Posterior Cervical Decompression and Fusion using DePuy Mountaineer Instrumentation
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Cervical stenosis is an age-related condition whereby the spinal canal is narrowed which may put pressure upon the spinal cord and cause myelomalacia. If the patient is experiencing symptoms of myelopathy then surgery may be appropriate to decompress the spinal cord. If the stenosis is localised to one or two levels then anterior or posterior surgery can be undertaken (depending on whether there is more compression coming from the front or the back of the canal).
Anterior cervical decompression and fusion (ACDF) is commonly undertaken both for myelopathy and radiculopathy when the problem lies at a limited number of levels.
Posterior cervical decompression surgery on the other hand is most commonly undertaken where there are multiple levels of cervical spinal stenosis, that can’t be addressed with one- or two-level ACDF.
Multiple level anterior surgery to address three or more levels, though technically possible, has increased morbidity when compared to one or two-level surgery. The shape of the cervical spine does play a role in this. If the normal cervical lordosis is preserved then one can imagine with posterior decompression the cervical spinal cord may drift back away from the compression. When the lordosis is lost or has become kyphotic then real thought needs to be given as to whether posterior surgery is going to allow adequate decompression.
Author: Mr Andrew Young, FRCS (Tr & Orth)
Institution: The Royal Orthopaedic Hospital, Birmingham, UK.
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