Short form-36 outcomes following focal 1-and 2-level cervical laminectomy with multilevel instrumented fusion

Background: Multilevel laminectomy with instrumented fusion addresses diffuse dorsal cord compression with an adequately preserved cervical lordosis. However, for patients with only I to 2 laminar impingement, more "focar' laminectomy and fusion may suffice, the shortened laminectomy allowing for a more simple spinous process fusion skipping the 1 or 2 lamina that have been removed. Methods: Fourteen patients presented with severe spastic myeloradiculopathy (Nurick grade IV) attributed to magnetic resonance imaging- and CT-documented 1- to 2-level laminar compression, stenosis, and ossification of the yellow ligament. Magnetic resonance images also revealed I- to 2level hyperintense signals within the cord at the levels of maximal compromise. Surgical. procedures included 1- to 2-level laminectomies and average 6.4-level posterior fusions. Dynamic x-ray/CT studies, which were obtained 3, 6, and up to 12 months postoperatively, followed progression toward fusion. Outcomes were assessed using Nurick grades (O-V) and SF-36 questionnaires assessed preoperatively and up to 12 months postoperatively. Results: Patients improved on all 8 SF-36 Health Scales within the first postoperative year. Maximal improvement was observed on 5 Health Scales within the first 6 postoperative months (physical function, mental health, vitality, general health, role physical). The preoperative average Nurick grade (3.8) improved postoperatively (0.7 at 6 months, 0.5 at I year). Dynamic x-ray and CT studies documented fusion for all 14 patients by the sixth postoperative month. Conclusions: One- and two-level cervical laminectomies with multilevel-instrumented fusion effectively decompressed "focal" cord compression, whereas fusion maintained the cervical lordotic curvature and provided stability to avert future disease progression. (c) 2006 Elsevier Inc. All rights reserved.