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J Neurosci Rural Pract. 2019 Jan-Mar;10(1):21-27. doi: 10.4103/jnrp.jnrp_254_18.

Role of Decompressive Laminectomy without Instrumentation in the Management of Nurick Grade 4 and 5 Cervical Compressive Myelopathy.

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1
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

Abstract

Introduction:

Cervical laminectomy is a very well-known posterior decompressive procedure for cervical compressive myelopathy (CCM). Our objective is to evaluate the functional effect of posterior decompressive laminectomy for poor grade CCM.

Methods:

This study was an observational retrospective study carried out on patients with poor-grade CCM who underwent decompressive laminectomy from January 2010 to December 2015. Patients with Nurick Grades 4 and 5 (walking with support or bedbound) were included in the study. Clinical data and radiological information were collected from medical records, and objective scales were applied to compare the surgical outcome between preoperative score and postoperative score.

Results:

A total of 69 patients who underwent decompressive laminectomy for poor grade CCM were included. The mean age was 54.9 years, and the male-to-female ratio was 5.3:1. Ossified posterior longitudinal ligament comprised 52.6% cases. The follow-up data of at least 6 months' duration after surgery was available for 57 (82.6%) cases. On comparing with preoperative Nurick grade at follow-up, 40 of the 57 patients (70.2%) were found to have improvement following surgery by at least one grade. The remaining 17 (29.8%) had either remained the same or had deteriorated further. The mean preoperative modified Japanese Orthopedic Association score was 8.4 ± 2.8, and the mean follow-up score was 11.8±0.3 (P = 0.0001). On multivariate analysis, the number of levels of laminectomy, postoperative deterioration, and anesthesia grade were predictors of outcome.

Conclusion:

Decompressive laminectomy for poor grade myelopathy is effective in improving functional outcome.

KEYWORDS:

Cervical canal stenosis; cervical myelopathy; decompressive laminectomy; nurick grade; ossified posterior longitudinal ligament

Conflict of interest statement

The manuscript has been read and approved by all the authors, that the requirements for authorship as stated earlier in this document have been met, and that each author believes that the manuscript represents honest work.

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