Caracterización de pacientes con mielopatía espondilótica cervical intervenidos por disectomía anterior

Introduction: cervical spondylotic myelopathy is a common disease, which accounts for a quarter of all upper-limb paresthesia. Anterior graft discectomy is one of the most widely used surgical techniques in the world to treat this disease.Objective: to characterize patients with cervical spondylotic myelopathy who underwent surgery using the anterior discectomy with graft technique.Methods: a retrospective, descriptive, longitudinal study was conducted in 35 patients with cervical spondylotic myelopathy who underwent surgery using the anterior graft discectomy technique at “Lucia Iñiguez Landín” Clinical Surgical Teaching Hospital from January 2017 to December 2019. The variables studied were: age, sex, race, personal pathological history, signs and symptoms (before the surgery), cervical level affected, sequelae and complications.Results: male patients predominated (59,9 %), with ages between 45 and 60 years (45,71 %) and with personal pathological history of obesity (40 %). The prevailing clinical manifestations before surgery were hyperreflexia (65,71 %) and paresthesia (62,85 %). The most affected cervical segment was C5-C7 (91,42 %). The main complications were generalized hyperreflexia (17,14 %) and pain (8,57 %).Conclusions: patients with cervical spondylotic myelopathy surgically treated by the anterior discectomy with graft technique were mostly male, in ages after the fourth decade of life. Patients presented hyperreflexia before the surgery, and could develop generalized hyperreflexia as a complication.Introducción: la mielopatía espondilótica cervical es una enfermedad frecuente, que representa la cuarta parte de las parestesias en miembros superiores.  La disectomía anterior con injerto es una de las técnicas quirúrgicas más utilizadas en el mundo para tratar esta enfermedad.Objetivo: Caracterizar los pacientes con mielopatía espondilótica cervical intervenidos quirúrgicamente por la técnica disectomía anterior con injerto.Método: Se realizó un estudio observacional, descriptivo, longitudinal retrospectivo en 35 pacientes con mielopatía espondilótica cervical intervenidos quirúrgicamente por la técnica de disectomía anterior con injerto en el Hospital Clínico Quirúrgico Docente “Lucia Iñiguez Landín” en el período de enero del 2017 a diciembre del 2019. Las variables estudiadas fueron: edad, sexo, color de piel, antecedentes patológicos personales, signos y síntomas (antes de la operación), nivel cervical afectado, secuelas y complicaciones.Resultados: Se encontró predominio de pacientes masculinos (59,9 %), con edades entre 45 y 60 años (45,71 %) y con antecedentes patológicos personales de obesidad (40 %). Las manifestaciones clínicas que predominaron antes de la intervención quirúrgica fueron la hiperreflexia (65,71 %) y la parestesia (62,85 %). El segmento cervical más afectado fue C5-C7 (91,42 %). Las principales complicaciones fueron la hiperreflexia generalizada (17,14 %) y el dolor (8,57).Conclusiones: los pacientes con mielopatía espondilótica cervical intervenidos quirúrgicamente por la técnica disectomía anterior con injerto fueron de sexo masculino en su mayoría, con edades pasadas de la cuarta década de vida. Los pacientes presentaron hiperreflexia antes de la operación, pudiendo desarrollar hiperreflexia generalizada como complicación

Cervical spondylosis with spinal cord encroachment: should preventive surgery be recommended?

<p>Abstract</p> <p>Background</p> <p>It has been stated that individuals who have spondylotic encroachment on the cervical spinal cord without myelopathy are at increased risk of spinal cord injury if they experience minor trauma. Preventive decompression surgery has been recommended for these individuals. The purpose of this paper is to provide the non-surgical spine specialist with information upon which to base advice to patients. The evidence behind claims of increased risk is investigated as well as the evidence regarding the risk of decompression surgery.</p> <p>Methods</p> <p>A literature search was conducted on the risk of spinal cord injury in individuals with asymptomatic cord encroachment and the risk and benefit of preventive decompression surgery.</p> <p>Results</p> <p>Three studies on the risk of spinal cord injury in this population met the inclusion criteria. All reported increased risk. However, none were prospective cohort studies or case-control studies, so the designs did not allow firm conclusions to be drawn. A number of studies and reviews of the risks and benefits of decompression surgery in patients with cervical myelopathy were found, but no studies were found that addressed surgery in asymptomatic individuals thought to be at risk. The complications of decompression surgery range from transient hoarseness to spinal cord injury, with rates ranging from 0.3% to 60%.</p> <p>Conclusion</p> <p>There is insufficient evidence that individuals with spondylotic spinal cord encroachment are at increased risk of spinal cord injury from minor trauma. Prospective cohort or case-control studies are needed to assess this risk. There is no evidence that prophylactic decompression surgery is helpful in this patient population. Decompression surgery appears to be helpful in patients with cervical myelopathy, but the significant risks may outweigh the unknown benefit in asymptomatic individuals. Thus, broad recommendations for decompression surgery in suspected at-risk individuals cannot be made. Recommendations to individual patients must consider possible unique circumstances.</p