compressive myelopathy

Abstract

Introduction. Cervical compressive myelopathy manifests mainly as spastic paralysis, exaggerated reflexes, and clumsiness of the hand, with/without gait disturbances. It mainly results from degenerative changes in cervical spine along with infolding of the ligamentum flavum, the presence of spondylolisthesis, the development of osteophytes, and the hypertrophy of facet joints. Though the recent pathology appears to be facetal instability, hence facetal fixation with or without laminectomy in these patients should be advocated. Materials and Methods. 25 patients with cervical compressive myelopathy were operated with transfacet cervical spine fixation with or without laminectomy, decided on the basis of clinical symptomatology and MRI features. Results. All patients with laminectomy showed improved power and significant lightness in limbs post-surgery. In two patients, there was CSF leak, which was stopped by suture re-enforcing of the wound, and one patient required a lumbar drain to be kept for five days. One patient had a temporary deterioration of power in the left upper limb. Among patients undergoing only transfacet fixation, one patient had no change in symptoms, and three patients had a significant lightness in limbs. Conclusion. The decision to perform transfacet fixation with laminectomy versus transfacet fixation alone is based on the severity and type of spinal cord compression and the clinical presentation of the patient.

Keywords

• cervical compressive myelopathy
• laminectomy
• transfacet screw