Surgical strategy

Dorn Spinal Therapy

Spine Healing Therapy

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The goal of surgical treatment is to achieve a maximum of decompression without compromising the spinal stability and respecting the sagittal profile of the spine. Depending on the affected area the decompression may be executed through a simple discectomy, with or without fusion, or through extensive vertebrectomy with grafting and internal fixation. There are reports in the literature, advocating a discectomy without fusion [60, 90], but the majority of patients included in those studies had disc herniation and not CSM. The nonfusion discectomy eliminates the radicular symptoms in most of the cases but results for a long time in axial neck pain and compromises the lordotic curvature of the spine. This is the reason why discectomy is predominantly combined with interbody fusion today.

In a systematic review covering the literature until 1996 we were not able to identify the anterior interbody fusion as a gold standard for the treatment of degenerative disc disease [56] Nevertheless, the anterior discectomy and interbody fusion is the time-honored procedure in treat-

Fig. 1 Three level decompression and fusion with iliac crest grafts and internal fixation. Note the restoration of lordosis

ment of degenerative conditions of the cervical spine. This procedure is predictable with respect to decompression and symptom relief. It is suitable for addressing stenotic changes at single or multiple levels. Restoration of the intervertebral height and the lordotic curvature is possible when approaching each level separately (Fig. 1). On the other hand, this may result in increased risk for symptomatic pseudarthrosis because of the large number areas to fuse [39, 54, 83]. Since the degenerative changes in CSM cover a large area of the subaxial spine, corpec-tomy and grafting may be advocated [9, 10, 58]. Various terms have been adopted to describe the partial vertebral body resection, including complete or partial vertebrec-tomy, anterior corpectomy, and partial corpectomy. Basically all the terms refer to a partial resection of the vertebral body without removal of the transverse processes, pedicles, lateral masses, or other posterior elements. Resection of the lateral part of the uncovertebral joints must also be avoided to prevent injury of the vertebral artery. After decompression the spine must be reconstructed using strut grafts or artificial devices with or without internal fixation [21, 31, 36, 38, 44, 51, 63, 66, 94, 95].

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