Anterior Approach for Multilevel Cervical Disc Prolapse with Spondylotic Myelopathy: Surgical Results, Prognostic Factors and Efficacy of Intraoperative Neuromonitoring

Document Type : Original Article


The Department of Neurosurgery, Faculty of Medicine, Benha University


Abstract Background: Degenerative cervical myelopathy (DCM) is a nonspecific general term including multiple different components leading to neurological injury of the cervical spinal cord due to both static and dynamic mechanisms of injury both anterior and posterior approaches can be used during surgery according to situation with successful results. Aim of Study: This retrospective study was carried out with the aim of investigating the operative results and factors affecting outcome for patients withmultilevel cervical disc herniation with compressive myelopathy with the use of intraoperative neuro-monitoring. Patients and Methods: 54 patients with cervical discogenic myelopathy were operated using anterior cervical discectomy and interbody fusion (ACDF). Clinical and radiographic features were reviewed to evaluate the surgical results and prognostic factors. The clinical outcome was judged using two grading systems (Herkowitz's scale and Nurick's grade). Intraoperative neuro-monitoring was used in 32 cases. Results: Male involvement was more common than female involvement (3:1), C5-6 level was involved in most cases. Difficult walking, variable degree of spasticity, paraesthesia were the most obvious signs. Magnetic resonance (MRI) images showed that central disc herniation was present in all cases with signal changes in the cervical cord in 41 cases. Postoperative, 47 patients showed favourable results (excellent, good) according to Herkowitz's scale. The use of intraoperative neuro-monitoring (IOM) did not produce any significant changes in the outcome regarding postoperative results. Conclusion: Anterior approach is very efficient for suc-cessful surgical treatment of non-traumatic degenerative cervical spondylotic myelopathy affecting multiple levels with satisfactory postoperative results, several factors affect postoperative outcome especially duration of complain and preoperative neurological status. The use of intraoperative neuromonitoring is useless.